{"hospital_name":"Adventhealth Hendersonville","last_updated_on":"2026-04-01","version":"3.0.0","location_name":["Adventhealth Hendersonville"],"hospital_address":["100 Hospital Drive, Hendersonville, NC 28792"],"license_information":{"license_number":"H0049","state":"NC"},"type_2_npi":["1427075027"],"attestation":{"attestation":"To the best of its knowledge and belief, this hospital has included all applicable standard charge information in accordance with the requirements of 45 CFR 180.50, and the information encoded is true, accurate, and complete as of the date in the file. This hospital has included all payer-specific negotiated charges in dollars that can be expressed as a dollar amount. For payer-specific negotiated charges that cannot be expressed as a dollar amount in the machine-readable file or not knowable in advance, the hospital attests that the payer-specific negotiated charge is based on a contractual algorithm, percentage or formula that precludes the provision of a dollar amount and has provided all necessary information available to the hospital for the public to be able to derive the dollar amount, including, but not limited to, the specific fee schedule or components referenced in such percentage, algorithm or formula.","confirm_attestation":true,"attester_name":"Tim Reiner "},"modifier_information":[{"description":"Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities","code":"TC","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"AdventHealth Employee","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"HMO/PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"HMO/PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Behavioral Health Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"HMO/PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Health/Coventry","plan_name":"First Health PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Behavioral Health","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"PFFS Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"MedCost","plan_name":"Metro Sewage Employee PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"MedCost","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"MedCost","plan_name":"Ultra PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Multiplan","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","description":"The modified price is presented in the standard charge value."},{"payer_name":"PHCS","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Vaya Health","plan_name":"Smoky Mountain Medicaid Managed Care - Behavioral Health","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care - HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","description":"The modified price is presented in the standard charge value."}]}],"standard_charge_information":[{"description":"AMPICILLIN SODIUM 2 G IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0290","type":"HCPCS"},{"code":"00781927395","type":"NDC"}],"standard_charges":[{"gross_charge":41.67,"discounted_cash":41.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"PHENOBARBITAL SODIUM 65 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2560","type":"HCPCS"},{"code":"42494041525","type":"NDC"}],"standard_charges":[{"gross_charge":60.41,"discounted_cash":60.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"DIAZEPAM 5 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3360","type":"HCPCS"},{"code":"00641624410","type":"NDC"}],"standard_charges":[{"gross_charge":34.2,"discounted_cash":34.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.2 ML"}]},{"description":"ARSENIC TRIOXIDE 10 MG/10ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9017","type":"HCPCS"},{"code":"25021022610","type":"NDC"}],"standard_charges":[{"gross_charge":1342.85,"discounted_cash":1342.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 9.4 ML"}]},{"description":"DICYCLOMINE HCL 10 MG/ML IM SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0500","type":"HCPCS"},{"code":"00641617310","type":"NDC"}],"standard_charges":[{"gross_charge":55.67,"discounted_cash":55.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"NALOXONE HCL 2 MG/2ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2310","type":"HCPCS"},{"code":"76329146901","type":"NDC"}],"standard_charges":[{"gross_charge":64.79,"discounted_cash":64.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"ENOXAPARIN SODIUM 80 MG/0.8ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"00955100810","type":"NDC"}],"standard_charges":[{"gross_charge":25.95,"discounted_cash":25.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.1 ML"}]},{"description":"METHYLPREDNISOLONE ACETATE 40 MG/ML IJ SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1030","type":"HCPCS"},{"code":"60219157305","type":"NDC"}],"standard_charges":[{"gross_charge":50.73,"discounted_cash":50.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"DROPERIDOL 2.5 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1790","type":"HCPCS"},{"code":"00143951425","type":"NDC"}],"standard_charges":[{"gross_charge":28.74,"discounted_cash":28.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.2 ML"}]},{"description":"HEPARIN SODIUM (PORCINE) PF 5000 UNIT/0.5ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"00409131632","type":"NDC"}],"standard_charges":[{"gross_charge":35.63,"discounted_cash":35.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"NALOXONE HCL 0.4 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2310","type":"HCPCS"},{"code":"00409121501","type":"NDC"}],"standard_charges":[{"gross_charge":41.82,"discounted_cash":41.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.2 ML"}]},{"description":"HYDROXYZINE HCL 25 MG/ML IM SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3410","type":"HCPCS"},{"code":"00517420125","type":"NDC"}],"standard_charges":[{"gross_charge":79.2,"discounted_cash":79.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"CLADRIBINE 10 MG/10ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9065","type":"HCPCS"},{"code":"63323014010","type":"NDC"}],"standard_charges":[{"gross_charge":542.54,"discounted_cash":542.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.2 ML"}]},{"description":"ENOXAPARIN SODIUM 60 MG/0.6ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"68001045942","type":"NDC"}],"standard_charges":[{"gross_charge":30.27,"discounted_cash":30.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.1 ML"}]},{"description":"FERUMOXYTOL 510 MG/17ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"Q0138","type":"HCPCS"},{"code":"00781315401","type":"NDC"}],"standard_charges":[{"gross_charge":395.03,"discounted_cash":395.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 17 ML"}]},{"description":"HYDRALAZINE HCL 20 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0360","type":"HCPCS"},{"code":"00517090125","type":"NDC"}],"standard_charges":[{"gross_charge":38.12,"discounted_cash":38.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.15 ML"}]},{"description":"PHENOBARBITAL SODIUM 130 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2560","type":"HCPCS"},{"code":"14789012805","type":"NDC"}],"standard_charges":[{"gross_charge":113.75,"discounted_cash":113.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"ENOXAPARIN SODIUM 40 MG/0.4ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"16714001610","type":"NDC"}],"standard_charges":[{"gross_charge":66.88,"discounted_cash":66.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.4 ML"}]},{"description":"VASOPRESSIN 20 UNIT/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2598","type":"HCPCS"},{"code":"00548970100","type":"NDC"}],"standard_charges":[{"gross_charge":208.22,"discounted_cash":208.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"PHENOBARBITAL SODIUM 130 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2560","type":"HCPCS"},{"code":"54288013710","type":"NDC"}],"standard_charges":[{"gross_charge":178.16,"discounted_cash":178.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"FULVESTRANT 250 MG/5ML IM SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9395","type":"HCPCS"},{"code":"71288055586","type":"NDC"}],"standard_charges":[{"gross_charge":10451.77,"discounted_cash":10451.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"DOXORUBICIN HCL LIPOSOMAL 2 MG/ML IV SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"Q2050","type":"HCPCS"},{"code":"68001034536","type":"NDC"}],"standard_charges":[{"gross_charge":4620.38,"discounted_cash":4620.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 ML"}]},{"description":"HYOSCYAMINE SULFATE 0.5 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1980","type":"HCPCS"},{"code":"54288011105","type":"NDC"}],"standard_charges":[{"gross_charge":299.44,"discounted_cash":299.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"COCAINE HCL 40 MG/ML NA SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"C9046","type":"HCPCS"},{"code":"81665030102","type":"NDC"}],"standard_charges":[{"gross_charge":997.04,"discounted_cash":997.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"DOXORUBICIN HCL LIPOSOMAL 2 MG/ML IV SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"Q2050","type":"HCPCS"},{"code":"70710153101","type":"NDC"}],"standard_charges":[{"gross_charge":11126.64,"discounted_cash":11126.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 22 ML"}]},{"description":"ENOXAPARIN SODIUM 120 MG/0.8ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"00548560600","type":"NDC"}],"standard_charges":[{"gross_charge":76.45,"discounted_cash":76.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.8 ML"}]},{"description":"HYDROXYZINE HCL 50 MG/ML IM SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3410","type":"HCPCS"},{"code":"00517560125","type":"NDC"}],"standard_charges":[{"gross_charge":89.32,"discounted_cash":89.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"CLONIDINE HCL (ANALGESIA) 100 MCG/ML EP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0735","type":"HCPCS"},{"code":"39822200001","type":"NDC"}],"standard_charges":[{"gross_charge":25.42,"discounted_cash":25.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.4 ML"}]},{"description":"SUCCINYLCHOLINE CHLORIDE 100 MG/5ML IV SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0330","type":"HCPCS"},{"code":"69374092005","type":"NDC"}],"standard_charges":[{"gross_charge":38.21,"discounted_cash":38.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"IBANDRONATE SODIUM 3 MG/3ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1740","type":"HCPCS"},{"code":"67457052433","type":"NDC"}],"standard_charges":[{"gross_charge":212.84,"discounted_cash":212.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.5 ML"}]},{"description":"CLINDAMYCIN PHOSPHATE 300 MG/2ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0736","type":"HCPCS"},{"code":"25021011502","type":"NDC"}],"standard_charges":[{"gross_charge":46.3,"discounted_cash":46.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"}]},{"description":"PHYTONADIONE 10 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3430","type":"HCPCS"},{"code":"43598040516","type":"NDC"}],"standard_charges":[{"gross_charge":41.93,"discounted_cash":41.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.1 ML"}]},{"description":"TESTOSTERONE CYPIONATE 200 MG/ML IM SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1071","type":"HCPCS"},{"code":"00143965901","type":"NDC"}],"standard_charges":[{"gross_charge":49.46,"discounted_cash":49.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"DIAZEPAM 5 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3360","type":"HCPCS"},{"code":"43598010610","type":"NDC"}],"standard_charges":[{"gross_charge":44.72,"discounted_cash":44.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"ORPHENADRINE CITRATE 30 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2360","type":"HCPCS"},{"code":"00641618210","type":"NDC"}],"standard_charges":[{"gross_charge":53.03,"discounted_cash":53.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"NALOXONE HCL 0.4 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2310","type":"HCPCS"},{"code":"70069007110","type":"NDC"}],"standard_charges":[{"gross_charge":55.57,"discounted_cash":55.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"NALOXONE HCL 0.4 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2310","type":"HCPCS"},{"code":"67457029202","type":"NDC"}],"standard_charges":[{"gross_charge":22.51,"discounted_cash":22.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.1 ML"}]},{"description":"ENOXAPARIN SODIUM 60 MG/0.6ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"71288043485","type":"NDC"}],"standard_charges":[{"gross_charge":23.94,"discounted_cash":23.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.1 ML"}]},{"description":"METHYLPREDNISOLONE ACETATE 80 MG/ML IJ SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1040","type":"HCPCS"},{"code":"60219157405","type":"NDC"}],"standard_charges":[{"gross_charge":45.95,"discounted_cash":45.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"ENOXAPARIN SODIUM 60 MG/0.6ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"00781325666","type":"NDC"}],"standard_charges":[{"gross_charge":60.94,"discounted_cash":60.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.6 ML"}]},{"description":"CHLORPROMAZINE HCL 25 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3230","type":"HCPCS"},{"code":"00641139735","type":"NDC"}],"standard_charges":[{"gross_charge":95.71,"discounted_cash":95.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"MEDROXYPROGESTERONE ACETATE 150 MG/ML IM SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1050","type":"HCPCS"},{"code":"70121146702","type":"NDC"}],"standard_charges":[{"gross_charge":114.72,"discounted_cash":114.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"DIAZEPAM 5 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3360","type":"HCPCS"},{"code":"00409127332","type":"NDC"}],"standard_charges":[{"gross_charge":31.94,"discounted_cash":31.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.1 ML"}]},{"description":"REGADENOSON 0.4 MG/5ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2785","type":"HCPCS"},{"code":"60505611600","type":"NDC"}],"standard_charges":[{"gross_charge":303.52,"discounted_cash":303.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"IBUTILIDE FUMARATE 1 MG/10ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1742","type":"HCPCS"},{"code":"67457036610","type":"NDC"}],"standard_charges":[{"gross_charge":303.96,"discounted_cash":303.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"VINCRISTINE SULFATE 1 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9370","type":"HCPCS"},{"code":"61703030906","type":"NDC"}],"standard_charges":[{"gross_charge":215.57,"discounted_cash":215.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"DOXORUBICIN HCL LIPOSOMAL 2 MG/ML IV SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"Q2050","type":"HCPCS"},{"code":"47335004940","type":"NDC"}],"standard_charges":[{"gross_charge":1971.63,"discounted_cash":1971.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"DICYCLOMINE HCL 10 MG/ML IM SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0500","type":"HCPCS"},{"code":"72266012705","type":"NDC"}],"standard_charges":[{"gross_charge":75.49,"discounted_cash":75.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"ENOXAPARIN SODIUM 30 MG/0.3ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"00955100310","type":"NDC"}],"standard_charges":[{"gross_charge":42.16,"discounted_cash":42.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.3 ML"}]},{"description":"SUMATRIPTAN SUCCINATE 6 MG/0.5ML SC SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3030","type":"HCPCS"},{"code":"55150017305","type":"NDC"}],"standard_charges":[{"gross_charge":45.36,"discounted_cash":45.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"FULVESTRANT 250 MG/5ML IM SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9395","type":"HCPCS"},{"code":"00143902202","type":"NDC"}],"standard_charges":[{"gross_charge":671.37,"discounted_cash":671.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"ENOXAPARIN SODIUM 30 MG/0.3ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"00781323863","type":"NDC"}],"standard_charges":[{"gross_charge":42.58,"discounted_cash":42.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.3 ML"}]},{"description":"FULVESTRANT 250 MG/5ML IM SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9395","type":"HCPCS"},{"code":"70121146302","type":"NDC"}],"standard_charges":[{"gross_charge":1390.6,"discounted_cash":1390.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"TOPOTECAN HCL 4 MG/4ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9351","type":"HCPCS"},{"code":"00409030201","type":"NDC"}],"standard_charges":[{"gross_charge":182.79,"discounted_cash":182.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.15 ML"}]},{"description":"HEPARIN SODIUM (PORCINE) PF 5000 UNIT/0.5ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"71839011825","type":"NDC"}],"standard_charges":[{"gross_charge":34.9,"discounted_cash":34.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"DICYCLOMINE HCL 10 MG/ML IM SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0500","type":"HCPCS"},{"code":"14789001002","type":"NDC"}],"standard_charges":[{"gross_charge":63.68,"discounted_cash":63.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"NALOXONE HCL 2 MG/2ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2310","type":"HCPCS"},{"code":"76329346901","type":"NDC"}],"standard_charges":[{"gross_charge":64.89,"discounted_cash":64.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"ENOXAPARIN SODIUM 40 MG/0.4ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"25021041076","type":"NDC"}],"standard_charges":[{"gross_charge":41.41,"discounted_cash":41.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.4 ML"}]},{"description":"DICYCLOMINE HCL 10 MG/ML IM SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0500","type":"HCPCS"},{"code":"00517198005","type":"NDC"}],"standard_charges":[{"gross_charge":45.59,"discounted_cash":45.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"DICYCLOMINE HCL 10 MG/ML IM SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0500","type":"HCPCS"},{"code":"70436014781","type":"NDC"}],"standard_charges":[{"gross_charge":49.34,"discounted_cash":49.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"ENOXAPARIN SODIUM 120 MG/0.8ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"68001046242","type":"NDC"}],"standard_charges":[{"gross_charge":29.11,"discounted_cash":29.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.067 ML"}]},{"description":"VASOPRESSIN 20 UNIT/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2598","type":"HCPCS"},{"code":"63323093001","type":"NDC"}],"standard_charges":[{"gross_charge":83.1,"discounted_cash":83.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"ZOLEDRONIC ACID 4 MG/5ML IV CONC","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3489","type":"HCPCS"},{"code":"72603019801","type":"NDC"}],"standard_charges":[{"gross_charge":49.42,"discounted_cash":49.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4.375 ML"}]},{"description":"NICARDIPINE HCL 2.5 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2404","type":"HCPCS"},{"code":"55150018310","type":"NDC"}],"standard_charges":[{"gross_charge":70.94,"discounted_cash":70.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"LIDOCAINE HCL 2 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2003","type":"HCPCS"},{"code":"63323020202","type":"NDC"}],"standard_charges":[{"gross_charge":17.76,"discounted_cash":17.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.125 ML"}]},{"description":"REGADENOSON 0.4 MG/5ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2785","type":"HCPCS"},{"code":"16729047731","type":"NDC"}],"standard_charges":[{"gross_charge":696.53,"discounted_cash":696.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"ISOSULFAN BLUE 1 % SC SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"Q9968","type":"HCPCS"},{"code":"67457022005","type":"NDC"}],"standard_charges":[{"gross_charge":336.34,"discounted_cash":336.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"DESMOPRESSIN ACETATE PF 4 MCG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2597","type":"HCPCS"},{"code":"69918089910","type":"NDC"}],"standard_charges":[{"gross_charge":70.31,"discounted_cash":70.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.723 ML"}]},{"description":"ENOXAPARIN SODIUM 80 MG/0.8ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"68001046042","type":"NDC"}],"standard_charges":[{"gross_charge":30.36,"discounted_cash":30.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.1 ML"}]},{"description":"FULVESTRANT 250 MG/5ML IM SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9395","type":"HCPCS"},{"code":"25021047174","type":"NDC"}],"standard_charges":[{"gross_charge":1982.91,"discounted_cash":1982.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"ENOXAPARIN SODIUM 80 MG/0.8ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"71288043587","type":"NDC"}],"standard_charges":[{"gross_charge":24.13,"discounted_cash":24.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.1 ML"}]},{"description":"NALOXONE HCL 2 MG/2ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2310","type":"HCPCS"},{"code":"00641620510","type":"NDC"}],"standard_charges":[{"gross_charge":44.43,"discounted_cash":44.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"ENOXAPARIN SODIUM 30 MG/0.3ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"71288043281","type":"NDC"}],"standard_charges":[{"gross_charge":40.29,"discounted_cash":40.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.3 ML"}]},{"description":"ENOXAPARIN SODIUM 30 MG/0.3ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"25021041070","type":"NDC"}],"standard_charges":[{"gross_charge":41.71,"discounted_cash":41.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.3 ML"}]},{"description":"PAPAVERINE HCL 30 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2440","type":"HCPCS"},{"code":"54288014210","type":"NDC"}],"standard_charges":[{"gross_charge":69.1,"discounted_cash":69.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"METHYLPREDNISOLONE ACETATE 40 MG/ML IJ SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1030","type":"HCPCS"},{"code":"70121157301","type":"NDC"}],"standard_charges":[{"gross_charge":36.95,"discounted_cash":36.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"OXALIPLATIN 50 MG/10ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9263","type":"HCPCS"},{"code":"00703398501","type":"NDC"}],"standard_charges":[{"gross_charge":105.66,"discounted_cash":105.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"ADENOSINE 6 MG/2ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0153","type":"HCPCS"},{"code":"67457085502","type":"NDC"}],"standard_charges":[{"gross_charge":29.93,"discounted_cash":29.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.33 ML"}]},{"description":"FONDAPARINUX SODIUM 2.5 MG/0.5ML SC SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1652","type":"HCPCS"},{"code":"55150023010","type":"NDC"}],"standard_charges":[{"gross_charge":40.61,"discounted_cash":40.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"TRIAMCINOLONE ACETONIDE 40 MG/ML IJ SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3301","type":"HCPCS"},{"code":"00703024101","type":"NDC"}],"standard_charges":[{"gross_charge":42.52,"discounted_cash":42.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"HYDROMORPHONE HCL 0.2 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1171","type":"HCPCS"},{"code":"00641625910","type":"NDC"}],"standard_charges":[{"gross_charge":46.45,"discounted_cash":46.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"PALONOSETRON HCL 0.25 MG/5ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2469","type":"HCPCS"},{"code":"00703409401","type":"NDC"}],"standard_charges":[{"gross_charge":60.7,"discounted_cash":60.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"DICYCLOMINE HCL 10 MG/ML IM SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0500","type":"HCPCS"},{"code":"70069044105","type":"NDC"}],"standard_charges":[{"gross_charge":135.49,"discounted_cash":135.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"DOXORUBICIN HCL LIPOSOMAL 2 MG/ML IV SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"Q2050","type":"HCPCS"},{"code":"47335005040","type":"NDC"}],"standard_charges":[{"gross_charge":4882.55,"discounted_cash":4882.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 ML"}]},{"description":"IBANDRONATE SODIUM 3 MG/3ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1740","type":"HCPCS"},{"code":"60505609700","type":"NDC"}],"standard_charges":[{"gross_charge":349.15,"discounted_cash":349.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"COCAINE HCL 40 MG/ML NA SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"C9046","type":"HCPCS"},{"code":"70839036204","type":"NDC"}],"standard_charges":[{"gross_charge":1089.04,"discounted_cash":1089.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"}]},{"description":"PHENOBARBITAL SODIUM 130 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2560","type":"HCPCS"},{"code":"00641047725","type":"NDC"}],"standard_charges":[{"gross_charge":121.13,"discounted_cash":121.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"ENOXAPARIN SODIUM 150 MG/ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"16714006610","type":"NDC"}],"standard_charges":[{"gross_charge":122.58,"discounted_cash":122.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"MEDROXYPROGESTERONE ACETATE 150 MG/ML IM SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1050","type":"HCPCS"},{"code":"66993037083","type":"NDC"}],"standard_charges":[{"gross_charge":148.88,"discounted_cash":148.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"FULVESTRANT 250 MG/5ML IM SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9395","type":"HCPCS"},{"code":"70860021174","type":"NDC"}],"standard_charges":[{"gross_charge":1178.27,"discounted_cash":1178.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"TESTOSTERONE CYPIONATE 200 MG/ML IM SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1071","type":"HCPCS"},{"code":"00574082701","type":"NDC"}],"standard_charges":[{"gross_charge":51.12,"discounted_cash":51.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"DESMOPRESSIN ACETATE PF 4 MCG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2597","type":"HCPCS"},{"code":"25021046001","type":"NDC"}],"standard_charges":[{"gross_charge":61.1,"discounted_cash":61.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.75 ML"}]},{"description":"PALONOSETRON HCL 0.25 MG/5ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2469","type":"HCPCS"},{"code":"00781331275","type":"NDC"}],"standard_charges":[{"gross_charge":370.67,"discounted_cash":370.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"ADENOSINE 12 MG/4ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0153","type":"HCPCS"},{"code":"67457085404","type":"NDC"}],"standard_charges":[{"gross_charge":63.73,"discounted_cash":63.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"}]},{"description":"TESTOSTERONE CYPIONATE 200 MG/ML IM SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"96372","type":"HCPCS"},{"code":"00409656201","type":"NDC"}],"standard_charges":[{"gross_charge":52.1,"discounted_cash":52.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.75 ML"}]},{"description":"ENOXAPARIN SODIUM 60 MG/0.6ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"16714002610","type":"NDC"}],"standard_charges":[{"gross_charge":37.59,"discounted_cash":37.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.6 ML"}]},{"description":"ENOXAPARIN SODIUM 40 MG/0.4ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"71288043392","type":"NDC"}],"standard_charges":[{"gross_charge":39.16,"discounted_cash":39.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.4 ML"}]},{"description":"ADENOSINE 6 MG/2ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0153","type":"HCPCS"},{"code":"25021031802","type":"NDC"}],"standard_charges":[{"gross_charge":40.07,"discounted_cash":40.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"SUCCINYLCHOLINE CHLORIDE 200 MG/10ML IV SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0330","type":"HCPCS"},{"code":"73177011603","type":"NDC"}],"standard_charges":[{"gross_charge":65.22,"discounted_cash":65.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"DIGOXIN 0.25 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1160","type":"HCPCS"},{"code":"00641141035","type":"NDC"}],"standard_charges":[{"gross_charge":26.87,"discounted_cash":26.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"OXALIPLATIN 100 MG/20ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9263","type":"HCPCS"},{"code":"00781331780","type":"NDC"}],"standard_charges":[{"gross_charge":167.63,"discounted_cash":167.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"GEMCITABINE HCL 200 MG/5.26ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9201","type":"HCPCS"},{"code":"71288011706","type":"NDC"}],"standard_charges":[{"gross_charge":66.35,"discounted_cash":66.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.2 ML"}]},{"description":"NALOXONE HCL 0.4 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2310","type":"HCPCS"},{"code":"55150032710","type":"NDC"}],"standard_charges":[{"gross_charge":66.54,"discounted_cash":66.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"NALBUPHINE HCL 10 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2300","type":"HCPCS"},{"code":"00409146301","type":"NDC"}],"standard_charges":[{"gross_charge":39.29,"discounted_cash":39.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"HEPARIN SODIUM (PORCINE) PF 1000 UNIT/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"63323027601","type":"NDC"}],"standard_charges":[{"gross_charge":66.62,"discounted_cash":66.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"}]},{"description":"NALOXONE HCL 0.4 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2310","type":"HCPCS"},{"code":"36000030810","type":"NDC"}],"standard_charges":[{"gross_charge":23.38,"discounted_cash":23.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.2 ML"}]},{"description":"NEOSTIGMINE METHYLSULFATE 3 MG/3ML IV SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2710","type":"HCPCS"},{"code":"76045038330","type":"NDC"}],"standard_charges":[{"gross_charge":58.01,"discounted_cash":58.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"KETOROLAC TROMETHAMINE 15 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1885","type":"HCPCS"},{"code":"00409379325","type":"NDC"}],"standard_charges":[{"gross_charge":44.55,"discounted_cash":44.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"LABETALOL HCL 20 MG/4ML IV SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1920","type":"HCPCS"},{"code":"70092100944","type":"NDC"}],"standard_charges":[{"gross_charge":55.85,"discounted_cash":55.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"}]},{"description":"CYANOCOBALAMIN 1000 MCG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3420","type":"HCPCS"},{"code":"00143962125","type":"NDC"}],"standard_charges":[{"gross_charge":34.7,"discounted_cash":34.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"VINORELBINE TARTRATE 50 MG/5ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9390","type":"HCPCS"},{"code":"45963060756","type":"NDC"}],"standard_charges":[{"gross_charge":343.47,"discounted_cash":343.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"ENOXAPARIN SODIUM 30 MG/0.3ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"00548560100","type":"NDC"}],"standard_charges":[{"gross_charge":37.23,"discounted_cash":37.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.3 ML"}]},{"description":"FULVESTRANT 250 MG/5ML IM SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9394","type":"HCPCS"},{"code":"63323071505","type":"NDC"}],"standard_charges":[{"gross_charge":2140.16,"discounted_cash":2140.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"ENOXAPARIN SODIUM 100 MG/ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"16714004610","type":"NDC"}],"standard_charges":[{"gross_charge":86.04,"discounted_cash":86.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"ENOXAPARIN SODIUM 80 MG/0.8ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"16714003610","type":"NDC"}],"standard_charges":[{"gross_charge":73.25,"discounted_cash":73.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.8 ML"}]},{"description":"IBANDRONATE SODIUM 3 MG/3ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1740","type":"HCPCS"},{"code":"55150019183","type":"NDC"}],"standard_charges":[{"gross_charge":340.75,"discounted_cash":340.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.5 ML"}]},{"description":"CLADRIBINE 10 MG/10ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9065","type":"HCPCS"},{"code":"00143987101","type":"NDC"}],"standard_charges":[{"gross_charge":4213.8,"discounted_cash":4213.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7.5 ML"}]},{"description":"ENOXAPARIN SODIUM 80 MG/0.8ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"00548560400","type":"NDC"}],"standard_charges":[{"gross_charge":34.38,"discounted_cash":34.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.1 ML"}]},{"description":"PHYTONADIONE 10 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3430","type":"HCPCS"},{"code":"69097070896","type":"NDC"}],"standard_charges":[{"gross_charge":64.05,"discounted_cash":64.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"MEDROXYPROGESTERONE ACETATE 150 MG/ML IM SUSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1050","type":"HCPCS"},{"code":"66993037179","type":"NDC"}],"standard_charges":[{"gross_charge":132.52,"discounted_cash":132.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"PALONOSETRON HCL 0.25 MG/5ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2469","type":"HCPCS"},{"code":"16714083401","type":"NDC"}],"standard_charges":[{"gross_charge":845.35,"discounted_cash":845.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"BEVACIZUMAB 1.25 MG/0.05ML IZ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"C9257","type":"HCPCS"},{"code":"71266800601","type":"NDC"}],"standard_charges":[{"gross_charge":742.04,"discounted_cash":742.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.1 ML"}]},{"description":"FULVESTRANT 250 MG/5ML IM SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9395","type":"HCPCS"},{"code":"43598026223","type":"NDC"}],"standard_charges":[{"gross_charge":1928.54,"discounted_cash":1928.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"ENOXAPARIN SODIUM 120 MG/0.8ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"00955101210","type":"NDC"}],"standard_charges":[{"gross_charge":59.5,"discounted_cash":59.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.8 ML"}]},{"description":"CHLORPROMAZINE HCL 50 MG/2ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3230","type":"HCPCS"},{"code":"00641139835","type":"NDC"}],"standard_charges":[{"gross_charge":106.44,"discounted_cash":106.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"ENOXAPARIN SODIUM 100 MG/ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"00548560500","type":"NDC"}],"standard_charges":[{"gross_charge":34.38,"discounted_cash":34.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.1 ML"}]},{"description":"ENOXAPARIN SODIUM 80 MG/0.8ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"00781326268","type":"NDC"}],"standard_charges":[{"gross_charge":41.52,"discounted_cash":41.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.8 ML"}]},{"description":"HYDRALAZINE HCL 20 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0360","type":"HCPCS"},{"code":"55150040025","type":"NDC"}],"standard_charges":[{"gross_charge":57.02,"discounted_cash":57.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"METHYLPREDNISOLONE ACETATE 80 MG/ML IJ SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1010","type":"HCPCS"},{"code":"70121157401","type":"NDC"}],"standard_charges":[{"gross_charge":27.74,"discounted_cash":27.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.125 ML"}]},{"description":"HALOPERIDOL DECANOATE 100 MG/ML IM SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1631","type":"HCPCS"},{"code":"67457040913","type":"NDC"}],"standard_charges":[{"gross_charge":57.73,"discounted_cash":57.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"AMINOPHYLLINE 25 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0280","type":"HCPCS"},{"code":"00409592101","type":"NDC"}],"standard_charges":[{"gross_charge":28.28,"discounted_cash":28.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"KETOROLAC TROMETHAMINE 30 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1885","type":"HCPCS"},{"code":"72266011825","type":"NDC"}],"standard_charges":[{"gross_charge":24.25,"discounted_cash":24.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"KETOROLAC TROMETHAMINE 15 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1885","type":"HCPCS"},{"code":"72266023425","type":"NDC"}],"standard_charges":[{"gross_charge":30.24,"discounted_cash":30.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"LIDOCAINE HCL 1 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2003","type":"HCPCS"},{"code":"69374052005","type":"NDC"}],"standard_charges":[{"gross_charge":33.95,"discounted_cash":33.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"LIDOCAINE-EPINEPHRINE (PF) 1.5 %-1:200000 IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2004","type":"HCPCS"},{"code":"00409120901","type":"NDC"}],"standard_charges":[{"gross_charge":17.29,"discounted_cash":17.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.2 ML"}]},{"description":"FLUOROURACIL 1 GM/20ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9190","type":"HCPCS"},{"code":"70700018723","type":"NDC"}],"standard_charges":[{"gross_charge":157.27,"discounted_cash":157.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7 ML"}]},{"description":"CALCIUM GLUCONATE 10 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0612","type":"HCPCS"},{"code":"00143918025","type":"NDC"}],"standard_charges":[{"gross_charge":48.14,"discounted_cash":48.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"GEMCITABINE HCL 1 GM/26.3ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9201","type":"HCPCS"},{"code":"71288011728","type":"NDC"}],"standard_charges":[{"gross_charge":505.8,"discounted_cash":505.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 26.3 ML"}]},{"description":"KETOROLAC TROMETHAMINE 15 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1885","type":"HCPCS"},{"code":"72603015325","type":"NDC"}],"standard_charges":[{"gross_charge":27.7,"discounted_cash":27.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"PAMIDRONATE DISODIUM 90 MG/10ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2430","type":"HCPCS"},{"code":"61703032618","type":"NDC"}],"standard_charges":[{"gross_charge":120.91,"discounted_cash":120.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"OXALIPLATIN 100 MG/20ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9263","type":"HCPCS"},{"code":"25021023320","type":"NDC"}],"standard_charges":[{"gross_charge":411.65,"discounted_cash":411.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5.5 ML"}]},{"description":"REGADENOSON 0.4 MG/5ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2785","type":"HCPCS"},{"code":"00641625301","type":"NDC"}],"standard_charges":[{"gross_charge":63.89,"discounted_cash":63.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"HYDRALAZINE HCL 20 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0360","type":"HCPCS"},{"code":"63323061401","type":"NDC"}],"standard_charges":[{"gross_charge":20.01,"discounted_cash":20.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.1 ML"}]},{"description":"KETOROLAC TROMETHAMINE 60 MG/2ML IM SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1885","type":"HCPCS"},{"code":"00409379601","type":"NDC"}],"standard_charges":[{"gross_charge":22.4,"discounted_cash":22.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.33 ML"}]},{"description":"FUROSEMIDE 10 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1940","type":"HCPCS"},{"code":"00409610202","type":"NDC"}],"standard_charges":[{"gross_charge":42.82,"discounted_cash":42.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"REGADENOSON 0.4 MG/5ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2785","type":"HCPCS"},{"code":"36000036401","type":"NDC"}],"standard_charges":[{"gross_charge":151.48,"discounted_cash":151.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"TRIAMCINOLONE ACETONIDE 40 MG/ML IJ SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3301","type":"HCPCS"},{"code":"16714013025","type":"NDC"}],"standard_charges":[{"gross_charge":34.81,"discounted_cash":34.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 ML"}]},{"description":"ENOXAPARIN SODIUM 60 MG/0.6ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"71839011110","type":"NDC"}],"standard_charges":[{"gross_charge":44.17,"discounted_cash":44.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.6 ML"}]},{"description":"ENOXAPARIN SODIUM 100 MG/ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"71288043689","type":"NDC"}],"standard_charges":[{"gross_charge":30.3,"discounted_cash":30.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.2 ML"}]},{"description":"ENOXAPARIN SODIUM 100 MG/ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"25021041071","type":"NDC"}],"standard_charges":[{"gross_charge":24.47,"discounted_cash":24.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.1 ML"}]},{"description":"DIAZEPAM 5 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3360","type":"HCPCS"},{"code":"69339013634","type":"NDC"}],"standard_charges":[{"gross_charge":34.08,"discounted_cash":34.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.2 ML"}]},{"description":"FULVESTRANT 250 MG/5ML IM SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9395","type":"HCPCS"},{"code":"16714007002","type":"NDC"}],"standard_charges":[{"gross_charge":1380.72,"discounted_cash":1380.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"ENOXAPARIN SODIUM 100 MG/ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"00781326869","type":"NDC"}],"standard_charges":[{"gross_charge":26.44,"discounted_cash":26.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.1 ML"}]},{"description":"OXALIPLATIN 50 MG/10ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9263","type":"HCPCS"},{"code":"25021023310","type":"NDC"}],"standard_charges":[{"gross_charge":267.53,"discounted_cash":267.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"DICYCLOMINE HCL 10 MG/ML IM SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0500","type":"HCPCS"},{"code":"63323084202","type":"NDC"}],"standard_charges":[{"gross_charge":49.23,"discounted_cash":49.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"DROPERIDOL 2.5 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1790","type":"HCPCS"},{"code":"00517970225","type":"NDC"}],"standard_charges":[{"gross_charge":23.13,"discounted_cash":23.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.125 ML"}]},{"description":"METHYLPREDNISOLONE ACETATE 40 MG/ML IJ SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1010","type":"HCPCS"},{"code":"70121157305","type":"NDC"}],"standard_charges":[{"gross_charge":50.93,"discounted_cash":50.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"ZOLEDRONIC ACID 4 MG/5ML IV CONC","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3489","type":"HCPCS"},{"code":"54288010001","type":"NDC"}],"standard_charges":[{"gross_charge":42.66,"discounted_cash":42.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.25 ML"}]},{"description":"ENOXAPARIN SODIUM 100 MG/ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"00955101010","type":"NDC"}],"standard_charges":[{"gross_charge":26.52,"discounted_cash":26.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.1 ML"}]},{"description":"KETOROLAC TROMETHAMINE 30 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1885","type":"HCPCS"},{"code":"76045010410","type":"NDC"}],"standard_charges":[{"gross_charge":36.79,"discounted_cash":36.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"ADENOSINE 12 MG/4ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0153","type":"HCPCS"},{"code":"63323065104","type":"NDC"}],"standard_charges":[{"gross_charge":52.64,"discounted_cash":52.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"}]},{"description":"KESIMPTA 20 MG/0.4ML SC SOAJ","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9302","type":"HCPCS"},{"code":"00078100768","type":"NDC"}],"standard_charges":[{"gross_charge":23816.59,"discounted_cash":23816.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.4 ML"}]},{"description":"NYVEPRIA 6 MG/0.6ML SC SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"Q5122","type":"HCPCS"},{"code":"00069032401","type":"NDC"}],"standard_charges":[{"gross_charge":4915.81,"discounted_cash":4915.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.6 ML"}]},{"description":"SARCLISA 500 MG/25ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9227","type":"HCPCS"},{"code":"00024065601","type":"NDC"}],"standard_charges":[{"gross_charge":18863.1,"discounted_cash":18863.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 ML"}]},{"description":"DARZALEX FASPRO 1800-30000 MG-UT/15ML SC SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9144","type":"HCPCS"},{"code":"57894050301","type":"NDC"}],"standard_charges":[{"gross_charge":52885.13,"discounted_cash":52885.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"SARCLISA 100 MG/5ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9227","type":"HCPCS"},{"code":"00024065401","type":"NDC"}],"standard_charges":[{"gross_charge":6832.36,"discounted_cash":6832.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"NICARDIPINE HCL IN NACL 40-0.9 MG/200ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2404","type":"HCPCS"},{"code":"00143963310","type":"NDC"}],"standard_charges":[{"gross_charge":18.17,"discounted_cash":18.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"RELISTOR 12 MG/0.6ML SC SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2212","type":"HCPCS"},{"code":"65649055102","type":"NDC"}],"standard_charges":[{"gross_charge":478.39,"discounted_cash":478.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.6 ML"}]},{"description":"LEXISCAN 0.4 MG/5ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2785","type":"HCPCS"},{"code":"00469650189","type":"NDC"}],"standard_charges":[{"gross_charge":563.65,"discounted_cash":563.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"RELISTOR 12 MG/0.6ML SC SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2212","type":"HCPCS"},{"code":"65649055107","type":"NDC"}],"standard_charges":[{"gross_charge":478.39,"discounted_cash":478.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.6 ML"}]},{"description":"OCTREOTIDE ACETATE 500 MCG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2354","type":"HCPCS"},{"code":"63323037701","type":"NDC"}],"standard_charges":[{"gross_charge":64.69,"discounted_cash":64.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"OCTREOTIDE ACETATE 500 MCG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2354","type":"HCPCS"},{"code":"00641617610","type":"NDC"}],"standard_charges":[{"gross_charge":53.88,"discounted_cash":53.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"OCTREOTIDE ACETATE 500 MCG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2354","type":"HCPCS"},{"code":"63323037704","type":"NDC"}],"standard_charges":[{"gross_charge":64.69,"discounted_cash":64.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"VAQTA 50 UNIT/ML IM SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"90632","type":"HCPCS"},{"code":"00006409602","type":"NDC"}],"standard_charges":[{"gross_charge":129.74,"discounted_cash":129.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"AMPHADASE 150 UNIT/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3470","type":"HCPCS"},{"code":"00548909010","type":"NDC"}],"standard_charges":[{"gross_charge":72.54,"discounted_cash":72.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"PROMETHAZINE HCL 25 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2550","type":"HCPCS"},{"code":"00641149535","type":"NDC"}],"standard_charges":[{"gross_charge":21.46,"discounted_cash":21.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 ML"}]},{"description":"HAVRIX 1440 EL U/ML IM SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"90632","type":"HCPCS"},{"code":"58160082652","type":"NDC"}],"standard_charges":[{"gross_charge":135.21,"discounted_cash":135.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"NAROPIN 5 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2795","type":"HCPCS"},{"code":"63323028638","type":"NDC"}],"standard_charges":[{"gross_charge":30.15,"discounted_cash":30.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7 ML"}]},{"description":"NAROPIN 5 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2795","type":"HCPCS"},{"code":"63323028623","type":"NDC"}],"standard_charges":[{"gross_charge":44.46,"discounted_cash":44.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"NAROPIN 5 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2795","type":"HCPCS"},{"code":"63323028627","type":"NDC"}],"standard_charges":[{"gross_charge":20.96,"discounted_cash":20.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"HYPERRAB 1500 UNIT/5ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"90375","type":"HCPCS"},{"code":"13533031805","type":"NDC"}],"standard_charges":[{"gross_charge":6008.97,"discounted_cash":6008.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4.9 ML"}]},{"description":"KEDRAB 1500 UNIT/10ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"90377","type":"HCPCS"},{"code":"76125015010","type":"NDC"}],"standard_charges":[{"gross_charge":6005.01,"discounted_cash":6005.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"KEDRAB 300 UNIT/2ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"90377","type":"HCPCS"},{"code":"76125015002","type":"NDC"}],"standard_charges":[{"gross_charge":503.29,"discounted_cash":503.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"OPDIVO 240 MG/24ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9299","type":"HCPCS"},{"code":"00003373413","type":"NDC"}],"standard_charges":[{"gross_charge":5267.04,"discounted_cash":5267.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"SUBLOCADE 100 MG/0.5ML SC SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"Q9991","type":"HCPCS"},{"code":"12496010001","type":"NDC"}],"standard_charges":[{"gross_charge":3709.37,"discounted_cash":3709.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"FASENRA 30 MG/ML SC SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0517","type":"HCPCS"},{"code":"00310173030","type":"NDC"}],"standard_charges":[{"gross_charge":14405.42,"discounted_cash":14405.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"CINVANTI 130 MG/18ML IV EMUL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0185","type":"HCPCS"},{"code":"47426020101","type":"NDC"}],"standard_charges":[{"gross_charge":663.8,"discounted_cash":663.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 18 ML"}]},{"description":"DUROLANE 60 MG/3ML IX PRSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J7318","type":"HCPCS"},{"code":"89130202001","type":"NDC"}],"standard_charges":[{"gross_charge":1534.16,"discounted_cash":1534.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.5 ML"}]},{"description":"AFLURIA PRESERVATIVE FREE 0.5 ML IM SUSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"90656","type":"HCPCS"},{"code":"33332002403","type":"NDC"}],"standard_charges":[{"gross_charge":68.55,"discounted_cash":68.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"ULTOMIRIS 300 MG/3ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1303","type":"HCPCS"},{"code":"25682002501","type":"NDC"}],"standard_charges":[{"gross_charge":18908.59,"discounted_cash":18908.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"NAROPIN 5 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2795","type":"HCPCS"},{"code":"63323028631","type":"NDC"}],"standard_charges":[{"gross_charge":55.27,"discounted_cash":55.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"MORPHINE SULFATE (PF) 10 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2270","type":"HCPCS"},{"code":"00409189323","type":"NDC"}],"standard_charges":[{"gross_charge":39.05,"discounted_cash":39.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"HYDROMORPHONE HCL PF 10 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1171","type":"HCPCS"},{"code":"00409263401","type":"NDC"}],"standard_charges":[{"gross_charge":145.29,"discounted_cash":145.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"PROMETHAZINE HCL 50 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2550","type":"HCPCS"},{"code":"00641149635","type":"NDC"}],"standard_charges":[{"gross_charge":35.31,"discounted_cash":35.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"METOCLOPRAMIDE HCL 5 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2765","type":"HCPCS"},{"code":"00703450204","type":"NDC"}],"standard_charges":[{"gross_charge":36.59,"discounted_cash":36.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"PROMETHAZINE HCL 50 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2550","type":"HCPCS"},{"code":"39822555006","type":"NDC"}],"standard_charges":[{"gross_charge":22.02,"discounted_cash":22.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 ML"}]},{"description":"IRINOTECAN HCL 40 MG/2ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9206","type":"HCPCS"},{"code":"60505612800","type":"NDC"}],"standard_charges":[{"gross_charge":70.1,"discounted_cash":70.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.8 ML"}]},{"description":"PROTAMINE SULFATE 10 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2720","type":"HCPCS"},{"code":"63323022930","type":"NDC"}],"standard_charges":[{"gross_charge":43.1,"discounted_cash":43.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 ML"}]},{"description":"TERBUTALINE SULFATE 1 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3105","type":"HCPCS"},{"code":"63323066501","type":"NDC"}],"standard_charges":[{"gross_charge":20.42,"discounted_cash":20.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 ML"}]},{"description":"OXALIPLATIN 50 MG/10ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9263","type":"HCPCS"},{"code":"67457046910","type":"NDC"}],"standard_charges":[{"gross_charge":92.38,"discounted_cash":92.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.5 ML"}]},{"description":"OXALIPLATIN 100 MG/20ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9263","type":"HCPCS"},{"code":"67457044220","type":"NDC"}],"standard_charges":[{"gross_charge":92.38,"discounted_cash":92.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.5 ML"}]},{"description":"DEXAMETHASONE SOD PHOSPHATE PF 10 MG/ML INJ (WRAPPED)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1100","type":"HCPCS"},{"code":"25021005301","type":"NDC"}],"standard_charges":[{"gross_charge":19.06,"discounted_cash":19.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.2 ML"}]},{"description":"ZOLEDRONIC ACID 4 MG/5ML IV CONC","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3489","type":"HCPCS"},{"code":"55111068507","type":"NDC"}],"standard_charges":[{"gross_charge":34.95,"discounted_cash":34.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.25 ML"}]},{"description":"ATROPINE SULFATE 1 MG/10ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0461","type":"HCPCS"},{"code":"00409163010","type":"NDC"}],"standard_charges":[{"gross_charge":38.68,"discounted_cash":38.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"ATROPINE SULFATE 1 MG/10ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0461","type":"HCPCS"},{"code":"76329334001","type":"NDC"}],"standard_charges":[{"gross_charge":50.14,"discounted_cash":50.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"}]},{"description":"DIPHENHYDRAMINE HCL 50 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1200","type":"HCPCS"},{"code":"72485010105","type":"NDC"}],"standard_charges":[{"gross_charge":23.22,"discounted_cash":23.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"KETOROLAC TROMETHAMINE 30 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1885","type":"HCPCS"},{"code":"25021070101","type":"NDC"}],"standard_charges":[{"gross_charge":20.61,"discounted_cash":20.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"KETOROLAC TROMETHAMINE 30 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1885","type":"HCPCS"},{"code":"68462075625","type":"NDC"}],"standard_charges":[{"gross_charge":21.89,"discounted_cash":21.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"DIPHENHYDRAMINE HCL 50 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1200","type":"HCPCS"},{"code":"63323066416","type":"NDC"}],"standard_charges":[{"gross_charge":16.6,"discounted_cash":16.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.125 ML"}]},{"description":"HEPARIN SODIUM (PORCINE) 1000 UNIT/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"71288040202","type":"NDC"}],"standard_charges":[{"gross_charge":32.88,"discounted_cash":32.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"LACOSAMIDE 200 MG/20ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"C9254","type":"HCPCS"},{"code":"25021079120","type":"NDC"}],"standard_charges":[{"gross_charge":62.33,"discounted_cash":62.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"LIDOCAINE-SODIUM BICARBONATE 1-8.4 % IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2003","type":"HCPCS"},{"code":"70092117546","type":"NDC"}],"standard_charges":[{"gross_charge":53.72,"discounted_cash":53.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"LABETALOL HCL 5 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1920","type":"HCPCS"},{"code":"00409233934","type":"NDC"}],"standard_charges":[{"gross_charge":31.0,"discounted_cash":31.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"PROTAMINE SULFATE 10 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2720","type":"HCPCS"},{"code":"63323022905","type":"NDC"}],"standard_charges":[{"gross_charge":31.39,"discounted_cash":31.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"TRIAMCINOLONE ACETONIDE 40 MG/ML IJ SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3301","type":"HCPCS"},{"code":"70121104902","type":"NDC"}],"standard_charges":[{"gross_charge":17.1,"discounted_cash":17.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.05 ML"}]},{"description":"REGADENOSON 0.4 MG/5ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2785","type":"HCPCS"},{"code":"71288020185","type":"NDC"}],"standard_charges":[{"gross_charge":52.58,"discounted_cash":52.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"PROMETHAZINE HCL 25 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2550","type":"HCPCS"},{"code":"00641092825","type":"NDC"}],"standard_charges":[{"gross_charge":20.35,"discounted_cash":20.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.2 ML"}]},{"description":"VASOPRESSIN 20 UNIT/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2598","type":"HCPCS"},{"code":"00517102025","type":"NDC"}],"standard_charges":[{"gross_charge":40.38,"discounted_cash":40.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.05 ML"}]},{"description":"ENOXAPARIN SODIUM 40 MG/0.4ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"81952012424","type":"NDC"}],"standard_charges":[{"gross_charge":56.51,"discounted_cash":56.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.4 ML"}]},{"description":"ENOXAPARIN SODIUM 40 MG/0.4ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"68001045842","type":"NDC"}],"standard_charges":[{"gross_charge":38.42,"discounted_cash":38.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.4 ML"}]},{"description":"TESTOSTERONE CYPIONATE 200 MG/ML IM SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1071","type":"HCPCS"},{"code":"00574082001","type":"NDC"}],"standard_charges":[{"gross_charge":57.47,"discounted_cash":57.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"ENOXAPARIN SODIUM 40 MG/0.4ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"00548560200","type":"NDC"}],"standard_charges":[{"gross_charge":44.47,"discounted_cash":44.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.4 ML"}]},{"description":"HEPARIN SODIUM (PORCINE) 1000 UNIT/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"71288041996","type":"NDC"}],"standard_charges":[{"gross_charge":36.72,"discounted_cash":36.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"}]},{"description":"LIDOCAINE HCL (PF) 4 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2003","type":"HCPCS"},{"code":"00409428301","type":"NDC"}],"standard_charges":[{"gross_charge":16.71,"discounted_cash":16.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.1 ML"}]},{"description":"MORPHINE SULFATE (PF) 0.5 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2270","type":"HCPCS"},{"code":"00409381412","type":"NDC"}],"standard_charges":[{"gross_charge":34.98,"discounted_cash":34.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"KETOROLAC TROMETHAMINE 30 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1885","type":"HCPCS"},{"code":"62332060025","type":"NDC"}],"standard_charges":[{"gross_charge":24.26,"discounted_cash":24.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"IRINOTECAN HCL 300 MG/15ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9206","type":"HCPCS"},{"code":"55150035401","type":"NDC"}],"standard_charges":[{"gross_charge":116.3,"discounted_cash":116.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.2 ML"}]},{"description":"HEPARIN SODIUM (PORCINE) PF 1000 UNIT/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"63323027602","type":"NDC"}],"standard_charges":[{"gross_charge":41.07,"discounted_cash":41.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"LABETALOL HCL 10 MG/2ML IV SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1921","type":"HCPCS"},{"code":"00641625210","type":"NDC"}],"standard_charges":[{"gross_charge":49.16,"discounted_cash":49.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"ENOXAPARIN SODIUM 60 MG/0.6ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"00548560300","type":"NDC"}],"standard_charges":[{"gross_charge":58.86,"discounted_cash":58.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.6 ML"}]},{"description":"DESMOPRESSIN ACETATE 4 MCG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2597","type":"HCPCS"},{"code":"39822620002","type":"NDC"}],"standard_charges":[{"gross_charge":48.52,"discounted_cash":48.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 ML"}]},{"description":"FONDAPARINUX SODIUM 2.5 MG/0.5ML SC SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1652","type":"HCPCS"},{"code":"55111067802","type":"NDC"}],"standard_charges":[{"gross_charge":56.11,"discounted_cash":56.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"CHLORPROMAZINE HCL 50 MG/2ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3230","type":"HCPCS"},{"code":"55150031925","type":"NDC"}],"standard_charges":[{"gross_charge":66.59,"discounted_cash":66.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"PALONOSETRON HCL 0.25 MG/5ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2469","type":"HCPCS"},{"code":"68001035525","type":"NDC"}],"standard_charges":[{"gross_charge":150.93,"discounted_cash":150.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"ENOXAPARIN SODIUM 100 MG/ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"68001046142","type":"NDC"}],"standard_charges":[{"gross_charge":29.22,"discounted_cash":29.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.1 ML"}]},{"description":"BUTORPHANOL TARTRATE 2 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0595","type":"HCPCS"},{"code":"00409162601","type":"NDC"}],"standard_charges":[{"gross_charge":35.61,"discounted_cash":35.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 ML"}]},{"description":"ZOLEDRONIC ACID 4 MG/5ML IV CONC","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3489","type":"HCPCS"},{"code":"67457039054","type":"NDC"}],"standard_charges":[{"gross_charge":113.45,"discounted_cash":113.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4.125 ML"}]},{"description":"ENOXAPARIN SODIUM 30 MG/0.3ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"71288043292","type":"NDC"}],"standard_charges":[{"gross_charge":34.28,"discounted_cash":34.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.3 ML"}]},{"description":"HEPARIN SODIUM (PORCINE) PF 5000 UNIT/0.5ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"63323054313","type":"NDC"}],"standard_charges":[{"gross_charge":37.31,"discounted_cash":37.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"ENOXAPARIN SODIUM 100 MG/ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"71839011310","type":"NDC"}],"standard_charges":[{"gross_charge":43.75,"discounted_cash":43.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"HYDRALAZINE HCL 20 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0360","type":"HCPCS"},{"code":"00641623125","type":"NDC"}],"standard_charges":[{"gross_charge":34.5,"discounted_cash":34.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 ML"}]},{"description":"DROPERIDOL 2.5 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1790","type":"HCPCS"},{"code":"00143951525","type":"NDC"}],"standard_charges":[{"gross_charge":29.72,"discounted_cash":29.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 ML"}]},{"description":"ORPHENADRINE CITRATE 30 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2360","type":"HCPCS"},{"code":"25021065102","type":"NDC"}],"standard_charges":[{"gross_charge":37.81,"discounted_cash":37.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"NALOXONE HCL 2 MG/2ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2310","type":"HCPCS"},{"code":"76329336901","type":"NDC"}],"standard_charges":[{"gross_charge":31.6,"discounted_cash":31.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 ML"}]},{"description":"OXALIPLATIN 100 MG/20ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9263","type":"HCPCS"},{"code":"00703398601","type":"NDC"}],"standard_charges":[{"gross_charge":344.68,"discounted_cash":344.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4.5 ML"}]},{"description":"HEPARIN SODIUM (PORCINE) 5000 UNIT/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"00409272301","type":"NDC"}],"standard_charges":[{"gross_charge":18.19,"discounted_cash":18.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.2 ML"}]},{"description":"ARSENIC TRIOXIDE 10 MG/10ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9017","type":"HCPCS"},{"code":"70121148307","type":"NDC"}],"standard_charges":[{"gross_charge":661.75,"discounted_cash":661.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 9.4 ML"}]},{"description":"NICARDIPINE HCL 2.5 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2404","type":"HCPCS"},{"code":"00517073510","type":"NDC"}],"standard_charges":[{"gross_charge":93.23,"discounted_cash":93.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"TRIAMCINOLONE ACETONIDE 40 MG/ML IJ SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3301","type":"HCPCS"},{"code":"81298578105","type":"NDC"}],"standard_charges":[{"gross_charge":25.36,"discounted_cash":25.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 ML"}]},{"description":"REGADENOSON 0.4 MG/5ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2785","type":"HCPCS"},{"code":"43598061611","type":"NDC"}],"standard_charges":[{"gross_charge":58.86,"discounted_cash":58.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"LABETALOL HCL 5 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1920","type":"HCPCS"},{"code":"69374094634","type":"NDC"}],"standard_charges":[{"gross_charge":23.48,"discounted_cash":23.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.4 ML"}]},{"description":"LORAZEPAM 2 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2060","type":"HCPCS"},{"code":"65219036802","type":"NDC"}],"standard_charges":[{"gross_charge":25.71,"discounted_cash":25.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"KETOROLAC TROMETHAMINE 30 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1885","type":"HCPCS"},{"code":"00409379501","type":"NDC"}],"standard_charges":[{"gross_charge":31.71,"discounted_cash":31.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"MORPHINE SULFATE (PF) 10 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2270","type":"HCPCS"},{"code":"00409189301","type":"NDC"}],"standard_charges":[{"gross_charge":23.37,"discounted_cash":23.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.4 ML"}]},{"description":"GENTAMICIN SULFATE 10 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1580","type":"HCPCS"},{"code":"63323017302","type":"NDC"}],"standard_charges":[{"gross_charge":41.68,"discounted_cash":41.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"METHYLPREDNISOLONE ACETATE 80 MG/ML IJ SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1010","type":"HCPCS"},{"code":"70121157405","type":"NDC"}],"standard_charges":[{"gross_charge":45.95,"discounted_cash":45.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"ENOXAPARIN SODIUM 40 MG/0.4ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"63323056497","type":"NDC"}],"standard_charges":[{"gross_charge":46.53,"discounted_cash":46.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.4 ML"}]},{"description":"BENZTROPINE MESYLATE 1 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0515","type":"HCPCS"},{"code":"68382086010","type":"NDC"}],"standard_charges":[{"gross_charge":53.16,"discounted_cash":53.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"ENOXAPARIN SODIUM 40 MG/0.4ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"00955100410","type":"NDC"}],"standard_charges":[{"gross_charge":35.22,"discounted_cash":35.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.4 ML"}]},{"description":"XYLOCAINE 1 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2001","type":"HCPCS"},{"code":"63323048557","type":"NDC"}],"standard_charges":[{"gross_charge":16.34,"discounted_cash":16.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"XYLOCAINE 1 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2003","type":"HCPCS"},{"code":"63323048526","type":"NDC"}],"standard_charges":[{"gross_charge":19.34,"discounted_cash":19.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"XYLOCAINE 1 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2003","type":"HCPCS"},{"code":"63323048527","type":"NDC"}],"standard_charges":[{"gross_charge":18.17,"discounted_cash":18.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"XYLOCAINE 2 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2003","type":"HCPCS"},{"code":"63323048657","type":"NDC"}],"standard_charges":[{"gross_charge":17.58,"discounted_cash":17.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"XYLOCAINE 2 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2003","type":"HCPCS"},{"code":"63323048627","type":"NDC"}],"standard_charges":[{"gross_charge":21.09,"discounted_cash":21.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"DEXAMETHASONE SODIUM PHOSPHATE 100 MG/10ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1100","type":"HCPCS"},{"code":"67457042010","type":"NDC"}],"standard_charges":[{"gross_charge":21.33,"discounted_cash":21.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"CISPLATIN 100 MG/100ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9060","type":"HCPCS"},{"code":"63323010365","type":"NDC"}],"standard_charges":[{"gross_charge":315.06,"discounted_cash":315.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 35 ML"}]},{"description":"MIDAZOLAM HCL 2 MG/2ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2250","type":"HCPCS"},{"code":"63323041112","type":"NDC"}],"standard_charges":[{"gross_charge":17.55,"discounted_cash":17.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 ML"}]},{"description":"HEPARIN SODIUM (PORCINE) 5000 UNIT/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"25021040266","type":"NDC"}],"standard_charges":[{"gross_charge":25.6,"discounted_cash":25.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"HEPARIN SODIUM (PORCINE) 5000 UNIT/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"25021040201","type":"NDC"}],"standard_charges":[{"gross_charge":19.75,"discounted_cash":19.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.42 ML"}]},{"description":"MIDAZOLAM HCL 50 MG/10ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2250","type":"HCPCS"},{"code":"00409259605","type":"NDC"}],"standard_charges":[{"gross_charge":103.96,"discounted_cash":103.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 ML"}]},{"description":"NEOSTIGMINE METHYLSULFATE 10 MG/10ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2710","type":"HCPCS"},{"code":"63323041510","type":"NDC"}],"standard_charges":[{"gross_charge":18.78,"discounted_cash":18.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"NEOSTIGMINE METHYLSULFATE 10 MG/10ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2710","type":"HCPCS"},{"code":"25021061110","type":"NDC"}],"standard_charges":[{"gross_charge":19.29,"discounted_cash":19.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"XYLOCAINE 0.5 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2003","type":"HCPCS"},{"code":"63323048457","type":"NDC"}],"standard_charges":[{"gross_charge":20.2,"discounted_cash":20.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6 ML"}]},{"description":"HEPARIN SODIUM (PORCINE) 1000 UNIT/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"63323054015","type":"NDC"}],"standard_charges":[{"gross_charge":35.27,"discounted_cash":35.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"}]},{"description":"AMIODARONE HCL 450 MG/9ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0282","type":"HCPCS"},{"code":"67457015309","type":"NDC"}],"standard_charges":[{"gross_charge":49.49,"discounted_cash":49.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 9 ML"}]},{"description":"LORAZEPAM 2 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2060","type":"HCPCS"},{"code":"00641604610","type":"NDC"}],"standard_charges":[{"gross_charge":19.0,"discounted_cash":19.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 ML"}]},{"description":"FLUOROURACIL 2.5 GM/50ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9190","type":"HCPCS"},{"code":"62332075150","type":"NDC"}],"standard_charges":[{"gross_charge":474.88,"discounted_cash":474.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 ML"}]},{"description":"PHENYLEPHRINE HCL (PRESSORS) 10 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2371","type":"HCPCS"},{"code":"72205026507","type":"NDC"}],"standard_charges":[{"gross_charge":34.46,"discounted_cash":34.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"TOBRAMYCIN SULFATE 80 MG/2ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3260","type":"HCPCS"},{"code":"36000024425","type":"NDC"}],"standard_charges":[{"gross_charge":29.93,"discounted_cash":29.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"MIDAZOLAM HCL 5 MG/5ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2250","type":"HCPCS"},{"code":"63323041125","type":"NDC"}],"standard_charges":[{"gross_charge":19.63,"discounted_cash":19.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"HEPARIN SODIUM (PORCINE) 1000 UNIT/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"00409272002","type":"NDC"}],"standard_charges":[{"gross_charge":17.48,"discounted_cash":17.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"SUCCINYLCHOLINE CHLORIDE 20 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0330","type":"HCPCS"},{"code":"70069030110","type":"NDC"}],"standard_charges":[{"gross_charge":38.35,"discounted_cash":38.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"}]},{"description":"CARBOPLATIN 450 MG/45ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9045","type":"HCPCS"},{"code":"61703033950","type":"NDC"}],"standard_charges":[{"gross_charge":160.68,"discounted_cash":160.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"FLUOROURACIL 5 GM/100ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9190","type":"HCPCS"},{"code":"16729027638","type":"NDC"}],"standard_charges":[{"gross_charge":261.42,"discounted_cash":261.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 18 ML"}]},{"description":"HALOPERIDOL LACTATE 5 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1630","type":"HCPCS"},{"code":"63323047401","type":"NDC"}],"standard_charges":[{"gross_charge":17.81,"discounted_cash":17.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.2 ML"}]},{"description":"CISPLATIN 100 MG/100ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9060","type":"HCPCS"},{"code":"00143950501","type":"NDC"}],"standard_charges":[{"gross_charge":38.43,"discounted_cash":38.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"DEXAMETHASONE SODIUM PHOSPHATE 20 MG/5ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1100","type":"HCPCS"},{"code":"25021005205","type":"NDC"}],"standard_charges":[{"gross_charge":20.77,"discounted_cash":20.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"GENTAMICIN SULFATE 40 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1580","type":"HCPCS"},{"code":"63323001002","type":"NDC"}],"standard_charges":[{"gross_charge":17.2,"discounted_cash":17.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.2 ML"}]},{"description":"HEPARIN SODIUM (PORCINE) 1000 UNIT/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"25021040010","type":"NDC"}],"standard_charges":[{"gross_charge":18.05,"discounted_cash":18.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.1 ML"}]},{"description":"DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1100","type":"HCPCS"},{"code":"00641614525","type":"NDC"}],"standard_charges":[{"gross_charge":21.14,"discounted_cash":21.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"SENSORCAINE 0.25 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0665","type":"HCPCS"},{"code":"63323046557","type":"NDC"}],"standard_charges":[{"gross_charge":28.96,"discounted_cash":28.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"}]},{"description":"CARBOPLATIN 600 MG/60ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9045","type":"HCPCS"},{"code":"54288016701","type":"NDC"}],"standard_charges":[{"gross_charge":290.1,"discounted_cash":290.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"PROCHLORPERAZINE EDISYLATE 10 MG/2ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0780","type":"HCPCS"},{"code":"70069037125","type":"NDC"}],"standard_charges":[{"gross_charge":23.91,"discounted_cash":23.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"ETOPOSIDE 100 MG/5ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9181","type":"HCPCS"},{"code":"63323010406","type":"NDC"}],"standard_charges":[{"gross_charge":171.06,"discounted_cash":171.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"VASOPRESSIN 20 UNIT/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2598","type":"HCPCS"},{"code":"55150037025","type":"NDC"}],"standard_charges":[{"gross_charge":121.59,"discounted_cash":121.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"LIDOCAINE-EPINEPHRINE 2 %-1:100000 IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2004","type":"HCPCS"},{"code":"50227103005","type":"NDC"}],"standard_charges":[{"gross_charge":161.85,"discounted_cash":161.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"PROCAINAMIDE HCL 500 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2690","type":"HCPCS"},{"code":"14789090002","type":"NDC"}],"standard_charges":[{"gross_charge":1569.22,"discounted_cash":1569.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"TESTOSTERONE CYPIONATE 200 MG/ML IM SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1071","type":"HCPCS"},{"code":"69097080232","type":"NDC"}],"standard_charges":[{"gross_charge":59.7,"discounted_cash":59.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"PHENOBARBITAL SODIUM 130 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2560","type":"HCPCS"},{"code":"42494041625","type":"NDC"}],"standard_charges":[{"gross_charge":126.69,"discounted_cash":126.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"ENOXAPARIN SODIUM 300 MG/3ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"00548560800","type":"NDC"}],"standard_charges":[{"gross_charge":51.48,"discounted_cash":51.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.4 ML"}]},{"description":"DESMOPRESSIN ACETATE 4 MCG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2597","type":"HCPCS"},{"code":"25021046110","type":"NDC"}],"standard_charges":[{"gross_charge":321.85,"discounted_cash":321.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5.4 ML"}]},{"description":"PROCHLORPERAZINE EDISYLATE 10 MG/2ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0780","type":"HCPCS"},{"code":"43066009025","type":"NDC"}],"standard_charges":[{"gross_charge":31.97,"discounted_cash":31.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"HEPARIN SODIUM (PORCINE) 5000 UNIT/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"63323026201","type":"NDC"}],"standard_charges":[{"gross_charge":30.06,"discounted_cash":30.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.6 ML"}]},{"description":"PROMETHAZINE HCL 25 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2550","type":"HCPCS"},{"code":"00641620825","type":"NDC"}],"standard_charges":[{"gross_charge":21.56,"discounted_cash":21.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 ML"}]},{"description":"SENSORCAINE 0.5 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0665","type":"HCPCS"},{"code":"63323046757","type":"NDC"}],"standard_charges":[{"gross_charge":19.26,"discounted_cash":19.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"THIAMINE HCL 100 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3411","type":"HCPCS"},{"code":"67457019602","type":"NDC"}],"standard_charges":[{"gross_charge":36.37,"discounted_cash":36.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"HEPARIN SODIUM (PORCINE) 1000 UNIT/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"63323054001","type":"NDC"}],"standard_charges":[{"gross_charge":38.5,"discounted_cash":38.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"THIAMINE HCL 100 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3411","type":"HCPCS"},{"code":"72603013925","type":"NDC"}],"standard_charges":[{"gross_charge":58.91,"discounted_cash":58.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"PACLITAXEL 300 MG/50ML IV CONC","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9267","type":"HCPCS"},{"code":"63323076350","type":"NDC"}],"standard_charges":[{"gross_charge":172.38,"discounted_cash":172.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"PROCHLORPERAZINE EDISYLATE 10 MG/2ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0780","type":"HCPCS"},{"code":"00641613525","type":"NDC"}],"standard_charges":[{"gross_charge":35.67,"discounted_cash":35.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"BETAMETHASONE SOD PHOS & ACET 6 (3-3) MG/ML IJ SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0702","type":"HCPCS"},{"code":"00517072001","type":"NDC"}],"standard_charges":[{"gross_charge":24.69,"discounted_cash":24.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.083 ML"}]},{"description":"DOCETAXEL 80 MG/4ML IV CONC","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9171","type":"HCPCS"},{"code":"00409036701","type":"NDC"}],"standard_charges":[{"gross_charge":392.24,"discounted_cash":392.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.1 ML"}]},{"description":"METHADONE HCL 10 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1230","type":"HCPCS"},{"code":"67457021720","type":"NDC"}],"standard_charges":[{"gross_charge":620.57,"discounted_cash":620.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"CYCLOSPORINE MODIFIED 100 MG/ML PO SOLN UNIT DOSE","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J7502","type":"HCPCS"},{"code":"00172731320","type":"NDC"}],"standard_charges":[{"gross_charge":34.67,"discounted_cash":34.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"GEMCITABINE HCL 200 MG/2ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9196","type":"HCPCS"},{"code":"16729039130","type":"NDC"}],"standard_charges":[{"gross_charge":601.23,"discounted_cash":601.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"HEPARIN SODIUM (PORCINE) 10000 UNIT/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"63323054201","type":"NDC"}],"standard_charges":[{"gross_charge":20.04,"discounted_cash":20.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.1 ML"}]},{"description":"DESMOPRESSIN ACETATE 4 MCG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2597","type":"HCPCS"},{"code":"69918090110","type":"NDC"}],"standard_charges":[{"gross_charge":288.19,"discounted_cash":288.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5.8 ML"}]},{"description":"DOCETAXEL 160 MG/8ML IV CONC","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9171","type":"HCPCS"},{"code":"16729026765","type":"NDC"}],"standard_charges":[{"gross_charge":1055.19,"discounted_cash":1055.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.475 ML"}]},{"description":"DEPO-MEDROL 80 MG/ML IJ SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1010","type":"HCPCS"},{"code":"00009030602","type":"NDC"}],"standard_charges":[{"gross_charge":49.37,"discounted_cash":49.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"NEOSTIGMINE METHYLSULFATE 10 MG/10ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2710","type":"HCPCS"},{"code":"00548960200","type":"NDC"}],"standard_charges":[{"gross_charge":45.71,"discounted_cash":45.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 ML"}]},{"description":"HEPARIN SODIUM (PORCINE) 1000 UNIT/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"00781354025","type":"NDC"}],"standard_charges":[{"gross_charge":21.23,"discounted_cash":21.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.7 ML"}]},{"description":"FLUPHENAZINE DECANOATE 25 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2680","type":"HCPCS"},{"code":"00143952901","type":"NDC"}],"standard_charges":[{"gross_charge":43.26,"discounted_cash":43.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"GENTAMICIN SULFATE 40 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1580","type":"HCPCS"},{"code":"55150040325","type":"NDC"}],"standard_charges":[{"gross_charge":35.76,"discounted_cash":35.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"PROCHLORPERAZINE EDISYLATE 10 MG/2ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0780","type":"HCPCS"},{"code":"00713035125","type":"NDC"}],"standard_charges":[{"gross_charge":38.78,"discounted_cash":38.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"RETACRIT 20000 UNIT/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"Q5106","type":"HCPCS"},{"code":"00069131110","type":"NDC"}],"standard_charges":[{"gross_charge":392.78,"discounted_cash":392.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.7 ML"}]},{"description":"EPINEPHRINE 30 MG/30ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0171","type":"HCPCS"},{"code":"76329906000","type":"NDC"}],"standard_charges":[{"gross_charge":34.38,"discounted_cash":34.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 ML"}]},{"description":"NAROPIN 2 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2795","type":"HCPCS"},{"code":"63323028561","type":"NDC"}],"standard_charges":[{"gross_charge":141.09,"discounted_cash":141.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"PROCRIT 20000 UNIT/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0885","type":"HCPCS"},{"code":"59676032004","type":"NDC"}],"standard_charges":[{"gross_charge":477.43,"discounted_cash":477.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"EPOGEN 20000 UNIT/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0885","type":"HCPCS"},{"code":"55513047810","type":"NDC"}],"standard_charges":[{"gross_charge":967.12,"discounted_cash":967.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"DEXAMETHASONE SODIUM PHOSPHATE 20 MG/5ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1100","type":"HCPCS"},{"code":"00641614610","type":"NDC"}],"standard_charges":[{"gross_charge":15.69,"discounted_cash":15.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.063 ML"}]},{"description":"BUMETANIDE 0.25 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1939","type":"HCPCS"},{"code":"65219057210","type":"NDC"}],"standard_charges":[{"gross_charge":26.09,"discounted_cash":26.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"}]},{"description":"FLUOROURACIL 2.5 GM/50ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9190","type":"HCPCS"},{"code":"63323011751","type":"NDC"}],"standard_charges":[{"gross_charge":110.84,"discounted_cash":110.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 16.5 ML"}]},{"description":"DOXORUBICIN HCL 2 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9000","type":"HCPCS"},{"code":"25021020751","type":"NDC"}],"standard_charges":[{"gross_charge":172.44,"discounted_cash":172.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 18.5 ML"}]},{"description":"DEXAMETHASONE SODIUM PHOSPHATE 120 MG/30ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1100","type":"HCPCS"},{"code":"67457042130","type":"NDC"}],"standard_charges":[{"gross_charge":27.31,"discounted_cash":27.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 ML"}]},{"description":"LABETALOL HCL 5 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1920","type":"HCPCS"},{"code":"72266010201","type":"NDC"}],"standard_charges":[{"gross_charge":20.18,"discounted_cash":20.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"SUCCINYLCHOLINE CHLORIDE 20 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0330","type":"HCPCS"},{"code":"69918070025","type":"NDC"}],"standard_charges":[{"gross_charge":30.33,"discounted_cash":30.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 ML"}]},{"description":"PHENYLEPHRINE HCL (PRESSORS) 10 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2371","type":"HCPCS"},{"code":"00641618910","type":"NDC"}],"standard_charges":[{"gross_charge":46.87,"discounted_cash":46.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"CALCIUM GLUCONATE 10 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0612","type":"HCPCS"},{"code":"63323036061","type":"NDC"}],"standard_charges":[{"gross_charge":56.47,"discounted_cash":56.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"PACLITAXEL 300 MG/50ML IV CONC","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9267","type":"HCPCS"},{"code":"00703321801","type":"NDC"}],"standard_charges":[{"gross_charge":159.42,"discounted_cash":159.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"TOBRAMYCIN SULFATE 80 MG/2ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3260","type":"HCPCS"},{"code":"67457047322","type":"NDC"}],"standard_charges":[{"gross_charge":39.18,"discounted_cash":39.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"}]},{"description":"ETOPOSIDE 100 MG/5ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9181","type":"HCPCS"},{"code":"00143951001","type":"NDC"}],"standard_charges":[{"gross_charge":153.65,"discounted_cash":153.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6.2 ML"}]},{"description":"ETOPOSIDE 100 MG/5ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9181","type":"HCPCS"},{"code":"16729011431","type":"NDC"}],"standard_charges":[{"gross_charge":332.71,"discounted_cash":332.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6.9 ML"}]},{"description":"TOBRAMYCIN SULFATE 80 MG/2ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3260","type":"HCPCS"},{"code":"63323030602","type":"NDC"}],"standard_charges":[{"gross_charge":44.13,"discounted_cash":44.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"HEPARIN SODIUM (PORCINE) 10000 UNIT/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"63323054214","type":"NDC"}],"standard_charges":[{"gross_charge":51.87,"discounted_cash":51.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"PROCHLORPERAZINE EDISYLATE 10 MG/2ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0780","type":"HCPCS"},{"code":"67457064002","type":"NDC"}],"standard_charges":[{"gross_charge":42.27,"discounted_cash":42.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"INSULIN LISPRO 100 UNIT/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1815","type":"HCPCS"},{"code":"00002773701","type":"NDC"}],"standard_charges":[{"gross_charge":18.43,"discounted_cash":18.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.08 ML"}]},{"description":"MESNA 100 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9209","type":"HCPCS"},{"code":"10019095301","type":"NDC"}],"standard_charges":[{"gross_charge":77.18,"discounted_cash":77.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"DIPHENHYDRAMINE HCL 50 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1200","type":"HCPCS"},{"code":"67457012410","type":"NDC"}],"standard_charges":[{"gross_charge":17.55,"discounted_cash":17.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 ML"}]},{"description":"MIDAZOLAM HCL 5 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2250","type":"HCPCS"},{"code":"00641606125","type":"NDC"}],"standard_charges":[{"gross_charge":17.23,"discounted_cash":17.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.2 ML"}]},{"description":"DOXORUBICIN HCL 2 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9000","type":"HCPCS"},{"code":"00069154220","type":"NDC"}],"standard_charges":[{"gross_charge":237.54,"discounted_cash":237.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 16.5 ML"}]},{"description":"MEROPENEM 500 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2185","type":"HCPCS"},{"code":"44567040010","type":"NDC"}],"standard_charges":[{"gross_charge":55.22,"discounted_cash":55.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"DEXAMETHASONE SODIUM PHOSPHATE 20 MG/5ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1100","type":"HCPCS"},{"code":"67457042254","type":"NDC"}],"standard_charges":[{"gross_charge":18.35,"discounted_cash":18.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"GENTAMICIN SULFATE 40 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1580","type":"HCPCS"},{"code":"63323001095","type":"NDC"}],"standard_charges":[{"gross_charge":48.64,"discounted_cash":48.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5.5 ML"}]},{"description":"CARBOPLATIN 600 MG/60ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9045","type":"HCPCS"},{"code":"00703423901","type":"NDC"}],"standard_charges":[{"gross_charge":122.99,"discounted_cash":122.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 ML"}]},{"description":"CARBOPLATIN 450 MG/45ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9045","type":"HCPCS"},{"code":"00703424801","type":"NDC"}],"standard_charges":[{"gross_charge":31.6,"discounted_cash":31.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.05 ML"}]},{"description":"CYANOCOBALAMIN 1000 MCG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3420","type":"HCPCS"},{"code":"25021050201","type":"NDC"}],"standard_charges":[{"gross_charge":29.46,"discounted_cash":29.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"PROCHLORPERAZINE EDISYLATE 10 MG/2ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0780","type":"HCPCS"},{"code":"23155052341","type":"NDC"}],"standard_charges":[{"gross_charge":24.79,"discounted_cash":24.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"GENTAMICIN SULFATE 40 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1580","type":"HCPCS"},{"code":"63323001020","type":"NDC"}],"standard_charges":[{"gross_charge":36.55,"discounted_cash":36.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"PACLITAXEL 300 MG/50ML IV CONC","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9267","type":"HCPCS"},{"code":"61703034250","type":"NDC"}],"standard_charges":[{"gross_charge":64.25,"discounted_cash":64.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"HEPARIN SODIUM (PORCINE) 5000 UNIT/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"81952011106","type":"NDC"}],"standard_charges":[{"gross_charge":32.41,"discounted_cash":32.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"PROCHLORPERAZINE EDISYLATE 10 MG/2ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0780","type":"HCPCS"},{"code":"23155029441","type":"NDC"}],"standard_charges":[{"gross_charge":28.16,"discounted_cash":28.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"PROCHLORPERAZINE EDISYLATE 10 MG/2ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0780","type":"HCPCS"},{"code":"23155029442","type":"NDC"}],"standard_charges":[{"gross_charge":42.12,"discounted_cash":42.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"TRIAMCINOLONE ACETONIDE 40 MG/ML IJ SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3301","type":"HCPCS"},{"code":"70121116801","type":"NDC"}],"standard_charges":[{"gross_charge":45.64,"discounted_cash":45.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"ETOPOSIDE 1 GM/50ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9181","type":"HCPCS"},{"code":"16729011411","type":"NDC"}],"standard_charges":[{"gross_charge":368.89,"discounted_cash":368.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7.6 ML"}]},{"description":"FOLIC ACID 5 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1808","type":"HCPCS"},{"code":"63323018410","type":"NDC"}],"standard_charges":[{"gross_charge":22.22,"discounted_cash":22.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.2 ML"}]},{"description":"CYANOCOBALAMIN 1000 MCG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3420","type":"HCPCS"},{"code":"00517003125","type":"NDC"}],"standard_charges":[{"gross_charge":34.52,"discounted_cash":34.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"PACLITAXEL 150 MG/25ML IV CONC","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9267","type":"HCPCS"},{"code":"00703321701","type":"NDC"}],"standard_charges":[{"gross_charge":1705.82,"discounted_cash":1705.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 42 ML"}]},{"description":"SUCCINYLCHOLINE CHLORIDE 20 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0330","type":"HCPCS"},{"code":"43598066625","type":"NDC"}],"standard_charges":[{"gross_charge":18.42,"discounted_cash":18.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"GENTAMICIN SULFATE 40 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1580","type":"HCPCS"},{"code":"63323001094","type":"NDC"}],"standard_charges":[{"gross_charge":24.01,"discounted_cash":24.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"HEPARIN SODIUM (PORCINE) 5000 UNIT/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"63323004710","type":"NDC"}],"standard_charges":[{"gross_charge":27.19,"discounted_cash":27.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"CLINDAMYCIN PHOSPHATE IN D5W 900 MG/50ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0737","type":"HCPCS"},{"code":"00338381424","type":"NDC"}],"standard_charges":[{"gross_charge":59.34,"discounted_cash":59.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 33.333 ML"}]},{"description":"HEPARIN SODIUM (PORCINE) 1000 UNIT/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"71288040211","type":"NDC"}],"standard_charges":[{"gross_charge":16.73,"discounted_cash":16.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"PREDNISOLONE SODIUM PHOSPHATE 15 MG/5ML PO SOLN UNIT DOSE","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J7510","type":"HCPCS"},{"code":"00121075908","type":"NDC"}],"standard_charges":[{"gross_charge":47.91,"discounted_cash":47.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"DEXAMETHASONE SODIUM PHOSPHATE 120 MG/30ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1100","type":"HCPCS"},{"code":"63323016530","type":"NDC"}],"standard_charges":[{"gross_charge":22.68,"discounted_cash":22.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"HEPARIN SODIUM (PORCINE) 1000 UNIT/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"63323054011","type":"NDC"}],"standard_charges":[{"gross_charge":24.37,"discounted_cash":24.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"LIDOCAINE HCL 1 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2003","type":"HCPCS"},{"code":"63323020110","type":"NDC"}],"standard_charges":[{"gross_charge":19.38,"discounted_cash":19.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"BUMETANIDE 0.25 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1939","type":"HCPCS"},{"code":"00641600710","type":"NDC"}],"standard_charges":[{"gross_charge":31.86,"discounted_cash":31.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"}]},{"description":"CISPLATIN 100 MG/100ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9060","type":"HCPCS"},{"code":"72266025301","type":"NDC"}],"standard_charges":[{"gross_charge":536.14,"discounted_cash":536.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 70 ML"}]},{"description":"FLUOROURACIL 5 GM/100ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9190","type":"HCPCS"},{"code":"70700018922","type":"NDC"}],"standard_charges":[{"gross_charge":180.5,"discounted_cash":180.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 13.5 ML"}]},{"description":"CISPLATIN 50 MG/50ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9060","type":"HCPCS"},{"code":"25021025350","type":"NDC"}],"standard_charges":[{"gross_charge":390.6,"discounted_cash":390.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 34 ML"}]},{"description":"MIDAZOLAM HCL 50 MG/10ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2250","type":"HCPCS"},{"code":"00641606010","type":"NDC"}],"standard_charges":[{"gross_charge":48.25,"discounted_cash":48.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 ML"}]},{"description":"FLUOROURACIL 2.5 GM/50ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9190","type":"HCPCS"},{"code":"25021021598","type":"NDC"}],"standard_charges":[{"gross_charge":94.23,"discounted_cash":94.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 14.5 ML"}]},{"description":"CISPLATIN 50 MG/50ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9060","type":"HCPCS"},{"code":"16729028811","type":"NDC"}],"standard_charges":[{"gross_charge":70.79,"discounted_cash":70.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"}]},{"description":"NEOSTIGMINE METHYLSULFATE 10 MG/10ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2710","type":"HCPCS"},{"code":"70069080610","type":"NDC"}],"standard_charges":[{"gross_charge":30.86,"discounted_cash":30.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"THIAMINE HCL 100 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3411","type":"HCPCS"},{"code":"25021050002","type":"NDC"}],"standard_charges":[{"gross_charge":40.42,"discounted_cash":40.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"CYANOCOBALAMIN 1000 MCG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3420","type":"HCPCS"},{"code":"70069000510","type":"NDC"}],"standard_charges":[{"gross_charge":31.62,"discounted_cash":31.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"DEXAMETHASONE SODIUM PHOSPHATE 10 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1100","type":"HCPCS"},{"code":"00641036725","type":"NDC"}],"standard_charges":[{"gross_charge":19.26,"discounted_cash":19.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.2 ML"}]},{"description":"PACLITAXEL 300 MG/50ML IV CONC","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9267","type":"HCPCS"},{"code":"68001051627","type":"NDC"}],"standard_charges":[{"gross_charge":483.78,"discounted_cash":483.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 23 ML"}]},{"description":"PROMETHAZINE HCL 6.25 MG/5ML PO SYRP UNIT DOSE","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"27808005102","type":"NDC"}],"standard_charges":[{"gross_charge":10.51,"discounted_cash":10.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"LACTULOSE 10 GM/15ML PO SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00121087316","type":"NDC"}],"standard_charges":[{"gross_charge":16.74,"discounted_cash":16.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"MAGNESIUM CITRATE 1.745 GM/30ML PO SOLN BULK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"69452038998","type":"NDC"}],"standard_charges":[{"gross_charge":84.06,"discounted_cash":84.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 148 ML"}]},{"description":"PROMETHAZINE HCL 6.25 MG/5ML PO SYRP UNIT DOSE","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"70752013812","type":"NDC"}],"standard_charges":[{"gross_charge":18.2,"discounted_cash":18.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"METHADOSE 10 MG/ML PO CONC","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00406052710","type":"NDC"}],"standard_charges":[{"gross_charge":4.16,"discounted_cash":4.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.9 ML"}]},{"description":"CITALOPRAM HYDROBROMIDE 10 MG/5ML PO SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00054006258","type":"NDC"}],"standard_charges":[{"gross_charge":12.82,"discounted_cash":12.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 ML"}]},{"description":"LORAZEPAM 2 MG/ML PO CONC UNIT DOSE","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00121077001","type":"NDC"}],"standard_charges":[{"gross_charge":8.9,"discounted_cash":8.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"IPRATROPIUM BROMIDE 0.06 % NA SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00054004641","type":"NDC"}],"standard_charges":[{"gross_charge":125.68,"discounted_cash":125.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"MIDAZOLAM HCL 2 MG/ML PO SYRP UNIT DOSE","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00054356699","type":"NDC"}],"standard_charges":[{"gross_charge":59.82,"discounted_cash":59.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"BRIMONIDINE TARTRATE 0.2 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"24208041105","type":"NDC"}],"standard_charges":[{"gross_charge":58.29,"discounted_cash":58.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"TROPICAMIDE-CYCLOPENTOLATE-PE 1-1-2.5 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"71266821105","type":"NDC"}],"standard_charges":[{"gross_charge":373.65,"discounted_cash":373.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"LEVOFLOXACIN 25 MG/ML PO SOLN BULK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00527194866","type":"NDC"}],"standard_charges":[{"gross_charge":549.24,"discounted_cash":549.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"IPRATROPIUM BROMIDE 0.03 % NA SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"24208039830","type":"NDC"}],"standard_charges":[{"gross_charge":303.63,"discounted_cash":303.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"FERRIC SUBSULFATE (BULK) SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"38779128408","type":"NDC"}],"standard_charges":[{"gross_charge":54.24,"discounted_cash":54.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"ADRENALIN 0.1 % NA SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"42023010301","type":"NDC"}],"standard_charges":[{"gross_charge":1004.6,"discounted_cash":1004.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"DEPO-MEDROL 40 MG/ML IJ SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1030","type":"HCPCS"},{"code":"00009028003","type":"NDC"}],"standard_charges":[{"gross_charge":40.23,"discounted_cash":40.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"DEPO-MEDROL 40 MG/ML IJ SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1010","type":"HCPCS"},{"code":"00009028002","type":"NDC"}],"standard_charges":[{"gross_charge":38.7,"discounted_cash":38.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"CELESTONE SOLUSPAN 6 (3-3) MG/ML IJ SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0702","type":"HCPCS"},{"code":"78206011801","type":"NDC"}],"standard_charges":[{"gross_charge":57.61,"discounted_cash":57.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"MIACALCIN 200 UNIT/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0630","type":"HCPCS"},{"code":"67457067502","type":"NDC"}],"standard_charges":[{"gross_charge":1082.41,"discounted_cash":1082.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"DDAVP 4 MCG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2597","type":"HCPCS"},{"code":"55566230000","type":"NDC"}],"standard_charges":[{"gross_charge":708.63,"discounted_cash":708.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"EPOGEN 10000 UNIT/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0885","type":"HCPCS"},{"code":"55513028310","type":"NDC"}],"standard_charges":[{"gross_charge":722.08,"discounted_cash":722.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.5 ML"}]},{"description":"HUMULIN R 100 UNIT/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1815","type":"HCPCS"},{"code":"00002021301","type":"NDC"}],"standard_charges":[{"gross_charge":16.21,"discounted_cash":16.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.03 ML"}]},{"description":"KENALOG-40 40 MG/ML IJ SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3301","type":"HCPCS"},{"code":"00003029320","type":"NDC"}],"standard_charges":[{"gross_charge":61.33,"discounted_cash":61.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"KENALOG-40 40 MG/ML IJ SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3301","type":"HCPCS"},{"code":"00003029328","type":"NDC"}],"standard_charges":[{"gross_charge":38.3,"discounted_cash":38.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 ML"}]},{"description":"ALBUMINEX 25 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"P9046","type":"HCPCS"},{"code":"64208251203","type":"NDC"}],"standard_charges":[{"gross_charge":205.87,"discounted_cash":205.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 ML"}]},{"description":"ALBUMIN HUMAN 25 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"P9046","type":"HCPCS"},{"code":"44206025110","type":"NDC"}],"standard_charges":[{"gross_charge":124.49,"discounted_cash":124.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 24 ML"}]},{"description":"ANECTINE 20 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0330","type":"HCPCS"},{"code":"00781341195","type":"NDC"}],"standard_charges":[{"gross_charge":34.37,"discounted_cash":34.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"QUELICIN 20 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0330","type":"HCPCS"},{"code":"00409662902","type":"NDC"}],"standard_charges":[{"gross_charge":22.48,"discounted_cash":22.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 ML"}]},{"description":"TEGRETOL 100 MG/5ML PO SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00078050883","type":"NDC"}],"standard_charges":[{"gross_charge":76.39,"discounted_cash":76.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"LACOSAMIDE 10 MG/ML PO SOLN UNIT DOSE","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"72603030501","type":"NDC"}],"standard_charges":[{"gross_charge":22.29,"discounted_cash":22.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"IPRATROPIUM BROMIDE 0.03 % NA SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00054004544","type":"NDC"}],"standard_charges":[{"gross_charge":147.06,"discounted_cash":147.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"METHADONE HCL 10 MG/ML PO CONC UNIT DOSE","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00054039168","type":"NDC"}],"standard_charges":[{"gross_charge":4.4,"discounted_cash":4.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.9 ML"}]},{"description":"ENOXAPARIN SODIUM 60 MG/0.6ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"25021041077","type":"NDC"}],"standard_charges":[{"gross_charge":24.15,"discounted_cash":24.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.1 ML"}]},{"description":"ENOXAPARIN SODIUM 40 MG/0.4ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"00781324664","type":"NDC"}],"standard_charges":[{"gross_charge":36.16,"discounted_cash":36.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.4 ML"}]},{"description":"ENOXAPARIN SODIUM 80 MG/0.8ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"71288043592","type":"NDC"}],"standard_charges":[{"gross_charge":42.54,"discounted_cash":42.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.8 ML"}]},{"description":"DESMOPRESSIN ACETATE PF 4 MCG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2597","type":"HCPCS"},{"code":"43598093109","type":"NDC"}],"standard_charges":[{"gross_charge":346.35,"discounted_cash":346.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4.7 ML"}]},{"description":"DOXORUBICIN HCL LIPOSOMAL 2 MG/ML IV SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"Q2050","type":"HCPCS"},{"code":"70710153001","type":"NDC"}],"standard_charges":[{"gross_charge":5589.23,"discounted_cash":5589.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 ML"}]},{"description":"MEDROXYPROGESTERONE ACETATE 150 MG/ML IM SUSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1050","type":"HCPCS"},{"code":"70121148001","type":"NDC"}],"standard_charges":[{"gross_charge":252.47,"discounted_cash":252.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"FOMEPIZOLE 1.5 GM/1.5ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1451","type":"HCPCS"},{"code":"70710147801","type":"NDC"}],"standard_charges":[{"gross_charge":1102.4,"discounted_cash":1102.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.4 ML"}]},{"description":"RECOMBIVAX HB 10 MCG/ML IJ SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"90746","type":"HCPCS"},{"code":"00006499541","type":"NDC"}],"standard_charges":[{"gross_charge":156.92,"discounted_cash":156.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"VENOFER 20 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1756","type":"HCPCS"},{"code":"00517234010","type":"NDC"}],"standard_charges":[{"gross_charge":130.54,"discounted_cash":130.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"VENOFER 20 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1756","type":"HCPCS"},{"code":"00517231005","type":"NDC"}],"standard_charges":[{"gross_charge":130.84,"discounted_cash":130.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"VENOFER 20 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1756","type":"HCPCS"},{"code":"00517234099","type":"NDC"}],"standard_charges":[{"gross_charge":130.54,"discounted_cash":130.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"VENOFER 20 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1756","type":"HCPCS"},{"code":"00517234025","type":"NDC"}],"standard_charges":[{"gross_charge":130.54,"discounted_cash":130.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"DOXIL 2 MG/ML IV SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"Q2050","type":"HCPCS"},{"code":"00338006301","type":"NDC"}],"standard_charges":[{"gross_charge":2710.63,"discounted_cash":2710.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 ML"}]},{"description":"LIDOCAINE-EPINEPHRINE 1 %-1:100000 IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2004","type":"HCPCS"},{"code":"00409317803","type":"NDC"}],"standard_charges":[{"gross_charge":17.47,"discounted_cash":17.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"DOTAREM 50 MMOL/100ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"255","type":"RC"},{"code":"A9575","type":"HCPCS"},{"code":"67684200104","type":"NDC"}],"standard_charges":[{"gross_charge":0.94,"discounted_cash":0.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.1 ML"}]},{"description":"LIPIODOL 480 MG/ML IJ OIL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"255","type":"RC"},{"code":"J3490","type":"HCPCS"},{"code":"67684190102","type":"NDC"}],"standard_charges":[{"gross_charge":14390.64,"discounted_cash":14390.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 ML"}]},{"description":"ISOVUE-370 76 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"255","type":"RC"},{"code":"Q9967","type":"HCPCS"},{"code":"00270131645","type":"NDC"}],"standard_charges":[{"gross_charge":54.51,"discounted_cash":54.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"CYSTO-CONRAY II 17.2 % UR SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"255","type":"RC"},{"code":"Q9958","type":"HCPCS"},{"code":"00019086250","type":"NDC"}],"standard_charges":[{"gross_charge":78.68,"discounted_cash":78.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 ML"}]},{"description":"GABAPENTIN 250 MG/5ML PO SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"42192060816","type":"NDC"}],"standard_charges":[{"gross_charge":18.14,"discounted_cash":18.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6 ML"}]},{"description":"MORPHINE SULFATE (CONCENTRATE) 100 MG/5ML PO SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00054051744","type":"NDC"}],"standard_charges":[{"gross_charge":8.86,"discounted_cash":8.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 ML"}]},{"description":"VUEWAY 0.5 MMOL/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"255","type":"RC"},{"code":"A9573","type":"HCPCS"},{"code":"00270701546","type":"NDC"}],"standard_charges":[{"gross_charge":234.63,"discounted_cash":234.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6 ML"}]},{"description":"ISOVUE-300 61 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"255","type":"RC"},{"code":"Q9967","type":"HCPCS"},{"code":"00270131595","type":"NDC"}],"standard_charges":[{"gross_charge":51.55,"discounted_cash":51.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"CYSTOGRAFIN 30 % UR SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"255","type":"RC"},{"code":"Q9958","type":"HCPCS"},{"code":"00270014957","type":"NDC"}],"standard_charges":[{"gross_charge":59.72,"discounted_cash":59.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"CYSTOGRAFIN 30 % UR SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"255","type":"RC"},{"code":"Q9958","type":"HCPCS"},{"code":"00270014960","type":"NDC"}],"standard_charges":[{"gross_charge":501.26,"discounted_cash":501.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 ML"}]},{"description":"ISOVUE-300 61 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"255","type":"RC"},{"code":"Q9967","type":"HCPCS"},{"code":"00270131545","type":"NDC"}],"standard_charges":[{"gross_charge":45.86,"discounted_cash":45.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 45 ML"}]},{"description":"GADOTERATE MEGLUMINE 50 MMOL/100ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"255","type":"RC"},{"code":"A9575","type":"HCPCS"},{"code":"65219008850","type":"NDC"}],"standard_charges":[{"gross_charge":142.73,"discounted_cash":142.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"ISOVUE-370 76 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"255","type":"RC"},{"code":"Q9967","type":"HCPCS"},{"code":"00270131695","type":"NDC"}],"standard_charges":[{"gross_charge":45.98,"discounted_cash":45.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 ML"}]},{"description":"ACETIC ACID 3 % SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"51552005106","type":"NDC"}],"standard_charges":[{"gross_charge":3.47,"discounted_cash":3.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"EYE WASH OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"10119000252","type":"NDC"}],"standard_charges":[{"gross_charge":52.42,"discounted_cash":52.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 118 ML"}]},{"description":"THIAMINE HCL 200 MG/2ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3411","type":"HCPCS"},{"code":"43598005025","type":"NDC"}],"standard_charges":[{"gross_charge":36.91,"discounted_cash":36.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"PHESGO 60-60-2000 MG-MG-U/ML SC SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9316","type":"HCPCS"},{"code":"50242026001","type":"NDC"}],"standard_charges":[{"gross_charge":26206.88,"discounted_cash":26206.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"BENDEKA 100 MG/4ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9034","type":"HCPCS"},{"code":"63459034804","type":"NDC"}],"standard_charges":[{"gross_charge":15563.45,"discounted_cash":15563.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"}]},{"description":"ALBURX 5 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"P9045","type":"HCPCS"},{"code":"44206031050","type":"NDC"}],"standard_charges":[{"gross_charge":310.95,"discounted_cash":310.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 ML"}]},{"description":"CYANOCOBALAMIN 1000 MCG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3420","type":"HCPCS"},{"code":"63323004401","type":"NDC"}],"standard_charges":[{"gross_charge":30.37,"discounted_cash":30.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"LORAZEPAM 2 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2060","type":"HCPCS"},{"code":"76329826101","type":"NDC"}],"standard_charges":[{"gross_charge":17.4,"discounted_cash":17.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.13 ML"}]},{"description":"FLUOROURACIL 5 GM/100ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9190","type":"HCPCS"},{"code":"62332077931","type":"NDC"}],"standard_charges":[{"gross_charge":1539.47,"discounted_cash":1539.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 70 ML"}]},{"description":"PROCHLORPERAZINE EDISYLATE 10 MG/2ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0780","type":"HCPCS"},{"code":"83634077802","type":"NDC"}],"standard_charges":[{"gross_charge":30.3,"discounted_cash":30.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"CYANOCOBALAMIN 1000 MCG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3420","type":"HCPCS"},{"code":"70512084025","type":"NDC"}],"standard_charges":[{"gross_charge":30.3,"discounted_cash":30.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"CYANOCOBALAMIN 1000 MCG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3420","type":"HCPCS"},{"code":"71288030302","type":"NDC"}],"standard_charges":[{"gross_charge":32.46,"discounted_cash":32.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"THIAMINE HCL 100 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3411","type":"HCPCS"},{"code":"63323001326","type":"NDC"}],"standard_charges":[{"gross_charge":37.72,"discounted_cash":37.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"ETOPOSIDE 500 MG/25ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9181","type":"HCPCS"},{"code":"63323010425","type":"NDC"}],"standard_charges":[{"gross_charge":256.78,"discounted_cash":256.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6.5 ML"}]},{"description":"FOLIC ACID 5 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1808","type":"HCPCS"},{"code":"39822110001","type":"NDC"}],"standard_charges":[{"gross_charge":21.09,"discounted_cash":21.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.2 ML"}]},{"description":"THIAMINE HCL 100 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3411","type":"HCPCS"},{"code":"63323001302","type":"NDC"}],"standard_charges":[{"gross_charge":38.45,"discounted_cash":38.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"CYANOCOBALAMIN 1000 MCG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3420","type":"HCPCS"},{"code":"69680011225","type":"NDC"}],"standard_charges":[{"gross_charge":37.21,"discounted_cash":37.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"ETOPOSIDE 500 MG/25ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9181","type":"HCPCS"},{"code":"16729011408","type":"NDC"}],"standard_charges":[{"gross_charge":307.53,"discounted_cash":307.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6.2 ML"}]},{"description":"PHENYLEPHRINE HCL (PRESSORS) 10 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2371","type":"HCPCS"},{"code":"00641618810","type":"NDC"}],"standard_charges":[{"gross_charge":37.24,"discounted_cash":37.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"CYANOCOBALAMIN 1000 MCG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3420","type":"HCPCS"},{"code":"63323004444","type":"NDC"}],"standard_charges":[{"gross_charge":30.37,"discounted_cash":30.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"MIDAZOLAM HCL 10 MG/2ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2250","type":"HCPCS"},{"code":"63323041202","type":"NDC"}],"standard_charges":[{"gross_charge":42.6,"discounted_cash":42.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"FLUPHENAZINE DECANOATE 25 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2680","type":"HCPCS"},{"code":"42023012989","type":"NDC"}],"standard_charges":[{"gross_charge":39.34,"discounted_cash":39.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"PAPAVERINE HCL 30 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2440","type":"HCPCS"},{"code":"00517400225","type":"NDC"}],"standard_charges":[{"gross_charge":58.33,"discounted_cash":58.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"DESMOPRESSIN ACETATE 4 MCG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2597","type":"HCPCS"},{"code":"69918090112","type":"NDC"}],"standard_charges":[{"gross_charge":51.44,"discounted_cash":51.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"PACLITAXEL 300 MG/50ML IV CONC","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9267","type":"HCPCS"},{"code":"62332062250","type":"NDC"}],"standard_charges":[{"gross_charge":646.4,"discounted_cash":646.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 17 ML"}]},{"description":"TRIAMCINOLONE ACETONIDE 40 MG/ML IJ SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3301","type":"HCPCS"},{"code":"16714015001","type":"NDC"}],"standard_charges":[{"gross_charge":35.87,"discounted_cash":35.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"NALOXONE HCL 0.4 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2310","type":"HCPCS"},{"code":"00641613225","type":"NDC"}],"standard_charges":[{"gross_charge":35.78,"discounted_cash":35.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"VINBLASTINE SULFATE 1 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9360","type":"HCPCS"},{"code":"63323027810","type":"NDC"}],"standard_charges":[{"gross_charge":816.52,"discounted_cash":816.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8.4 ML"}]},{"description":"DESMOPRESSIN ACETATE 4 MCG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2597","type":"HCPCS"},{"code":"65219029510","type":"NDC"}],"standard_charges":[{"gross_charge":205.27,"discounted_cash":205.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3.8 ML"}]},{"description":"PROCHLORPERAZINE EDISYLATE 10 MG/2ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0780","type":"HCPCS"},{"code":"72266020410","type":"NDC"}],"standard_charges":[{"gross_charge":40.77,"discounted_cash":40.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"THIAMINE HCL 100 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3411","type":"HCPCS"},{"code":"00641622825","type":"NDC"}],"standard_charges":[{"gross_charge":40.66,"discounted_cash":40.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"TRIAMCINOLONE ACETONIDE 40 MG/ML IJ SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3301","type":"HCPCS"},{"code":"16714014001","type":"NDC"}],"standard_charges":[{"gross_charge":61.25,"discounted_cash":61.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 UN"}]},{"description":"PHENYLEPHRINE HCL (PRESSORS) 10 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2371","type":"HCPCS"},{"code":"70069080210","type":"NDC"}],"standard_charges":[{"gross_charge":50.22,"discounted_cash":50.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"ETOPOSIDE 500 MG/25ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9181","type":"HCPCS"},{"code":"00143951101","type":"NDC"}],"standard_charges":[{"gross_charge":62.48,"discounted_cash":62.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.2 ML"}]},{"description":"DOCETAXEL 160 MG/8ML IV CONC","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9171","type":"HCPCS"},{"code":"67457078108","type":"NDC"}],"standard_charges":[{"gross_charge":256.1,"discounted_cash":256.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.1 ML"}]},{"description":"ETOPOSIDE 1 GM/50ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9181","type":"HCPCS"},{"code":"00143951201","type":"NDC"}],"standard_charges":[{"gross_charge":197.16,"discounted_cash":197.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8.3 ML"}]},{"description":"PHENYLEPHRINE HCL (PRESSORS) 10 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2371","type":"HCPCS"},{"code":"55150030110","type":"NDC"}],"standard_charges":[{"gross_charge":41.07,"discounted_cash":41.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"LORAZEPAM 2 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2060","type":"HCPCS"},{"code":"00641620725","type":"NDC"}],"standard_charges":[{"gross_charge":17.72,"discounted_cash":17.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.13 ML"}]},{"description":"XYLOCAINE/EPINEPHRINE 1 %-1:100000 IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2004","type":"HCPCS"},{"code":"63323048257","type":"NDC"}],"standard_charges":[{"gross_charge":18.03,"discounted_cash":18.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.8 ML"}]},{"description":"XYLOCAINE/EPINEPHRINE 1 %-1:100000 IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2004","type":"HCPCS"},{"code":"63323048227","type":"NDC"}],"standard_charges":[{"gross_charge":17.22,"discounted_cash":17.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"XYLOCAINE/EPINEPHRINE 2 %-1:100000 IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2004","type":"HCPCS"},{"code":"63323048357","type":"NDC"}],"standard_charges":[{"gross_charge":28.34,"discounted_cash":28.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"XYLOCAINE/EPINEPHRINE 2 %-1:100000 IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2004","type":"HCPCS"},{"code":"63323048327","type":"NDC"}],"standard_charges":[{"gross_charge":18.98,"discounted_cash":18.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"KENALOG-10 10 MG/ML IJ SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3301","type":"HCPCS"},{"code":"00003049420","type":"NDC"}],"standard_charges":[{"gross_charge":35.9,"discounted_cash":35.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"HYDROMORPHONE HCL 2 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1170","type":"HCPCS"},{"code":"00641234141","type":"NDC"}],"standard_charges":[{"gross_charge":23.22,"discounted_cash":23.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"GLYCOPYRROLATE 1 MG/5ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1596","type":"HCPCS"},{"code":"70700016725","type":"NDC"}],"standard_charges":[{"gross_charge":34.01,"discounted_cash":34.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"LEVETIRACETAM 100 MG/ML PO SOLN UNIT DOSE","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"31722057447","type":"NDC"}],"standard_charges":[{"gross_charge":5.75,"discounted_cash":5.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 ML"}]},{"description":"SENSORCAINE/EPINEPHRINE 0.25% -1:200000 IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0665","type":"HCPCS"},{"code":"63323046157","type":"NDC"}],"standard_charges":[{"gross_charge":48.24,"discounted_cash":48.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"MARCAINE/EPINEPHRINE 0.5% -1:200000 IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0665","type":"HCPCS"},{"code":"00409175550","type":"NDC"}],"standard_charges":[{"gross_charge":38.91,"discounted_cash":38.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 9 ML"}]},{"description":"SENSORCAINE/EPINEPHRINE 0.5% -1:200000 IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0665","type":"HCPCS"},{"code":"63323046357","type":"NDC"}],"standard_charges":[{"gross_charge":86.0,"discounted_cash":86.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"XYLOCAINE/EPINEPHRINE 0.5 %-1:200000 IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2004","type":"HCPCS"},{"code":"63323048157","type":"NDC"}],"standard_charges":[{"gross_charge":36.15,"discounted_cash":36.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"TUBERSOL 5 UNIT/0.1ML ID SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"86580","type":"HCPCS"},{"code":"49281075221","type":"NDC"}],"standard_charges":[{"gross_charge":52.85,"discounted_cash":52.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.1 ML"}]},{"description":"APLISOL 5 UNIT/0.1ML ID SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"86580","type":"HCPCS"},{"code":"42023010401","type":"NDC"}],"standard_charges":[{"gross_charge":63.14,"discounted_cash":63.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.1 ML"}]},{"description":"TUBERSOL 5 UNIT/0.1ML ID SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"86580","type":"HCPCS"},{"code":"49281075222","type":"NDC"}],"standard_charges":[{"gross_charge":56.91,"discounted_cash":56.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.1 ML"}]},{"description":"MARCAINE/EPINEPHRINE 0.25% -1:200000 IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0665","type":"HCPCS"},{"code":"00409175250","type":"NDC"}],"standard_charges":[{"gross_charge":25.33,"discounted_cash":25.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"CONSTULOSE 10 GM/15ML PO SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"45963043965","type":"NDC"}],"standard_charges":[{"gross_charge":70.1,"discounted_cash":70.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 ML"}]},{"description":"LIDOCAINE-EPINEPHRINE 0.5 %-1:200000 IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2004","type":"HCPCS"},{"code":"00409317701","type":"NDC"}],"standard_charges":[{"gross_charge":19.02,"discounted_cash":19.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"BUPIVACAINE-EPINEPHRINE 0.25% -1:200000 IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0665","type":"HCPCS"},{"code":"00409904301","type":"NDC"}],"standard_charges":[{"gross_charge":40.33,"discounted_cash":40.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"SALINE BACTERIOSTATIC 0.9 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J7030","type":"HCPCS"},{"code":"63323092410","type":"NDC"}],"standard_charges":[{"gross_charge":20.42,"discounted_cash":20.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"}]},{"description":"MAGNESIUM CITRATE 1.745 GM/30ML PO SOLN BULK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"69452039098","type":"NDC"}],"standard_charges":[{"gross_charge":166.56,"discounted_cash":166.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 296 ML"}]},{"description":"CARBOPLATIN 600 MG/60ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9045","type":"HCPCS"},{"code":"16729029512","type":"NDC"}],"standard_charges":[{"gross_charge":31.97,"discounted_cash":31.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.05 ML"}]},{"description":"DOXORUBICIN HCL 2 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9000","type":"HCPCS"},{"code":"45963073360","type":"NDC"}],"standard_charges":[{"gross_charge":158.1,"discounted_cash":158.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7 ML"}]},{"description":"FLUOROURACIL 2.5 GM/50ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9190","type":"HCPCS"},{"code":"70700018822","type":"NDC"}],"standard_charges":[{"gross_charge":204.14,"discounted_cash":204.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 13.5 ML"}]},{"description":"PACLITAXEL 300 MG/50ML IV CONC","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9267","type":"HCPCS"},{"code":"16714013701","type":"NDC"}],"standard_charges":[{"gross_charge":166.73,"discounted_cash":166.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 ML"}]},{"description":"CARBOPLATIN 600 MG/60ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9045","type":"HCPCS"},{"code":"61703033956","type":"NDC"}],"standard_charges":[{"gross_charge":32.08,"discounted_cash":32.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.05 ML"}]},{"description":"PACLITAXEL 300 MG/50ML IV CONC","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9267","type":"HCPCS"},{"code":"25021025550","type":"NDC"}],"standard_charges":[{"gross_charge":201.44,"discounted_cash":201.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10.5 ML"}]},{"description":"PHENYLEPHRINE HCL (PRESSORS) 10 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2371","type":"HCPCS"},{"code":"71288080876","type":"NDC"}],"standard_charges":[{"gross_charge":45.01,"discounted_cash":45.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"CARBOPLATIN 450 MG/45ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9045","type":"HCPCS"},{"code":"55150033501","type":"NDC"}],"standard_charges":[{"gross_charge":528.1,"discounted_cash":528.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 29 ML"}]},{"description":"ALBURX 5 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"P9045","type":"HCPCS"},{"code":"44206031025","type":"NDC"}],"standard_charges":[{"gross_charge":256.41,"discounted_cash":256.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 ML"}]},{"description":"MORPHINE SULFATE POWD","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2270","type":"HCPCS"},{"code":"38779067307","type":"NDC"}],"standard_charges":[{"gross_charge":50.57,"discounted_cash":50.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.04 GR"}]},{"description":"PHESGO 80-40-2000 MG-MG-U/ML SC SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9316","type":"HCPCS"},{"code":"50242024501","type":"NDC"}],"standard_charges":[{"gross_charge":36040.63,"discounted_cash":36040.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"NAROPIN 2 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2795","type":"HCPCS"},{"code":"63323028523","type":"NDC"}],"standard_charges":[{"gross_charge":30.12,"discounted_cash":30.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 ML"}]},{"description":"HEPARIN (PORCINE) IN NACL 25000-0.45 UT/250ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"00409765030","type":"NDC"}],"standard_charges":[{"gross_charge":24.97,"discounted_cash":24.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7.956 ML"}]},{"description":"MAGNESIUM SULFATE 4 GM/100ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3475","type":"HCPCS"},{"code":"00264420654","type":"NDC"}],"standard_charges":[{"gross_charge":33.6,"discounted_cash":33.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 ML"}]},{"description":"LEVOFLOXACIN IN D5W 250 MG/50ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1956","type":"HCPCS"},{"code":"00143972224","type":"NDC"}],"standard_charges":[{"gross_charge":35.95,"discounted_cash":35.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"CIPROFLOXACIN IN D5W 400 MG/200ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0744","type":"HCPCS"},{"code":"25021011487","type":"NDC"}],"standard_charges":[{"gross_charge":56.97,"discounted_cash":56.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 ML"}]},{"description":"POTASSIUM CL IN DEXTROSE 5% 20 MEQ/L IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3480","type":"HCPCS"},{"code":"00264762500","type":"NDC"}],"standard_charges":[{"gross_charge":84.7,"discounted_cash":84.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"}]},{"description":"KCL IN DEXTROSE-NACL 20-5-0.9 MEQ/L-%-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3480","type":"HCPCS"},{"code":"00338080304","type":"NDC"}],"standard_charges":[{"gross_charge":84.7,"discounted_cash":84.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"}]},{"description":"DEXTROSE 5 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J7060","type":"HCPCS"},{"code":"00264151032","type":"NDC"}],"standard_charges":[{"gross_charge":21.7,"discounted_cash":21.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 ML"}]},{"description":"HEPARIN SOD (PORCINE) IN D5W 100 UNIT/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"00264958720","type":"NDC"}],"standard_charges":[{"gross_charge":19.25,"discounted_cash":19.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8.525 ML"}]},{"description":"LACTATED RINGERS IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J7120","type":"HCPCS"},{"code":"00338011704","type":"NDC"}],"standard_charges":[{"gross_charge":82.7,"discounted_cash":82.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"}]},{"description":"DEXTROSE-SODIUM CHLORIDE 5-0.9 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J7042","type":"HCPCS"},{"code":"00338008904","type":"NDC"}],"standard_charges":[{"gross_charge":82.7,"discounted_cash":82.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"}]},{"description":"DEXTROSE 5 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J7070","type":"HCPCS"},{"code":"00264751010","type":"NDC"}],"standard_charges":[{"gross_charge":24.8,"discounted_cash":24.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"DEXTROSE-SODIUM CHLORIDE 5-0.9 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J7042","type":"HCPCS"},{"code":"00264761000","type":"NDC"}],"standard_charges":[{"gross_charge":37.19,"discounted_cash":37.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 ML"}]},{"description":"ACETAMINOPHEN 500 MG/50 ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0136","type":"HCPCS"},{"code":"00264405080","type":"NDC"}],"standard_charges":[{"gross_charge":43.15,"discounted_cash":43.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"FLUCONAZOLE IN SODIUM CHLORIDE 200-0.9 MG/100ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1450","type":"HCPCS"},{"code":"25021018482","type":"NDC"}],"standard_charges":[{"gross_charge":44.81,"discounted_cash":44.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"PROPOFOL 500 MG/50ML IV EMUL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2704","type":"HCPCS"},{"code":"00409469933","type":"NDC"}],"standard_charges":[{"gross_charge":14.98,"discounted_cash":14.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.27 ML"}]},{"description":"ACETAMINOPHEN 1000 MG/100 ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0131","type":"HCPCS"},{"code":"24201010024","type":"NDC"}],"standard_charges":[{"gross_charge":50.01,"discounted_cash":50.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"MAGNESIUM SULFATE 4 GM/50ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3475","type":"HCPCS"},{"code":"63323010705","type":"NDC"}],"standard_charges":[{"gross_charge":52.62,"discounted_cash":52.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"VANCOMYCIN HCL 2000 MG/400ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3372","type":"HCPCS"},{"code":"70594004402","type":"NDC"}],"standard_charges":[{"gross_charge":146.45,"discounted_cash":146.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 ML"}]},{"description":"LEVOFLOXACIN IN D5W 250 MG/50ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1956","type":"HCPCS"},{"code":"25021013281","type":"NDC"}],"standard_charges":[{"gross_charge":62.38,"discounted_cash":62.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"ACETAMINOPHEN 1000 MG/100 ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0136","type":"HCPCS"},{"code":"00264410090","type":"NDC"}],"standard_charges":[{"gross_charge":38.13,"discounted_cash":38.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 22.45 ML"}]},{"description":"POTASSIUM CHLORIDE 10 MEQ/100ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3480","type":"HCPCS"},{"code":"00990707426","type":"NDC"}],"standard_charges":[{"gross_charge":47.99,"discounted_cash":47.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"MAGNESIUM SULFATE 2 GM/50ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3475","type":"HCPCS"},{"code":"83634050081","type":"NDC"}],"standard_charges":[{"gross_charge":34.86,"discounted_cash":34.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 ML"}]},{"description":"DEXTROSE 5 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J7070","type":"HCPCS"},{"code":"00264151031","type":"NDC"}],"standard_charges":[{"gross_charge":30.99,"discounted_cash":30.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 ML"}]},{"description":"CIPROFLOXACIN IN D5W 400 MG/200ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0744","type":"HCPCS"},{"code":"25021019287","type":"NDC"}],"standard_charges":[{"gross_charge":58.35,"discounted_cash":58.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 ML"}]},{"description":"TRELEGY ELLIPTA 200-62.5-25 MCG/ACT IN AEPB","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00173089314","type":"NDC"}],"standard_charges":[{"gross_charge":912.2,"discounted_cash":912.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 28 UN"}]},{"description":"MAGNESIUM SULFATE 2 GM/50ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3475","type":"HCPCS"},{"code":"25021061281","type":"NDC"}],"standard_charges":[{"gross_charge":39.6,"discounted_cash":39.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"MAGNESIUM SULFATE 4 GM/100ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3475","type":"HCPCS"},{"code":"44567042124","type":"NDC"}],"standard_charges":[{"gross_charge":59.78,"discounted_cash":59.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"POTASSIUM CHLORIDE 10 MEQ/100ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3480","type":"HCPCS"},{"code":"00338070948","type":"NDC"}],"standard_charges":[{"gross_charge":62.38,"discounted_cash":62.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"CLINDAMYCIN PHOSPHATE IN NACL 900-0.9 MG/50ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0737","type":"HCPCS"},{"code":"00338955324","type":"NDC"}],"standard_charges":[{"gross_charge":50.06,"discounted_cash":50.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"HEPARIN (PORCINE) IN NACL 25000-0.45 UT/250ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"63323051774","type":"NDC"}],"standard_charges":[{"gross_charge":53.52,"discounted_cash":53.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 ML"}]},{"description":"DEXTROSE 5 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J7070","type":"HCPCS"},{"code":"00990792313","type":"NDC"}],"standard_charges":[{"gross_charge":54.58,"discounted_cash":54.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 ML"}]},{"description":"MAGNESIUM SULFATE 2 GM/50ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3475","type":"HCPCS"},{"code":"63323010626","type":"NDC"}],"standard_charges":[{"gross_charge":57.17,"discounted_cash":57.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"FENTANYL CITRATE (PF) 50 MCG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3010","type":"HCPCS"},{"code":"00641624725","type":"NDC"}],"standard_charges":[{"gross_charge":20.21,"discounted_cash":20.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 ML"}]},{"description":"FENTANYL CITRATE (PF) 50 MCG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3010","type":"HCPCS"},{"code":"63323080601","type":"NDC"}],"standard_charges":[{"gross_charge":21.53,"discounted_cash":21.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 ML"}]},{"description":"FENTANYL CITRATE PF 50 MCG/ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3010","type":"HCPCS"},{"code":"00641624810","type":"NDC"}],"standard_charges":[{"gross_charge":26.64,"discounted_cash":26.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"INJECTAFER 750 MG/15ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1439","type":"HCPCS"},{"code":"00517065001","type":"NDC"}],"standard_charges":[{"gross_charge":149.99,"discounted_cash":149.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.6 ML"}]},{"description":"SIMPONI ARIA 50 MG/4ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1602","type":"HCPCS"},{"code":"57894035001","type":"NDC"}],"standard_charges":[{"gross_charge":1449.08,"discounted_cash":1449.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"MARCAINE 0.75 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0665","type":"HCPCS"},{"code":"00409158210","type":"NDC"}],"standard_charges":[{"gross_charge":47.13,"discounted_cash":47.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"SENSORCAINE-MPF 0.75 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0665","type":"HCPCS"},{"code":"63323047237","type":"NDC"}],"standard_charges":[{"gross_charge":18.12,"discounted_cash":18.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"MORPHINE SULFATE 8 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2270","type":"HCPCS"},{"code":"00641612625","type":"NDC"}],"standard_charges":[{"gross_charge":39.02,"discounted_cash":39.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.75 ML"}]},{"description":"MAGNESIUM SULFATE IN D5W 1-5 GM/100ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3475","type":"HCPCS"},{"code":"00409672723","type":"NDC"}],"standard_charges":[{"gross_charge":46.76,"discounted_cash":46.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"MAGNESIUM SULFATE 4 GM/100ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3475","type":"HCPCS"},{"code":"70121172009","type":"NDC"}],"standard_charges":[{"gross_charge":48.06,"discounted_cash":48.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"DEXTROSE 5 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J7060","type":"HCPCS"},{"code":"00990792323","type":"NDC"}],"standard_charges":[{"gross_charge":30.99,"discounted_cash":30.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 ML"}]},{"description":"KCL IN DEXTROSE-NACL 10-5-0.45 MEQ/L-%-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3480","type":"HCPCS"},{"code":"00264763400","type":"NDC"}],"standard_charges":[{"gross_charge":54.58,"discounted_cash":54.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"}]},{"description":"KCL IN DEXTROSE-NACL 20-5-0.9 MEQ/L-%-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3480","type":"HCPCS"},{"code":"00264765200","type":"NDC"}],"standard_charges":[{"gross_charge":54.58,"discounted_cash":54.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"}]},{"description":"MAGNESIUM SULFATE 4 GM/100ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3475","type":"HCPCS"},{"code":"00409672923","type":"NDC"}],"standard_charges":[{"gross_charge":61.81,"discounted_cash":61.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"LEVOFLOXACIN IN D5W 750 MG/150ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1956","type":"HCPCS"},{"code":"00409444424","type":"NDC"}],"standard_charges":[{"gross_charge":46.76,"discounted_cash":46.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 ML"}]},{"description":"DEXTROSE IN LACTATED RINGERS 5 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J7121","type":"HCPCS"},{"code":"00338012504","type":"NDC"}],"standard_charges":[{"gross_charge":54.58,"discounted_cash":54.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"}]},{"description":"LACTATED RINGERS IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J7120","type":"HCPCS"},{"code":"65219047905","type":"NDC"}],"standard_charges":[{"gross_charge":54.58,"discounted_cash":54.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"}]},{"description":"KCL IN DEXTROSE-NACL 20-5-0.45 MEQ/L-%-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3480","type":"HCPCS"},{"code":"00264763500","type":"NDC"}],"standard_charges":[{"gross_charge":54.58,"discounted_cash":54.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"}]},{"description":"TRUXIMA 500 MG/50ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"Q5115","type":"HCPCS"},{"code":"63459010450","type":"NDC"}],"standard_charges":[{"gross_charge":7662.64,"discounted_cash":7662.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"TRUXIMA 100 MG/10ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"Q5115","type":"HCPCS"},{"code":"63459010310","type":"NDC"}],"standard_charges":[{"gross_charge":1520.68,"discounted_cash":1520.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"DILAUDID 0.2 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1171","type":"HCPCS"},{"code":"76045012111","type":"NDC"}],"standard_charges":[{"gross_charge":43.78,"discounted_cash":43.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"MVASI 400 MG/16ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"Q5107","type":"HCPCS"},{"code":"55513020701","type":"NDC"}],"standard_charges":[{"gross_charge":3496.79,"discounted_cash":3496.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"MVASI 100 MG/4ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"Q5107","type":"HCPCS"},{"code":"55513020601","type":"NDC"}],"standard_charges":[{"gross_charge":1763.93,"discounted_cash":1763.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"NUCALA 100 MG/ML SC SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2182","type":"HCPCS"},{"code":"00173089242","type":"NDC"}],"standard_charges":[{"gross_charge":10898.32,"discounted_cash":10898.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"KENALOG-80 80 MG/ML IJ SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3301","type":"HCPCS"},{"code":"00003031505","type":"NDC"}],"standard_charges":[{"gross_charge":79.1,"discounted_cash":79.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"EVENITY 105 MG/1.17ML SC SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3111","type":"HCPCS"},{"code":"55513088002","type":"NDC"}],"standard_charges":[{"gross_charge":6855.38,"discounted_cash":6855.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.34 ML"}]},{"description":"EVENITY 105 MG/1.17ML SC SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3111","type":"HCPCS"},{"code":"55513099802","type":"NDC"}],"standard_charges":[{"gross_charge":7771.37,"discounted_cash":7771.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.34 ML"}]},{"description":"POTASSIUM CHLORIDE 2 MEQ/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3480","type":"HCPCS"},{"code":"63323096520","type":"NDC"}],"standard_charges":[{"gross_charge":31.53,"discounted_cash":31.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"DEXTROSE 5 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J7070","type":"HCPCS"},{"code":"00338001748","type":"NDC"}],"standard_charges":[{"gross_charge":33.47,"discounted_cash":33.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"ZOLEDRONIC ACID 5 MG/100ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3489","type":"HCPCS"},{"code":"55111068852","type":"NDC"}],"standard_charges":[{"gross_charge":115.83,"discounted_cash":115.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"FUROSEMIDE 10 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1940","type":"HCPCS"},{"code":"55150032225","type":"NDC"}],"standard_charges":[{"gross_charge":18.78,"discounted_cash":18.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"FUROSEMIDE 10 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1940","type":"HCPCS"},{"code":"63323028004","type":"NDC"}],"standard_charges":[{"gross_charge":17.81,"discounted_cash":17.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"VANCOMYCIN HCL 1250 MG/250ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3372","type":"HCPCS"},{"code":"70594005702","type":"NDC"}],"standard_charges":[{"gross_charge":96.03,"discounted_cash":96.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 ML"}]},{"description":"HEPARIN (PORCINE) IN NACL 25000-0.45 UT/250ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"00409765062","type":"NDC"}],"standard_charges":[{"gross_charge":70.95,"discounted_cash":70.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 ML"}]},{"description":"ACETAMINOPHEN 1000 MG/100 ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0137","type":"HCPCS"},{"code":"00143938610","type":"NDC"}],"standard_charges":[{"gross_charge":52.13,"discounted_cash":52.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"ACETAMINOPHEN 1000 MG/100 ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0131","type":"HCPCS"},{"code":"55150030724","type":"NDC"}],"standard_charges":[{"gross_charge":57.17,"discounted_cash":57.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"DEXTROSE IN LACTATED RINGERS 5 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J7121","type":"HCPCS"},{"code":"00990792903","type":"NDC"}],"standard_charges":[{"gross_charge":54.58,"discounted_cash":54.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 ML"}]},{"description":"DEXTROSE 5 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J7070","type":"HCPCS"},{"code":"00990792209","type":"NDC"}],"standard_charges":[{"gross_charge":84.11,"discounted_cash":84.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 850 ML"}]},{"description":"CLINDAMYCIN PHOSPHATE IN D5W 600 MG/50ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0737","type":"HCPCS"},{"code":"00338361624","type":"NDC"}],"standard_charges":[{"gross_charge":43.5,"discounted_cash":43.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"PROPOFOL 1000 MG/100ML IV EMUL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2704","type":"HCPCS"},{"code":"00409469924","type":"NDC"}],"standard_charges":[{"gross_charge":15.11,"discounted_cash":15.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.317 ML"}]},{"description":"LEVETIRACETAM IN NACL 500 MG/100ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1953","type":"HCPCS"},{"code":"67457025510","type":"NDC"}],"standard_charges":[{"gross_charge":107.38,"discounted_cash":107.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 ML"}]},{"description":"VANCOMYCIN HCL IN NACL 1.25-0.9 GM/250ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3370","type":"HCPCS"},{"code":"70092905405","type":"NDC"}],"standard_charges":[{"gross_charge":140.91,"discounted_cash":140.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 ML"}]},{"description":"CLINDAMYCIN PHOSPHATE IN NACL 600-0.9 MG/50ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0737","type":"HCPCS"},{"code":"00338954924","type":"NDC"}],"standard_charges":[{"gross_charge":43.5,"discounted_cash":43.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"VANCOMYCIN HCL 1750 MG/350ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3372","type":"HCPCS"},{"code":"70594005802","type":"NDC"}],"standard_charges":[{"gross_charge":130.09,"discounted_cash":130.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 350 ML"}]},{"description":"NITROGLYCERIN IN D5W 100-5 MCG/ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2305","type":"HCPCS"},{"code":"00338104702","type":"NDC"}],"standard_charges":[{"gross_charge":17.45,"discounted_cash":17.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"BUPIVACAINE HCL (PF) 0.5 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0665","type":"HCPCS"},{"code":"00409116201","type":"NDC"}],"standard_charges":[{"gross_charge":18.89,"discounted_cash":18.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"ACETAMINOPHEN 1000 MG/100 ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0131","type":"HCPCS"},{"code":"00781927495","type":"NDC"}],"standard_charges":[{"gross_charge":66.29,"discounted_cash":66.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"MAGNESIUM SULFATE IN D5W 1-5 GM/100ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3475","type":"HCPCS"},{"code":"00264440054","type":"NDC"}],"standard_charges":[{"gross_charge":49.36,"discounted_cash":49.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"CIPROFLOXACIN IN D5W 400 MG/200ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0744","type":"HCPCS"},{"code":"00409330024","type":"NDC"}],"standard_charges":[{"gross_charge":37.41,"discounted_cash":37.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"SODIUM CHLORIDE 3 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J7131","type":"HCPCS"},{"code":"63323053075","type":"NDC"}],"standard_charges":[{"gross_charge":63.58,"discounted_cash":63.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 ML"}]},{"description":"DEXTROSE IN LACTATED RINGERS 5 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J7121","type":"HCPCS"},{"code":"00264775100","type":"NDC"}],"standard_charges":[{"gross_charge":43.11,"discounted_cash":43.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 ML"}]},{"description":"LACTATED RINGERS IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J7120","type":"HCPCS"},{"code":"00264775010","type":"NDC"}],"standard_charges":[{"gross_charge":16.12,"discounted_cash":16.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"ROPIVACAINE HCL 2 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2795","type":"HCPCS"},{"code":"43066001510","type":"NDC"}],"standard_charges":[{"gross_charge":20.65,"discounted_cash":20.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.6 ML"}]},{"description":"ROPIVACAINE HCL 5 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2795","type":"HCPCS"},{"code":"70069006425","type":"NDC"}],"standard_charges":[{"gross_charge":23.67,"discounted_cash":23.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"}]},{"description":"BUPIVACAINE HCL (PF) 0.25 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0665","type":"HCPCS"},{"code":"55150016710","type":"NDC"}],"standard_charges":[{"gross_charge":23.86,"discounted_cash":23.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"}]},{"description":"CLINDAMYCIN PHOSPHATE IN D5W 900 MG/50ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0737","type":"HCPCS"},{"code":"00338411424","type":"NDC"}],"standard_charges":[{"gross_charge":50.41,"discounted_cash":50.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"PROPOFOL 1000 MG/100ML IV EMUL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2704","type":"HCPCS"},{"code":"43598054910","type":"NDC"}],"standard_charges":[{"gross_charge":122.07,"discounted_cash":122.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"PROPOFOL 200 MG/20ML IV EMUL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2704","type":"HCPCS"},{"code":"23155034541","type":"NDC"}],"standard_charges":[{"gross_charge":16.37,"discounted_cash":16.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"NITROGLYCERIN IN D5W 200-5 MCG/ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2305","type":"HCPCS"},{"code":"00338104902","type":"NDC"}],"standard_charges":[{"gross_charge":16.04,"discounted_cash":16.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 ML"}]},{"description":"LINEZOLID 600 MG/300ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2020","type":"HCPCS"},{"code":"57664068357","type":"NDC"}],"standard_charges":[{"gross_charge":112.13,"discounted_cash":112.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 ML"}]},{"description":"MAGNESIUM SULFATE 4 GM/100ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3475","type":"HCPCS"},{"code":"00338171540","type":"NDC"}],"standard_charges":[{"gross_charge":45.46,"discounted_cash":45.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"POTASSIUM CHLORIDE 20 MEQ/100ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3480","type":"HCPCS"},{"code":"14789010810","type":"NDC"}],"standard_charges":[{"gross_charge":198.73,"discounted_cash":198.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"FUROSEMIDE 10 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1940","type":"HCPCS"},{"code":"23155047341","type":"NDC"}],"standard_charges":[{"gross_charge":26.0,"discounted_cash":26.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"POTASSIUM CHLORIDE 10 MEQ/100ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3480","type":"HCPCS"},{"code":"14789010910","type":"NDC"}],"standard_charges":[{"gross_charge":185.0,"discounted_cash":185.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"BUPIVACAINE HCL (PF) 0.25 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0665","type":"HCPCS"},{"code":"00143933010","type":"NDC"}],"standard_charges":[{"gross_charge":22.46,"discounted_cash":22.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"}]},{"description":"FENTANYL CITRATE (PF) 2500 MCG/50ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3010","type":"HCPCS"},{"code":"63323080650","type":"NDC"}],"standard_charges":[{"gross_charge":50.62,"discounted_cash":50.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"HEPARIN SOD (PORCINE) IN D5W 100 UNIT/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"63323052374","type":"NDC"}],"standard_charges":[{"gross_charge":65.61,"discounted_cash":65.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 ML"}]},{"description":"MAGNESIUM SULFATE 4 GM/100ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3475","type":"HCPCS"},{"code":"00409412150","type":"NDC"}],"standard_charges":[{"gross_charge":55.87,"discounted_cash":55.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"KCL IN DEXTROSE-NACL 20-5-0.45 MEQ/L-%-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3480","type":"HCPCS"},{"code":"00338067104","type":"NDC"}],"standard_charges":[{"gross_charge":96.76,"discounted_cash":96.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"}]},{"description":"LEVOFLOXACIN IN D5W 750 MG/150ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1956","type":"HCPCS"},{"code":"00143972024","type":"NDC"}],"standard_charges":[{"gross_charge":41.79,"discounted_cash":41.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 ML"}]},{"description":"LACTATED RINGERS IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J7120","type":"HCPCS"},{"code":"00264775000","type":"NDC"}],"standard_charges":[{"gross_charge":14.26,"discounted_cash":14.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 ML"}]},{"description":"DEXTROSE-SODIUM CHLORIDE 5-0.9 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J7042","type":"HCPCS"},{"code":"00990794109","type":"NDC"}],"standard_charges":[{"gross_charge":96.76,"discounted_cash":96.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"}]},{"description":"DEXTROSE IN LACTATED RINGERS 5 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J7121","type":"HCPCS"},{"code":"00990792909","type":"NDC"}],"standard_charges":[{"gross_charge":96.76,"discounted_cash":96.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"}]},{"description":"LACTATED RINGERS IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J7120","type":"HCPCS"},{"code":"00264775007","type":"NDC"}],"standard_charges":[{"gross_charge":49.25,"discounted_cash":49.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 900 ML"}]},{"description":"DEXTROSE IN LACTATED RINGERS 5 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J7121","type":"HCPCS"},{"code":"00264775110","type":"NDC"}],"standard_charges":[{"gross_charge":24.8,"discounted_cash":24.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 ML"}]},{"description":"CALCIUM GLUCONATE-NACL 2-0.675 GM/100ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0612","type":"HCPCS"},{"code":"44567062124","type":"NDC"}],"standard_charges":[{"gross_charge":102.63,"discounted_cash":102.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"ZOLEDRONIC ACID 5 MG/100ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3489","type":"HCPCS"},{"code":"67457061910","type":"NDC"}],"standard_charges":[{"gross_charge":210.87,"discounted_cash":210.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"LEVETIRACETAM 500 MG/5ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1953","type":"HCPCS"},{"code":"72485010610","type":"NDC"}],"standard_charges":[{"gross_charge":41.52,"discounted_cash":41.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"ESMOLOL HCL 100 MG/10ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1805","type":"HCPCS"},{"code":"67457018210","type":"NDC"}],"standard_charges":[{"gross_charge":45.84,"discounted_cash":45.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"ESMOLOL HCL 2500 MG/250ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1806","type":"HCPCS"},{"code":"44567081110","type":"NDC"}],"standard_charges":[{"gross_charge":456.39,"discounted_cash":456.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 ML"}]},{"description":"POTASSIUM CHLORIDE 2 MEQ/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3480","type":"HCPCS"},{"code":"63323096505","type":"NDC"}],"standard_charges":[{"gross_charge":40.04,"discounted_cash":40.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"LIDOCAINE HCL (CARDIAC) PF 100 MG/5ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2001","type":"HCPCS"},{"code":"63323020805","type":"NDC"}],"standard_charges":[{"gross_charge":35.12,"discounted_cash":35.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"FUROSEMIDE 10 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1940","type":"HCPCS"},{"code":"72603013325","type":"NDC"}],"standard_charges":[{"gross_charge":25.55,"discounted_cash":25.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"CEFAZOLIN SODIUM-DEXTROSE 2-3 GM-%(50ML) IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0690","type":"HCPCS"},{"code":"00264310511","type":"NDC"}],"standard_charges":[{"gross_charge":49.89,"discounted_cash":49.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 ML"}]},{"description":"FLUOROURACIL 500 MG/10ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9190","type":"HCPCS"},{"code":"63323011718","type":"NDC"}],"standard_charges":[{"gross_charge":79.09,"discounted_cash":79.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7 ML"}]},{"description":"FLUOROURACIL 500 MG/10ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9190","type":"HCPCS"},{"code":"63323011710","type":"NDC"}],"standard_charges":[{"gross_charge":79.09,"discounted_cash":79.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7 ML"}]},{"description":"LEVETIRACETAM 500 MG/5ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1953","type":"HCPCS"},{"code":"00409188602","type":"NDC"}],"standard_charges":[{"gross_charge":32.57,"discounted_cash":32.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"ROPIVACAINE HCL 10 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2795","type":"HCPCS"},{"code":"70069006710","type":"NDC"}],"standard_charges":[{"gross_charge":38.19,"discounted_cash":38.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"VANCOMYCIN HCL IN NACL 1.75-0.9 GM/500ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3370","type":"HCPCS"},{"code":"70004092644","type":"NDC"}],"standard_charges":[{"gross_charge":255.75,"discounted_cash":255.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 ML"}]},{"description":"FUROSEMIDE 10 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1940","type":"HCPCS"},{"code":"00409610210","type":"NDC"}],"standard_charges":[{"gross_charge":22.01,"discounted_cash":22.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"}]},{"description":"LIDOCAINE HCL (PF) 2 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2003","type":"HCPCS"},{"code":"00409206605","type":"NDC"}],"standard_charges":[{"gross_charge":16.31,"discounted_cash":16.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.125 ML"}]},{"description":"BUMETANIDE 0.25 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1939","type":"HCPCS"},{"code":"65219057004","type":"NDC"}],"standard_charges":[{"gross_charge":37.47,"discounted_cash":37.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"}]},{"description":"LIDOCAINE HCL (PF) 1 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2003","type":"HCPCS"},{"code":"65282160501","type":"NDC"}],"standard_charges":[{"gross_charge":25.23,"discounted_cash":25.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"FENTANYL CITRATE PF 50 MCG/ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3010","type":"HCPCS"},{"code":"63323080811","type":"NDC"}],"standard_charges":[{"gross_charge":22.62,"discounted_cash":22.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 ML"}]},{"description":"MAGNESIUM SULFATE 2 GM/50ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3475","type":"HCPCS"},{"code":"63323010605","type":"NDC"}],"standard_charges":[{"gross_charge":38.51,"discounted_cash":38.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 ML"}]},{"description":"FERAHEME 510 MG/17ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"Q0138","type":"HCPCS"},{"code":"59338077501","type":"NDC"}],"standard_charges":[{"gross_charge":844.25,"discounted_cash":844.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 17 ML"}]},{"description":"RUXIENCE 500 MG/50ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"Q5119","type":"HCPCS"},{"code":"00069024901","type":"NDC"}],"standard_charges":[{"gross_charge":7582.77,"discounted_cash":7582.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"PROTONIX 40 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2470","type":"HCPCS"},{"code":"00008092355","type":"NDC"}],"standard_charges":[{"gross_charge":40.17,"discounted_cash":40.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"CATHFLO ACTIVASE 2 MG IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2997","type":"HCPCS"},{"code":"50242004110","type":"NDC"}],"standard_charges":[{"gross_charge":346.27,"discounted_cash":346.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 UN"}]},{"description":"CATHFLO ACTIVASE 2 MG IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2997","type":"HCPCS"},{"code":"50242004164","type":"NDC"}],"standard_charges":[{"gross_charge":346.29,"discounted_cash":346.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 UN"}]},{"description":"ERYTHROCIN LACTOBIONATE 500 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1364","type":"HCPCS"},{"code":"00409648201","type":"NDC"}],"standard_charges":[{"gross_charge":161.68,"discounted_cash":161.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 UN"}]},{"description":"ZITHROMAX 500 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0456","type":"HCPCS"},{"code":"00069315083","type":"NDC"}],"standard_charges":[{"gross_charge":43.07,"discounted_cash":43.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"JEVTANA 60 MG/1.5ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9043","type":"HCPCS"},{"code":"00024582411","type":"NDC"}],"standard_charges":[{"gross_charge":18370.09,"discounted_cash":18370.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.283 UN"}]},{"description":"CEFTRIAXONE SODIUM-DEXTROSE 2-2.22 GM-%(50ML) IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0696","type":"HCPCS"},{"code":"00264315511","type":"NDC"}],"standard_charges":[{"gross_charge":69.35,"discounted_cash":69.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 UN"}]},{"description":"AZACITIDINE 100 MG IJ SUSR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9025","type":"HCPCS"},{"code":"72485020101","type":"NDC"}],"standard_charges":[{"gross_charge":290.53,"discounted_cash":290.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.267 UN"}]},{"description":"LEUCOVORIN CALCIUM 500 MG IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0640","type":"HCPCS"},{"code":"71288016450","type":"NDC"}],"standard_charges":[{"gross_charge":933.52,"discounted_cash":933.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"LEUCOVORIN CALCIUM 200 MG IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0640","type":"HCPCS"},{"code":"00143955301","type":"NDC"}],"standard_charges":[{"gross_charge":316.12,"discounted_cash":316.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"PIPERACILLIN SOD-TAZOBACTAM SO 4.5 (4-0.5) G IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2543","type":"HCPCS"},{"code":"64679001201","type":"NDC"}],"standard_charges":[{"gross_charge":70.31,"discounted_cash":70.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"MITOMYCIN 20 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9280","type":"HCPCS"},{"code":"71288013850","type":"NDC"}],"standard_charges":[{"gross_charge":1874.47,"discounted_cash":1874.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.85 UN"}]},{"description":"BORTEZOMIB 3.5 MG IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9041","type":"HCPCS"},{"code":"25021024410","type":"NDC"}],"standard_charges":[{"gross_charge":126.57,"discounted_cash":126.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.086 UN"}]},{"description":"PROTONIX 40 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2470","type":"HCPCS"},{"code":"00008400110","type":"NDC"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"VANCOMYCIN HCL 2 G IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3370","type":"HCPCS"},{"code":"72078006699","type":"NDC"}],"standard_charges":[{"gross_charge":159.21,"discounted_cash":159.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"ACETAZOLAMIDE SODIUM 500 MG IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1120","type":"HCPCS"},{"code":"23155031331","type":"NDC"}],"standard_charges":[{"gross_charge":42.31,"discounted_cash":42.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 UN"}]},{"description":"ACETAZOLAMIDE SODIUM 500 MG IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1120","type":"HCPCS"},{"code":"23155083131","type":"NDC"}],"standard_charges":[{"gross_charge":53.35,"discounted_cash":53.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"LEUCOVORIN CALCIUM 200 MG IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0640","type":"HCPCS"},{"code":"67457052920","type":"NDC"}],"standard_charges":[{"gross_charge":444.74,"discounted_cash":444.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 UN"}]},{"description":"PANTOPRAZOLE SODIUM 40 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2470","type":"HCPCS"},{"code":"70095002402","type":"NDC"}],"standard_charges":[{"gross_charge":54.12,"discounted_cash":54.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 UN"}]},{"description":"PIPERACILLIN SOD-TAZOBACTAM SO 3.375 (3-0.375) G IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2543","type":"HCPCS"},{"code":"64679005601","type":"NDC"}],"standard_charges":[{"gross_charge":47.1,"discounted_cash":47.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"PIPERACILLIN SOD-TAZOBACTAM SO 3.375 (3-0.375) G IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2543","type":"HCPCS"},{"code":"68001050782","type":"NDC"}],"standard_charges":[{"gross_charge":47.71,"discounted_cash":47.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"AMPICILLIN-SULBACTAM SODIUM 3 (2-1) G IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0295","type":"HCPCS"},{"code":"55150011710","type":"NDC"}],"standard_charges":[{"gross_charge":50.03,"discounted_cash":50.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"AMPICILLIN-SULBACTAM SODIUM 3 (2-1) G IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0295","type":"HCPCS"},{"code":"55150011720","type":"NDC"}],"standard_charges":[{"gross_charge":50.03,"discounted_cash":50.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"PIPERACILLIN SOD-TAZOBACTAM SO 3.375 (3-0.375) G IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2543","type":"HCPCS"},{"code":"55150012030","type":"NDC"}],"standard_charges":[{"gross_charge":43.53,"discounted_cash":43.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"AMPICILLIN-SULBACTAM SODIUM 3 (2-1) G IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0295","type":"HCPCS"},{"code":"72485041710","type":"NDC"}],"standard_charges":[{"gross_charge":45.6,"discounted_cash":45.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"AZACITIDINE 100 MG IJ SUSR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9025","type":"HCPCS"},{"code":"71288011530","type":"NDC"}],"standard_charges":[{"gross_charge":238.73,"discounted_cash":238.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.267 UN"}]},{"description":"VANCOMYCIN HCL 1 G IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3370","type":"HCPCS"},{"code":"70594012302","type":"NDC"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"LEUCOVORIN CALCIUM 200 MG IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0640","type":"HCPCS"},{"code":"63323071050","type":"NDC"}],"standard_charges":[{"gross_charge":529.3,"discounted_cash":529.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"BORTEZOMIB 3.5 MG IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9041","type":"HCPCS"},{"code":"55150033701","type":"NDC"}],"standard_charges":[{"gross_charge":1239.76,"discounted_cash":1239.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"LEUCOVORIN CALCIUM 350 MG IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0640","type":"HCPCS"},{"code":"00143955201","type":"NDC"}],"standard_charges":[{"gross_charge":140.71,"discounted_cash":140.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.166 UN"}]},{"description":"AZACITIDINE 100 MG IJ SUSR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9025","type":"HCPCS"},{"code":"16729030610","type":"NDC"}],"standard_charges":[{"gross_charge":607.53,"discounted_cash":607.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.267 UN"}]},{"description":"CEFAZOLIN SODIUM 2 G IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0690","type":"HCPCS"},{"code":"60505623105","type":"NDC"}],"standard_charges":[{"gross_charge":41.83,"discounted_cash":41.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 UN"}]},{"description":"MEROPENEM 500 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2185","type":"HCPCS"},{"code":"55150020720","type":"NDC"}],"standard_charges":[{"gross_charge":38.68,"discounted_cash":38.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"PIPERACILLIN SOD-TAZOBACTAM SO 4.5 (4-0.5) G IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2543","type":"HCPCS"},{"code":"81284015310","type":"NDC"}],"standard_charges":[{"gross_charge":43.94,"discounted_cash":43.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"PIPERACILLIN SOD-TAZOBACTAM SO 3.375 (3-0.375) G IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2543","type":"HCPCS"},{"code":"60505615704","type":"NDC"}],"standard_charges":[{"gross_charge":43.47,"discounted_cash":43.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"LEUCOVORIN CALCIUM 350 MG IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0640","type":"HCPCS"},{"code":"68001041838","type":"NDC"}],"standard_charges":[{"gross_charge":275.73,"discounted_cash":275.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.586 UN"}]},{"description":"AZACITIDINE 100 MG IJ SUSR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9025","type":"HCPCS"},{"code":"43598030562","type":"NDC"}],"standard_charges":[{"gross_charge":345.3,"discounted_cash":345.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.745 UN"}]},{"description":"AMPICILLIN-SULBACTAM SODIUM 3 (2-1) G IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0295","type":"HCPCS"},{"code":"44567021110","type":"NDC"}],"standard_charges":[{"gross_charge":77.98,"discounted_cash":77.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"PIPERACILLIN SOD-TAZOBACTAM SO 4.5 (4-0.5) G IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2543","type":"HCPCS"},{"code":"68001050831","type":"NDC"}],"standard_charges":[{"gross_charge":62.03,"discounted_cash":62.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"VANCOMYCIN HCL 750 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3370","type":"HCPCS"},{"code":"63323020326","type":"NDC"}],"standard_charges":[{"gross_charge":41.52,"discounted_cash":41.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"PIPERACILLIN SOD-TAZOBACTAM SO 3.375 (3-0.375) G IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2543","type":"HCPCS"},{"code":"44567080210","type":"NDC"}],"standard_charges":[{"gross_charge":44.99,"discounted_cash":44.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"PIPERACILLIN SOD-TAZOBACTAM SO 3.375 (3-0.375) G IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2543","type":"HCPCS"},{"code":"00781311395","type":"NDC"}],"standard_charges":[{"gross_charge":53.03,"discounted_cash":53.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"PIPERACILLIN SOD-TAZOBACTAM SO 4.5 (4-0.5) G IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2543","type":"HCPCS"},{"code":"65219025945","type":"NDC"}],"standard_charges":[{"gross_charge":55.38,"discounted_cash":55.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"AMPICILLIN-SULBACTAM SODIUM 3 (2-1) G IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0295","type":"HCPCS"},{"code":"00641611710","type":"NDC"}],"standard_charges":[{"gross_charge":55.98,"discounted_cash":55.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"VANCOMYCIN HCL 1 G IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3370","type":"HCPCS"},{"code":"25021015120","type":"NDC"}],"standard_charges":[{"gross_charge":37.01,"discounted_cash":37.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"ACETAZOLAMIDE SODIUM 500 MG IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1120","type":"HCPCS"},{"code":"67457085350","type":"NDC"}],"standard_charges":[{"gross_charge":83.24,"discounted_cash":83.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 UN"}]},{"description":"MAGNESIUM SULFATE 4 GM/100ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3475","type":"HCPCS"},{"code":"67457055400","type":"NDC"}],"standard_charges":[{"gross_charge":54.9,"discounted_cash":54.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"LEVETIRACETAM IN NACL 1000 MG/100ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1953","type":"HCPCS"},{"code":"14789022010","type":"NDC"}],"standard_charges":[{"gross_charge":65.26,"discounted_cash":65.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"PROPOFOL 1000 MG/100ML IV EMUL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2704","type":"HCPCS"},{"code":"00069024810","type":"NDC"}],"standard_charges":[{"gross_charge":14.72,"discounted_cash":14.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.04 ML"}]},{"description":"MILRINONE LACTATE IN DEXTROSE 20-5 MG/100ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2260","type":"HCPCS"},{"code":"00143971910","type":"NDC"}],"standard_charges":[{"gross_charge":92.54,"discounted_cash":92.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"LEVETIRACETAM IN NACL 500 MG/100ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1953","type":"HCPCS"},{"code":"44567050110","type":"NDC"}],"standard_charges":[{"gross_charge":54.9,"discounted_cash":54.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"ERYTHROMYCIN 5 MG/GM OP OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"72485067031","type":"NDC"}],"standard_charges":[{"gross_charge":81.95,"discounted_cash":81.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 GR"}]},{"description":"ASTRINGYN 259 MG/GM EX SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"59365606501","type":"NDC"}],"standard_charges":[{"gross_charge":137.15,"discounted_cash":137.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 GR"}]},{"description":"DESITIN 40 % EX PSTE","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"69968006102","type":"NDC"}],"standard_charges":[{"gross_charge":79.36,"discounted_cash":79.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 57 GR"}]},{"description":"AZITHROMYCIN 500 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0456","type":"HCPCS"},{"code":"63323039814","type":"NDC"}],"standard_charges":[{"gross_charge":39.54,"discounted_cash":39.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"TROPIC-CYCLOPENT-PE-KETOROLAC 1-1-2.5-0.5 % OP SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"71266824001","type":"NDC"}],"standard_charges":[{"gross_charge":107.21,"discounted_cash":107.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"ALBUTEROL SULFATE 2.5 MG/0.5ML IN NEBU","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00487990130","type":"NDC"}],"standard_charges":[{"gross_charge":12.88,"discounted_cash":12.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"UNASYN 3 (2-1) G IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0295","type":"HCPCS"},{"code":"00049001483","type":"NDC"}],"standard_charges":[{"gross_charge":56.91,"discounted_cash":56.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"CEFAZOLIN SODIUM 2 G IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0690","type":"HCPCS"},{"code":"44567084025","type":"NDC"}],"standard_charges":[{"gross_charge":45.89,"discounted_cash":45.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"CEFAZOLIN SODIUM 2 G IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0688","type":"HCPCS"},{"code":"00143913925","type":"NDC"}],"standard_charges":[{"gross_charge":44.17,"discounted_cash":44.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"VANCOMYCIN HCL 1 G IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3370","type":"HCPCS"},{"code":"70594004602","type":"NDC"}],"standard_charges":[{"gross_charge":38.12,"discounted_cash":38.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"VANCOMYCIN HCL 750 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3370","type":"HCPCS"},{"code":"00409653102","type":"NDC"}],"standard_charges":[{"gross_charge":62.08,"discounted_cash":62.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"LEUCOVORIN CALCIUM 200 MG IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0640","type":"HCPCS"},{"code":"25021081530","type":"NDC"}],"standard_charges":[{"gross_charge":242.78,"discounted_cash":242.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"ERTAPENEM SODIUM 1 G IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1335","type":"HCPCS"},{"code":"42023022110","type":"NDC"}],"standard_charges":[{"gross_charge":41.92,"discounted_cash":41.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 UN"}]},{"description":"LEUCOVORIN CALCIUM 100 MG IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0640","type":"HCPCS"},{"code":"71288016120","type":"NDC"}],"standard_charges":[{"gross_charge":370.54,"discounted_cash":370.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"CEFTRIAXONE SODIUM 500 MG IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0696","type":"HCPCS"},{"code":"60505615201","type":"NDC"}],"standard_charges":[{"gross_charge":23.48,"discounted_cash":23.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"CEFTRIAXONE SODIUM 500 MG IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0696","type":"HCPCS"},{"code":"44567070025","type":"NDC"}],"standard_charges":[{"gross_charge":27.45,"discounted_cash":27.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"PIPERACILLIN SOD-TAZOBACTAM SO 2.25 (2-0.25) G IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2543","type":"HCPCS"},{"code":"55150011930","type":"NDC"}],"standard_charges":[{"gross_charge":41.64,"discounted_cash":41.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"VANCOMYCIN HCL 1 G IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3370","type":"HCPCS"},{"code":"63323028420","type":"NDC"}],"standard_charges":[{"gross_charge":30.41,"discounted_cash":30.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 UN"}]},{"description":"CEFTRIAXONE SODIUM 500 MG IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0696","type":"HCPCS"},{"code":"00409733801","type":"NDC"}],"standard_charges":[{"gross_charge":29.38,"discounted_cash":29.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"PIPERACILLIN SOD-TAZOBACTAM SO 3.375 (3-0.375) G IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2543","type":"HCPCS"},{"code":"65219043620","type":"NDC"}],"standard_charges":[{"gross_charge":44.67,"discounted_cash":44.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"ZOLEDRONIC ACID 5 MG/100ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3489","type":"HCPCS"},{"code":"25021083082","type":"NDC"}],"standard_charges":[{"gross_charge":220.37,"discounted_cash":220.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"KETOROLAC TROMETHAMINE 60 MG/2ML IM SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1885","type":"HCPCS"},{"code":"63323016202","type":"NDC"}],"standard_charges":[{"gross_charge":17.58,"discounted_cash":17.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.33 ML"}]},{"description":"METOCLOPRAMIDE HCL 5 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2765","type":"HCPCS"},{"code":"00409525515","type":"NDC"}],"standard_charges":[{"gross_charge":21.85,"discounted_cash":21.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"FUROSEMIDE 10 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1940","type":"HCPCS"},{"code":"23155047342","type":"NDC"}],"standard_charges":[{"gross_charge":18.71,"discounted_cash":18.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"LEVETIRACETAM 500 MG/5ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1953","type":"HCPCS"},{"code":"67457079005","type":"NDC"}],"standard_charges":[{"gross_charge":24.8,"discounted_cash":24.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 ML"}]},{"description":"FENTANYL CITRATE (PF) 2500 MCG/50ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3010","type":"HCPCS"},{"code":"00409909461","type":"NDC"}],"standard_charges":[{"gross_charge":62.5,"discounted_cash":62.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"ACETAZOLAMIDE SODIUM 500 MG IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1120","type":"HCPCS"},{"code":"00143950301","type":"NDC"}],"standard_charges":[{"gross_charge":117.24,"discounted_cash":117.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"LIDOCAINE HCL (PF) 2 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2003","type":"HCPCS"},{"code":"55150016505","type":"NDC"}],"standard_charges":[{"gross_charge":18.43,"discounted_cash":18.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"BUPIVACAINE HCL (PF) 0.5 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0665","type":"HCPCS"},{"code":"55150016910","type":"NDC"}],"standard_charges":[{"gross_charge":35.19,"discounted_cash":35.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"CALCIUM GLUCONATE-NACL 1-0.675 GM/50ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0613","type":"HCPCS"},{"code":"44567062024","type":"NDC"}],"standard_charges":[{"gross_charge":69.41,"discounted_cash":69.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"MAGNESIUM SULFATE 50 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3475","type":"HCPCS"},{"code":"63323006411","type":"NDC"}],"standard_charges":[{"gross_charge":19.5,"discounted_cash":19.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"FUROSEMIDE 10 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1940","type":"HCPCS"},{"code":"00143915610","type":"NDC"}],"standard_charges":[{"gross_charge":23.48,"discounted_cash":23.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"}]},{"description":"FUROSEMIDE 10 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1940","type":"HCPCS"},{"code":"36000028325","type":"NDC"}],"standard_charges":[{"gross_charge":17.71,"discounted_cash":17.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"VANCOMYCIN HCL IN NACL 2-0.9 GM/500ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3370","type":"HCPCS"},{"code":"70004092844","type":"NDC"}],"standard_charges":[{"gross_charge":284.79,"discounted_cash":284.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 ML"}]},{"description":"BUPIVACAINE HCL (PF) 0.5 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0665","type":"HCPCS"},{"code":"00143933110","type":"NDC"}],"standard_charges":[{"gross_charge":20.96,"discounted_cash":20.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"DOBUTAMINE-DEXTROSE 1-5 MG/ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1250","type":"HCPCS"},{"code":"00409234632","type":"NDC"}],"standard_charges":[{"gross_charge":91.93,"discounted_cash":91.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 ML"}]},{"description":"MAGNESIUM SULFATE 2 GM/50ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3475","type":"HCPCS"},{"code":"00264420452","type":"NDC"}],"standard_charges":[{"gross_charge":53.27,"discounted_cash":53.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"BUPIVACAINE HCL (PF) 0.25 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0665","type":"HCPCS"},{"code":"00409115902","type":"NDC"}],"standard_charges":[{"gross_charge":17.52,"discounted_cash":17.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"LEVOFLOXACIN IN D5W 500 MG/100ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1956","type":"HCPCS"},{"code":"00409333024","type":"NDC"}],"standard_charges":[{"gross_charge":44.15,"discounted_cash":44.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"LEVOFLOXACIN IN D5W 750 MG/150ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1956","type":"HCPCS"},{"code":"44567043724","type":"NDC"}],"standard_charges":[{"gross_charge":60.43,"discounted_cash":60.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 ML"}]},{"description":"VYEPTI 100 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3032","type":"HCPCS"},{"code":"67386013051","type":"NDC"}],"standard_charges":[{"gross_charge":5585.93,"discounted_cash":5585.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"FUROSEMIDE 10 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1940","type":"HCPCS"},{"code":"72603025101","type":"NDC"}],"standard_charges":[{"gross_charge":27.24,"discounted_cash":27.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"}]},{"description":"LEUCOVORIN CALCIUM 350 MG IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0640","type":"HCPCS"},{"code":"71288016330","type":"NDC"}],"standard_charges":[{"gross_charge":139.85,"discounted_cash":139.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.16 UN"}]},{"description":"BORTEZOMIB 3.5 MG IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9041","type":"HCPCS"},{"code":"71288011810","type":"NDC"}],"standard_charges":[{"gross_charge":62.18,"discounted_cash":62.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.057 UN"}]},{"description":"ACETAZOLAMIDE SODIUM 500 MG IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1120","type":"HCPCS"},{"code":"39822019001","type":"NDC"}],"standard_charges":[{"gross_charge":115.61,"discounted_cash":115.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"ERTAPENEM SODIUM 1 G IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1335","type":"HCPCS"},{"code":"42023022185","type":"NDC"}],"standard_charges":[{"gross_charge":41.92,"discounted_cash":41.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 UN"}]},{"description":"DEFEROXAMINE MESYLATE 500 MG IJ SOLR (95 MG/ML WET VIAL)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0895","type":"HCPCS"},{"code":"63323059710","type":"NDC"}],"standard_charges":[{"gross_charge":318.54,"discounted_cash":318.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 UN"}]},{"description":"LEUCOVORIN CALCIUM 100 MG IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0640","type":"HCPCS"},{"code":"00143955401","type":"NDC"}],"standard_charges":[{"gross_charge":171.8,"discounted_cash":171.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"CEFTAZIDIME 1 G IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0713","type":"HCPCS"},{"code":"25021012720","type":"NDC"}],"standard_charges":[{"gross_charge":59.12,"discounted_cash":59.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"ERTAPENEM SODIUM 1 G IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1335","type":"HCPCS"},{"code":"60505619604","type":"NDC"}],"standard_charges":[{"gross_charge":117.25,"discounted_cash":117.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"LEUCOVORIN CALCIUM 200 MG IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0640","type":"HCPCS"},{"code":"71288016230","type":"NDC"}],"standard_charges":[{"gross_charge":323.46,"discounted_cash":323.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"LEUCOVORIN CALCIUM 350 MG IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0640","type":"HCPCS"},{"code":"25021081630","type":"NDC"}],"standard_charges":[{"gross_charge":77.09,"discounted_cash":77.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.143 UN"}]},{"description":"VANCOMYCIN HCL 750 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3370","type":"HCPCS"},{"code":"63323020320","type":"NDC"}],"standard_charges":[{"gross_charge":41.19,"discounted_cash":41.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"VANCOMYCIN HCL 750 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3370","type":"HCPCS"},{"code":"71288002421","type":"NDC"}],"standard_charges":[{"gross_charge":44.41,"discounted_cash":44.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"AZITHROMYCIN 500 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0456","type":"HCPCS"},{"code":"55150017410","type":"NDC"}],"standard_charges":[{"gross_charge":38.84,"discounted_cash":38.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 UN"}]},{"description":"VANCOMYCIN HCL 1 G IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3371","type":"HCPCS"},{"code":"67457034001","type":"NDC"}],"standard_charges":[{"gross_charge":28.31,"discounted_cash":28.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 UN"}]},{"description":"ERTAPENEM SODIUM 1 G IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1335","type":"HCPCS"},{"code":"43598090158","type":"NDC"}],"standard_charges":[{"gross_charge":123.82,"discounted_cash":123.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"ERTAPENEM SODIUM 1 G IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1335","type":"HCPCS"},{"code":"72266015910","type":"NDC"}],"standard_charges":[{"gross_charge":127.03,"discounted_cash":127.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"ERTAPENEM SODIUM 1 G IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1335","type":"HCPCS"},{"code":"00409351022","type":"NDC"}],"standard_charges":[{"gross_charge":71.47,"discounted_cash":71.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 UN"}]},{"description":"LEUCOVORIN CALCIUM 200 MG IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0640","type":"HCPCS"},{"code":"68001041737","type":"NDC"}],"standard_charges":[{"gross_charge":915.33,"discounted_cash":915.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 UN"}]},{"description":"AMPICILLIN-SULBACTAM SODIUM 3 (2-1) G IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0295","type":"HCPCS"},{"code":"70594008202","type":"NDC"}],"standard_charges":[{"gross_charge":60.94,"discounted_cash":60.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"PIPERACILLIN SOD-TAZOBACTAM SO 4.5 (4-0.5) G IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2543","type":"HCPCS"},{"code":"44567080310","type":"NDC"}],"standard_charges":[{"gross_charge":46.34,"discounted_cash":46.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"LEUCOVORIN CALCIUM 100 MG IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0640","type":"HCPCS"},{"code":"67457052810","type":"NDC"}],"standard_charges":[{"gross_charge":179.13,"discounted_cash":179.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"LEUCOVORIN CALCIUM 50 MG IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0640","type":"HCPCS"},{"code":"71288016010","type":"NDC"}],"standard_charges":[{"gross_charge":172.74,"discounted_cash":172.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"PIPERACILLIN SOD-TAZOBACTAM SO 4.5 (4-0.5) G IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2543","type":"HCPCS"},{"code":"55150012150","type":"NDC"}],"standard_charges":[{"gross_charge":63.03,"discounted_cash":63.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"VANCOMYCIN HCL 1 G IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3370","type":"HCPCS"},{"code":"63323028426","type":"NDC"}],"standard_charges":[{"gross_charge":42.69,"discounted_cash":42.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.75 UN"}]},{"description":"PIPERACILLIN SOD-TAZOBACTAM SO 4.5 (4-0.5) G IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2543","type":"HCPCS"},{"code":"00781311495","type":"NDC"}],"standard_charges":[{"gross_charge":43.21,"discounted_cash":43.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"BORTEZOMIB 3.5 MG IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9041","type":"HCPCS"},{"code":"43598042660","type":"NDC"}],"standard_charges":[{"gross_charge":160.87,"discounted_cash":160.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.343 UN"}]},{"description":"AZACITIDINE 100 MG IJ SUSR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9025","type":"HCPCS"},{"code":"43598046562","type":"NDC"}],"standard_charges":[{"gross_charge":211.56,"discounted_cash":211.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.4 UN"}]},{"description":"DEFEROXAMINE MESYLATE 500 MG IJ SOLR (95 MG/ML WET VIAL)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0895","type":"HCPCS"},{"code":"60505623606","type":"NDC"}],"standard_charges":[{"gross_charge":90.18,"discounted_cash":90.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 UN"}]},{"description":"MITOMYCIN 20 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9280","type":"HCPCS"},{"code":"25021025150","type":"NDC"}],"standard_charges":[{"gross_charge":362.84,"discounted_cash":362.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.26 UN"}]},{"description":"AZACITIDINE 100 MG IJ SUSR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9025","type":"HCPCS"},{"code":"00143960601","type":"NDC"}],"standard_charges":[{"gross_charge":677.26,"discounted_cash":677.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.4 UN"}]},{"description":"ERTAPENEM SODIUM 1 G IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1335","type":"HCPCS"},{"code":"00143939810","type":"NDC"}],"standard_charges":[{"gross_charge":98.44,"discounted_cash":98.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"CHLOROTHIAZIDE SODIUM 500 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1205","type":"HCPCS"},{"code":"63323065820","type":"NDC"}],"standard_charges":[{"gross_charge":60.61,"discounted_cash":60.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 UN"}]},{"description":"RUXIENCE 100 MG/10ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"Q5119","type":"HCPCS"},{"code":"00069023801","type":"NDC"}],"standard_charges":[{"gross_charge":1089.42,"discounted_cash":1089.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7 ML"}]},{"description":"LEVOFLOXACIN IN D5W 500 MG/100ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1956","type":"HCPCS"},{"code":"25021013282","type":"NDC"}],"standard_charges":[{"gross_charge":47.3,"discounted_cash":47.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"LEVOFLOXACIN IN D5W 250 MG/50ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1956","type":"HCPCS"},{"code":"44567043524","type":"NDC"}],"standard_charges":[{"gross_charge":47.3,"discounted_cash":47.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"POTASSIUM CHLORIDE 20 MEQ/100ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3480","type":"HCPCS"},{"code":"00990707526","type":"NDC"}],"standard_charges":[{"gross_charge":48.68,"discounted_cash":48.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"SUCCINYLCHOLINE CHLORIDE 200 MG/10ML IV SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0330","type":"HCPCS"},{"code":"71266200102","type":"NDC"}],"standard_charges":[{"gross_charge":43.15,"discounted_cash":43.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"ESMOLOL HCL 100 MG/10ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1805","type":"HCPCS"},{"code":"10019012001","type":"NDC"}],"standard_charges":[{"gross_charge":35.41,"discounted_cash":35.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"FENTANYL CITRATE (PF) 100 MCG/2ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3010","type":"HCPCS"},{"code":"00409909422","type":"NDC"}],"standard_charges":[{"gross_charge":18.98,"discounted_cash":18.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 ML"}]},{"description":"NICARDIPINE HCL 2.5 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2404","type":"HCPCS"},{"code":"00143954210","type":"NDC"}],"standard_charges":[{"gross_charge":63.66,"discounted_cash":63.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"CYTARABINE (PF) 20 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9100","type":"HCPCS"},{"code":"61703030538","type":"NDC"}],"standard_charges":[{"gross_charge":99.4,"discounted_cash":99.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 ML"}]},{"description":"DIPHENHYDRAMINE HCL 50 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1200","type":"HCPCS"},{"code":"72485010125","type":"NDC"}],"standard_charges":[{"gross_charge":18.62,"discounted_cash":18.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.2 ML"}]},{"description":"CALCIUM GLUCONATE 10 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0612","type":"HCPCS"},{"code":"65219063019","type":"NDC"}],"standard_charges":[{"gross_charge":96.87,"discounted_cash":96.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"KETOROLAC TROMETHAMINE 15 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1885","type":"HCPCS"},{"code":"68462075525","type":"NDC"}],"standard_charges":[{"gross_charge":23.38,"discounted_cash":23.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.667 ML"}]},{"description":"FUROSEMIDE 10 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1940","type":"HCPCS"},{"code":"16729050008","type":"NDC"}],"standard_charges":[{"gross_charge":49.6,"discounted_cash":49.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 ML"}]},{"description":"PAMIDRONATE DISODIUM 30 MG/10ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2430","type":"HCPCS"},{"code":"67457043010","type":"NDC"}],"standard_charges":[{"gross_charge":58.49,"discounted_cash":58.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"PALONOSETRON HCL 0.25 MG/5ML IV SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2469","type":"HCPCS"},{"code":"63323067389","type":"NDC"}],"standard_charges":[{"gross_charge":86.59,"discounted_cash":86.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"ENOXAPARIN SODIUM 40 MG/0.4ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"71288043383","type":"NDC"}],"standard_charges":[{"gross_charge":35.09,"discounted_cash":35.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.4 ML"}]},{"description":"ENOXAPARIN SODIUM 80 MG/0.8ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"71839011210","type":"NDC"}],"standard_charges":[{"gross_charge":24.09,"discounted_cash":24.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.1 ML"}]},{"description":"PROTAMINE SULFATE 10 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2720","type":"HCPCS"},{"code":"63323022995","type":"NDC"}],"standard_charges":[{"gross_charge":37.58,"discounted_cash":37.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"ENOXAPARIN SODIUM 30 MG/0.3ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"16714000610","type":"NDC"}],"standard_charges":[{"gross_charge":41.96,"discounted_cash":41.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.3 ML"}]},{"description":"NALOXONE HCL 0.4 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2310","type":"HCPCS"},{"code":"67457059902","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":42.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"NEOSTIGMINE METHYLSULFATE 5 MG/5ML IV SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2710","type":"HCPCS"},{"code":"71449012511","type":"NDC"}],"standard_charges":[{"gross_charge":46.86,"discounted_cash":46.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"HEPARIN SODIUM (PORCINE) 5000 UNIT/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"00641040012","type":"NDC"}],"standard_charges":[{"gross_charge":34.94,"discounted_cash":34.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"ZOLEDRONIC ACID 5 MG/100ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3489","type":"HCPCS"},{"code":"72266015201","type":"NDC"}],"standard_charges":[{"gross_charge":127.45,"discounted_cash":127.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"ZOLEDRONIC ACID 4 MG/100ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3489","type":"HCPCS"},{"code":"25021082682","type":"NDC"}],"standard_charges":[{"gross_charge":138.01,"discounted_cash":138.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"ACYCLOVIR SODIUM 50 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0133","type":"HCPCS"},{"code":"63323032524","type":"NDC"}],"standard_charges":[{"gross_charge":34.91,"discounted_cash":34.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6 ML"}]},{"description":"CEFAZOLIN IN SODIUM CHLORIDE 3-0.9 GM/100ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0690","type":"HCPCS"},{"code":"70092162303","type":"NDC"}],"standard_charges":[{"gross_charge":111.61,"discounted_cash":111.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"LIDOCAINE HCL (PF) 2 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2003","type":"HCPCS"},{"code":"00409428202","type":"NDC"}],"standard_charges":[{"gross_charge":17.11,"discounted_cash":17.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"LIDOCAINE HCL (PF) 1 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2003","type":"HCPCS"},{"code":"55150016205","type":"NDC"}],"standard_charges":[{"gross_charge":16.49,"discounted_cash":16.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.3 ML"}]},{"description":"MIDAZOLAM HCL (PF) 5 MG/5ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2250","type":"HCPCS"},{"code":"00409230505","type":"NDC"}],"standard_charges":[{"gross_charge":16.75,"discounted_cash":16.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"LIDOCAINE HCL (PF) 2 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2001","type":"HCPCS"},{"code":"00143959425","type":"NDC"}],"standard_charges":[{"gross_charge":18.12,"discounted_cash":18.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"ROPIVACAINE HCL 2 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2795","type":"HCPCS"},{"code":"70069006225","type":"NDC"}],"standard_charges":[{"gross_charge":60.49,"discounted_cash":60.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"FUROSEMIDE 10 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1940","type":"HCPCS"},{"code":"71288020305","type":"NDC"}],"standard_charges":[{"gross_charge":21.03,"discounted_cash":21.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"SUCCINYLCHOLINE CHLORIDE 200 MG/10ML IV SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0330","type":"HCPCS"},{"code":"70092108746","type":"NDC"}],"standard_charges":[{"gross_charge":52.18,"discounted_cash":52.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 ML"}]},{"description":"ROPIVACAINE HCL 5 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2795","type":"HCPCS"},{"code":"43066001910","type":"NDC"}],"standard_charges":[{"gross_charge":41.07,"discounted_cash":41.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 ML"}]},{"description":"KETOROLAC TROMETHAMINE 15 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1885","type":"HCPCS"},{"code":"62332059925","type":"NDC"}],"standard_charges":[{"gross_charge":30.91,"discounted_cash":30.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"CLONIDINE HCL (ANALGESIA) 100 MCG/ML EP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0735","type":"HCPCS"},{"code":"00143972401","type":"NDC"}],"standard_charges":[{"gross_charge":23.66,"discounted_cash":23.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.4 ML"}]},{"description":"FENTANYL CITRATE (PF) 250 MCG/5ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3010","type":"HCPCS"},{"code":"63323080605","type":"NDC"}],"standard_charges":[{"gross_charge":18.67,"discounted_cash":18.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"METOCLOPRAMIDE HCL 5 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2765","type":"HCPCS"},{"code":"00409341401","type":"NDC"}],"standard_charges":[{"gross_charge":18.69,"discounted_cash":18.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"MIDAZOLAM HCL (PF) 10 MG/2ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2250","type":"HCPCS"},{"code":"00409230802","type":"NDC"}],"standard_charges":[{"gross_charge":22.57,"discounted_cash":22.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"CALCIUM GLUCONATE 10 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0612","type":"HCPCS"},{"code":"63323036059","type":"NDC"}],"standard_charges":[{"gross_charge":54.69,"discounted_cash":54.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"FUROSEMIDE 10 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1940","type":"HCPCS"},{"code":"25021031102","type":"NDC"}],"standard_charges":[{"gross_charge":27.05,"discounted_cash":27.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"MIDAZOLAM HCL (PF) 2 MG/2ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2250","type":"HCPCS"},{"code":"00409000125","type":"NDC"}],"standard_charges":[{"gross_charge":24.47,"discounted_cash":24.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"LIDOCAINE HCL (PF) 1 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2001","type":"HCPCS"},{"code":"71351002110","type":"NDC"}],"standard_charges":[{"gross_charge":30.98,"discounted_cash":30.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"}]},{"description":"CALCIUM GLUCONATE-NACL 1-0.675 GM/50ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0612","type":"HCPCS"},{"code":"80830236209","type":"NDC"}],"standard_charges":[{"gross_charge":91.54,"discounted_cash":91.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"ROPIVACAINE HCL-NACL 0.2-0.9 % (ON-Q) IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2795","type":"HCPCS"},{"code":"71449007951","type":"NDC"}],"standard_charges":[{"gross_charge":771.31,"discounted_cash":771.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 545 ML"}]},{"description":"POTASSIUM CHLORIDE 2 MEQ/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3480","type":"HCPCS"},{"code":"00409665106","type":"NDC"}],"standard_charges":[{"gross_charge":34.27,"discounted_cash":34.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"FUROSEMIDE 10 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1940","type":"HCPCS"},{"code":"55150032325","type":"NDC"}],"standard_charges":[{"gross_charge":22.68,"discounted_cash":22.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"ESMOLOL HCL-SODIUM CHLORIDE 2500 MG/250ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1805","type":"HCPCS"},{"code":"25021030884","type":"NDC"}],"standard_charges":[{"gross_charge":334.95,"discounted_cash":334.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 ML"}]},{"description":"LIDOCAINE-EPINEPHRINE (PF) 2 %-1:200000 IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2004","type":"HCPCS"},{"code":"00409318301","type":"NDC"}],"standard_charges":[{"gross_charge":18.04,"discounted_cash":18.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"LACOSAMIDE 200 MG/20ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"C9254","type":"HCPCS"},{"code":"69543045510","type":"NDC"}],"standard_charges":[{"gross_charge":66.97,"discounted_cash":66.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"LIDOCAINE HCL (PF) 1 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2003","type":"HCPCS"},{"code":"00409471302","type":"NDC"}],"standard_charges":[{"gross_charge":21.12,"discounted_cash":21.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"BUPIVACAINE HCL (PF) 0.75 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0665","type":"HCPCS"},{"code":"00409116501","type":"NDC"}],"standard_charges":[{"gross_charge":20.6,"discounted_cash":20.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.5 ML"}]},{"description":"ROPIVACAINE HCL 5 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2795","type":"HCPCS"},{"code":"43066002310","type":"NDC"}],"standard_charges":[{"gross_charge":22.08,"discounted_cash":22.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"}]},{"description":"DOBUTAMINE-DEXTROSE 2-5 MG/ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1250","type":"HCPCS"},{"code":"00338107502","type":"NDC"}],"standard_charges":[{"gross_charge":267.26,"discounted_cash":267.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 ML"}]},{"description":"GEMCITABINE HCL 1 GM/26.3ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9201","type":"HCPCS"},{"code":"00409018101","type":"NDC"}],"standard_charges":[{"gross_charge":353.0,"discounted_cash":353.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 22.2 ML"}]},{"description":"KETOROLAC TROMETHAMINE 30 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1885","type":"HCPCS"},{"code":"63323016201","type":"NDC"}],"standard_charges":[{"gross_charge":18.02,"discounted_cash":18.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 ML"}]},{"description":"METHOCARBAMOL 1000 MG/10ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2800","type":"HCPCS"},{"code":"25021067510","type":"NDC"}],"standard_charges":[{"gross_charge":35.84,"discounted_cash":35.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"GEMCITABINE HCL 2 GM/52.6ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9201","type":"HCPCS"},{"code":"67457061810","type":"NDC"}],"standard_charges":[{"gross_charge":109.87,"discounted_cash":109.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5.26 ML"}]},{"description":"GLYCOPYRROLATE 0.2 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1596","type":"HCPCS"},{"code":"70860078101","type":"NDC"}],"standard_charges":[{"gross_charge":24.82,"discounted_cash":24.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"PROTAMINE SULFATE 10 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2720","type":"HCPCS"},{"code":"63323022994","type":"NDC"}],"standard_charges":[{"gross_charge":23.46,"discounted_cash":23.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 ML"}]},{"description":"MEPERIDINE HCL 25 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2175","type":"HCPCS"},{"code":"00641605225","type":"NDC"}],"standard_charges":[{"gross_charge":22.15,"discounted_cash":22.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.2 ML"}]},{"description":"REGADENOSON 0.4 MG/5ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2785","type":"HCPCS"},{"code":"76329332100","type":"NDC"}],"standard_charges":[{"gross_charge":54.0,"discounted_cash":54.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"PALONOSETRON HCL 0.25 MG/5ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2469","type":"HCPCS"},{"code":"55111069407","type":"NDC"}],"standard_charges":[{"gross_charge":47.19,"discounted_cash":47.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"DIGOXIN 0.25 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1160","type":"HCPCS"},{"code":"00781305995","type":"NDC"}],"standard_charges":[{"gross_charge":25.31,"discounted_cash":25.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"LEVETIRACETAM 500 MG/5ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1953","type":"HCPCS"},{"code":"00143967325","type":"NDC"}],"standard_charges":[{"gross_charge":22.76,"discounted_cash":22.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 ML"}]},{"description":"LEVETIRACETAM IN NACL 1000 MG/100ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1953","type":"HCPCS"},{"code":"67457026510","type":"NDC"}],"standard_charges":[{"gross_charge":82.57,"discounted_cash":82.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"FENTANYL CITRATE (PF) 100 MCG/2ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3010","type":"HCPCS"},{"code":"00641602725","type":"NDC"}],"standard_charges":[{"gross_charge":17.91,"discounted_cash":17.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 ML"}]},{"description":"HEPARIN SODIUM (PORCINE) 5000 UNIT/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"71288040302","type":"NDC"}],"standard_charges":[{"gross_charge":22.07,"discounted_cash":22.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.6 ML"}]},{"description":"MORPHINE SULFATE 1 MG/ML IJ SOLN (WRAPPED)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2270","type":"HCPCS"},{"code":"70092113343","type":"NDC"}],"standard_charges":[{"gross_charge":53.38,"discounted_cash":53.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"REGADENOSON 0.4 MG/5ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2785","type":"HCPCS"},{"code":"00409140101","type":"NDC"}],"standard_charges":[{"gross_charge":66.45,"discounted_cash":66.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"LABETALOL HCL 20 MG/4ML IV SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1920","type":"HCPCS"},{"code":"71506004645","type":"NDC"}],"standard_charges":[{"gross_charge":42.89,"discounted_cash":42.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"GLYCOPYRROLATE 0.2 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1598","type":"HCPCS"},{"code":"63323057811","type":"NDC"}],"standard_charges":[{"gross_charge":35.01,"discounted_cash":35.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"SUCCINYLCHOLINE CHLORIDE 200 MG/10ML IV SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0330","type":"HCPCS"},{"code":"69374091910","type":"NDC"}],"standard_charges":[{"gross_charge":46.27,"discounted_cash":46.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3.8 ML"}]},{"description":"NICARDIPINE HCL 2.5 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2404","type":"HCPCS"},{"code":"00143968910","type":"NDC"}],"standard_charges":[{"gross_charge":16.68,"discounted_cash":16.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.08 ML"}]},{"description":"ZOLEDRONIC ACID 4 MG/5ML IV CONC","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3489","type":"HCPCS"},{"code":"43598023311","type":"NDC"}],"standard_charges":[{"gross_charge":37.88,"discounted_cash":37.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3.75 ML"}]},{"description":"TERBUTALINE SULFATE 1 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3105","type":"HCPCS"},{"code":"00143974610","type":"NDC"}],"standard_charges":[{"gross_charge":20.25,"discounted_cash":20.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 ML"}]},{"description":"GLYCOPYRROLATE 0.4 MG/2ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1596","type":"HCPCS"},{"code":"63323057812","type":"NDC"}],"standard_charges":[{"gross_charge":22.76,"discounted_cash":22.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"METHOTREXATE SODIUM (PF) 50 MG/2ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9260","type":"HCPCS"},{"code":"00143951910","type":"NDC"}],"standard_charges":[{"gross_charge":35.38,"discounted_cash":35.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.16 ML"}]},{"description":"KETOROLAC TROMETHAMINE 30 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1885","type":"HCPCS"},{"code":"00338007225","type":"NDC"}],"standard_charges":[{"gross_charge":19.15,"discounted_cash":19.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"EPTIFIBATIDE 75 MG/100ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1327","type":"HCPCS"},{"code":"70436016380","type":"NDC"}],"standard_charges":[{"gross_charge":196.93,"discounted_cash":196.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"OXALIPLATIN 100 MG/20ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9263","type":"HCPCS"},{"code":"72603010101","type":"NDC"}],"standard_charges":[{"gross_charge":174.78,"discounted_cash":174.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15.5 ML"}]},{"description":"TRIAMCINOLONE ACETONIDE 40 MG/ML IJ SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3301","type":"HCPCS"},{"code":"70121165701","type":"NDC"}],"standard_charges":[{"gross_charge":33.95,"discounted_cash":33.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"LIDOCAINE HCL (PF) 1 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2003","type":"HCPCS"},{"code":"55150016102","type":"NDC"}],"standard_charges":[{"gross_charge":21.84,"discounted_cash":21.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"FENTANYL CITRATE (PF) 2500 MCG/50ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3010","type":"HCPCS"},{"code":"00641603001","type":"NDC"}],"standard_charges":[{"gross_charge":71.72,"discounted_cash":71.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"ROPIVACAINE HCL-NACL 0.2-0.9 % (ON-Q) IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2795","type":"HCPCS"},{"code":"71449007957","type":"NDC"}],"standard_charges":[{"gross_charge":339.2,"discounted_cash":339.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 ML"}]},{"description":"ROPIVACAINE HCL 10 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2795","type":"HCPCS"},{"code":"43066002710","type":"NDC"}],"standard_charges":[{"gross_charge":63.66,"discounted_cash":63.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 ML"}]},{"description":"MAGNESIUM SULFATE 2 GM/50ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3475","type":"HCPCS"},{"code":"67457055300","type":"NDC"}],"standard_charges":[{"gross_charge":76.23,"discounted_cash":76.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"ESMOLOL HCL 100 MG/10ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1805","type":"HCPCS"},{"code":"63323065210","type":"NDC"}],"standard_charges":[{"gross_charge":36.79,"discounted_cash":36.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 9.5 ML"}]},{"description":"BUPIVACAINE HCL (PF) 0.25 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0665","type":"HCPCS"},{"code":"00409115901","type":"NDC"}],"standard_charges":[{"gross_charge":18.67,"discounted_cash":18.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"PROPOFOL 200 MG/20ML IV EMUL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2704","type":"HCPCS"},{"code":"25021060820","type":"NDC"}],"standard_charges":[{"gross_charge":17.31,"discounted_cash":17.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"ROPIVACAINE HCL-NACL 0.2-0.9 % (ON-Q) IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2795","type":"HCPCS"},{"code":"71449007959","type":"NDC"}],"standard_charges":[{"gross_charge":904.57,"discounted_cash":904.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 745 ML"}]},{"description":"FUROSEMIDE 10 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1940","type":"HCPCS"},{"code":"36000028225","type":"NDC"}],"standard_charges":[{"gross_charge":19.03,"discounted_cash":19.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"CLINDAMYCIN PHOSPHATE IN D5W 900 MG/50ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0736","type":"HCPCS"},{"code":"00781329009","type":"NDC"}],"standard_charges":[{"gross_charge":75.63,"discounted_cash":75.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"DURAMORPH 1 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2270","type":"HCPCS"},{"code":"00641601910","type":"NDC"}],"standard_charges":[{"gross_charge":84.59,"discounted_cash":84.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"NAROPIN 5 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2795","type":"HCPCS"},{"code":"63323028635","type":"NDC"}],"standard_charges":[{"gross_charge":17.93,"discounted_cash":17.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"NAROPIN 10 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2795","type":"HCPCS"},{"code":"63323028821","type":"NDC"}],"standard_charges":[{"gross_charge":66.2,"discounted_cash":66.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 ML"}]},{"description":"FUROSEMIDE 10 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1940","type":"HCPCS"},{"code":"00409610204","type":"NDC"}],"standard_charges":[{"gross_charge":29.66,"discounted_cash":29.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"EPTIFIBATIDE 20 MG/10ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1327","type":"HCPCS"},{"code":"55150021910","type":"NDC"}],"standard_charges":[{"gross_charge":86.63,"discounted_cash":86.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"HALOPERIDOL LACTATE 5 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1630","type":"HCPCS"},{"code":"76045073710","type":"NDC"}],"standard_charges":[{"gross_charge":19.13,"discounted_cash":19.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.1 ML"}]},{"description":"NEOSTIGMINE METHYLSULFATE 5 MG/5ML IV SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2710","type":"HCPCS"},{"code":"69374090205","type":"NDC"}],"standard_charges":[{"gross_charge":55.39,"discounted_cash":55.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"METHOCARBAMOL 1000 MG/10ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2800","type":"HCPCS"},{"code":"43598083936","type":"NDC"}],"standard_charges":[{"gross_charge":40.82,"discounted_cash":40.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"CHLOROPROCAINE HCL (PF) 2 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2401","type":"HCPCS"},{"code":"00143920910","type":"NDC"}],"standard_charges":[{"gross_charge":36.86,"discounted_cash":36.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"}]},{"description":"ROPIVACAINE HCL-NACL 0.2-0.9 % (ON-Q) IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2795","type":"HCPCS"},{"code":"73177010913","type":"NDC"}],"standard_charges":[{"gross_charge":784.44,"discounted_cash":784.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 545 ML"}]},{"description":"METHOCARBAMOL 1000 MG/10ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2800","type":"HCPCS"},{"code":"70069010105","type":"NDC"}],"standard_charges":[{"gross_charge":35.33,"discounted_cash":35.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"GEMCITABINE HCL 1 GM/26.3ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9201","type":"HCPCS"},{"code":"67457061730","type":"NDC"}],"standard_charges":[{"gross_charge":190.26,"discounted_cash":190.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 14.599 ML"}]},{"description":"PHENYTOIN SODIUM 50 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1165","type":"HCPCS"},{"code":"00641255510","type":"NDC"}],"standard_charges":[{"gross_charge":42.42,"discounted_cash":42.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6 ML"}]},{"description":"BUMETANIDE 0.25 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1939","type":"HCPCS"},{"code":"68462046954","type":"NDC"}],"standard_charges":[{"gross_charge":28.39,"discounted_cash":28.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"BUPIVACAINE HCL (PF) 0.75 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0665","type":"HCPCS"},{"code":"55150017110","type":"NDC"}],"standard_charges":[{"gross_charge":23.13,"discounted_cash":23.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"FAMOTIDINE (PF) 20 MG/2ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1308","type":"HCPCS"},{"code":"67457043322","type":"NDC"}],"standard_charges":[{"gross_charge":19.37,"discounted_cash":19.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"LIDOCAINE HCL (PF) 1 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2003","type":"HCPCS"},{"code":"00409471332","type":"NDC"}],"standard_charges":[{"gross_charge":23.93,"discounted_cash":23.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"DIPHENHYDRAMINE HCL 50 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1200","type":"HCPCS"},{"code":"00641037625","type":"NDC"}],"standard_charges":[{"gross_charge":16.59,"discounted_cash":16.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.125 ML"}]},{"description":"MAGNESIUM SULFATE 50 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3475","type":"HCPCS"},{"code":"63323006443","type":"NDC"}],"standard_charges":[{"gross_charge":30.37,"discounted_cash":30.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"REGADENOSON 0.4 MG/5ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2785","type":"HCPCS"},{"code":"67457099405","type":"NDC"}],"standard_charges":[{"gross_charge":47.14,"discounted_cash":47.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"ATROPINE SULFATE 1 MG/10ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0461","type":"HCPCS"},{"code":"00409491134","type":"NDC"}],"standard_charges":[{"gross_charge":38.41,"discounted_cash":38.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"ADENOSINE 6 MG/2ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0153","type":"HCPCS"},{"code":"63323065102","type":"NDC"}],"standard_charges":[{"gross_charge":20.02,"discounted_cash":20.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.22 ML"}]},{"description":"IRINOTECAN HCL 100 MG/5ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9206","type":"HCPCS"},{"code":"60505612801","type":"NDC"}],"standard_charges":[{"gross_charge":69.54,"discounted_cash":69.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"LIDOCAINE HCL 1 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2003","type":"HCPCS"},{"code":"63323020102","type":"NDC"}],"standard_charges":[{"gross_charge":31.03,"discounted_cash":31.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"ACETYLCYSTEINE 200 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0132","type":"HCPCS"},{"code":"63323096330","type":"NDC"}],"standard_charges":[{"gross_charge":57.22,"discounted_cash":57.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 14 ML"}]},{"description":"POTASSIUM CHLORIDE 2 MEQ/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3480","type":"HCPCS"},{"code":"00409663501","type":"NDC"}],"standard_charges":[{"gross_charge":68.16,"discounted_cash":68.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"PHENYTOIN SODIUM 50 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1165","type":"HCPCS"},{"code":"00641049325","type":"NDC"}],"standard_charges":[{"gross_charge":31.22,"discounted_cash":31.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"KETOROLAC TROMETHAMINE 30 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1885","type":"HCPCS"},{"code":"63323016216","type":"NDC"}],"standard_charges":[{"gross_charge":20.54,"discounted_cash":20.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"METOCLOPRAMIDE HCL 5 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2765","type":"HCPCS"},{"code":"83634077941","type":"NDC"}],"standard_charges":[{"gross_charge":33.12,"discounted_cash":33.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"NA FERRIC GLUC CPLX IN SUCROSE 12.5 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2916","type":"HCPCS"},{"code":"00143957010","type":"NDC"}],"standard_charges":[{"gross_charge":194.55,"discounted_cash":194.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"IRINOTECAN HCL 40 MG/2ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9206","type":"HCPCS"},{"code":"00143970201","type":"NDC"}],"standard_charges":[{"gross_charge":93.13,"discounted_cash":93.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"HYDROMORPHONE HCL 0.25 MG/0.5ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1171","type":"HCPCS"},{"code":"00409180501","type":"NDC"}],"standard_charges":[{"gross_charge":43.72,"discounted_cash":43.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"ENOXAPARIN SODIUM 80 MG/0.8ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"25021041078","type":"NDC"}],"standard_charges":[{"gross_charge":23.7,"discounted_cash":23.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.1 ML"}]},{"description":"FENTANYL CITRATE PF 25 MCG/0.5ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3010","type":"HCPCS"},{"code":"00641624910","type":"NDC"}],"standard_charges":[{"gross_charge":34.72,"discounted_cash":34.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"HEPARIN SODIUM (PORCINE) 5000 UNIT/0.5ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"63323011805","type":"NDC"}],"standard_charges":[{"gross_charge":29.59,"discounted_cash":29.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"IRINOTECAN HCL 100 MG/5ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9206","type":"HCPCS"},{"code":"45963061455","type":"NDC"}],"standard_charges":[{"gross_charge":104.83,"discounted_cash":104.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.2 ML"}]},{"description":"DIPHENHYDRAMINE HCL 50 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1200","type":"HCPCS"},{"code":"25021048101","type":"NDC"}],"standard_charges":[{"gross_charge":19.89,"discounted_cash":19.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"POTASSIUM CHLORIDE 2 MEQ/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3480","type":"HCPCS"},{"code":"00409665305","type":"NDC"}],"standard_charges":[{"gross_charge":35.15,"discounted_cash":35.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"MIDAZOLAM HCL 2 MG/2ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2250","type":"HCPCS"},{"code":"23155060041","type":"NDC"}],"standard_charges":[{"gross_charge":22.05,"discounted_cash":22.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"FAMOTIDINE (PF) 20 MG/2ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1308","type":"HCPCS"},{"code":"00641602225","type":"NDC"}],"standard_charges":[{"gross_charge":23.64,"discounted_cash":23.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"FUROSEMIDE 10 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1940","type":"HCPCS"},{"code":"63323028026","type":"NDC"}],"standard_charges":[{"gross_charge":20.2,"discounted_cash":20.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"LIDOCAINE HCL (PF) 1 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2003","type":"HCPCS"},{"code":"00143959525","type":"NDC"}],"standard_charges":[{"gross_charge":16.02,"discounted_cash":16.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.18 ML"}]},{"description":"HALOPERIDOL LACTATE 5 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1630","type":"HCPCS"},{"code":"67457042612","type":"NDC"}],"standard_charges":[{"gross_charge":16.01,"discounted_cash":16.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.05 ML"}]},{"description":"OXALIPLATIN 50 MG/10ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9263","type":"HCPCS"},{"code":"60505613206","type":"NDC"}],"standard_charges":[{"gross_charge":40.55,"discounted_cash":40.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"HEPARIN SODIUM (PORCINE) 5000 UNIT/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"71288042296","type":"NDC"}],"standard_charges":[{"gross_charge":22.19,"discounted_cash":22.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.6 ML"}]},{"description":"FENTANYL CITRATE (PF) 100 MCG/2ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3010","type":"HCPCS"},{"code":"63323080602","type":"NDC"}],"standard_charges":[{"gross_charge":21.19,"discounted_cash":21.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"MAGNESIUM SULFATE 50 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3475","type":"HCPCS"},{"code":"63323006403","type":"NDC"}],"standard_charges":[{"gross_charge":29.99,"discounted_cash":29.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"GEMCITABINE HCL 2 GM/52.6ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9201","type":"HCPCS"},{"code":"00409018201","type":"NDC"}],"standard_charges":[{"gross_charge":119.37,"discounted_cash":119.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5.2 ML"}]},{"description":"METOCLOPRAMIDE HCL 5 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2765","type":"HCPCS"},{"code":"00409341411","type":"NDC"}],"standard_charges":[{"gross_charge":22.01,"discounted_cash":22.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"AMINOPHYLLINE 25 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0280","type":"HCPCS"},{"code":"00409592201","type":"NDC"}],"standard_charges":[{"gross_charge":23.48,"discounted_cash":23.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"CALCIUM GLUCONATE 10 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0612","type":"HCPCS"},{"code":"63323036019","type":"NDC"}],"standard_charges":[{"gross_charge":49.53,"discounted_cash":49.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"LABETALOL HCL 5 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1920","type":"HCPCS"},{"code":"36000032010","type":"NDC"}],"standard_charges":[{"gross_charge":21.83,"discounted_cash":21.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"ATROPINE SULFATE 1 MG/10ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0461","type":"HCPCS"},{"code":"64253040091","type":"NDC"}],"standard_charges":[{"gross_charge":36.63,"discounted_cash":36.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"ROPIVACAINE HCL 2 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2795","type":"HCPCS"},{"code":"25021067187","type":"NDC"}],"standard_charges":[{"gross_charge":223.52,"discounted_cash":223.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 ML"}]},{"description":"METOCLOPRAMIDE HCL 5 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2765","type":"HCPCS"},{"code":"23155024041","type":"NDC"}],"standard_charges":[{"gross_charge":20.26,"discounted_cash":20.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"HEPARIN SODIUM (PORCINE) 5000 UNIT/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"72603041225","type":"NDC"}],"standard_charges":[{"gross_charge":25.39,"discounted_cash":25.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"GEMCITABINE HCL 200 MG/5.26ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9201","type":"HCPCS"},{"code":"00409018301","type":"NDC"}],"standard_charges":[{"gross_charge":47.98,"discounted_cash":47.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.801 ML"}]},{"description":"METHOCARBAMOL 1000 MG/10ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2800","type":"HCPCS"},{"code":"71288071610","type":"NDC"}],"standard_charges":[{"gross_charge":40.31,"discounted_cash":40.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"LACOSAMIDE 200 MG/20ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"C9254","type":"HCPCS"},{"code":"31722020331","type":"NDC"}],"standard_charges":[{"gross_charge":46.13,"discounted_cash":46.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"DIPHENHYDRAMINE HCL 50 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1200","type":"HCPCS"},{"code":"63323066401","type":"NDC"}],"standard_charges":[{"gross_charge":16.73,"discounted_cash":16.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.13 ML"}]},{"description":"BUMETANIDE 0.25 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1939","type":"HCPCS"},{"code":"72205010107","type":"NDC"}],"standard_charges":[{"gross_charge":37.42,"discounted_cash":37.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"}]},{"description":"OXALIPLATIN 50 MG/10ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9263","type":"HCPCS"},{"code":"71288010110","type":"NDC"}],"standard_charges":[{"gross_charge":46.88,"discounted_cash":46.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"METHOCARBAMOL 1000 MG/10ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2800","type":"HCPCS"},{"code":"55150022310","type":"NDC"}],"standard_charges":[{"gross_charge":28.62,"discounted_cash":28.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 ML"}]},{"description":"FAMOTIDINE (PF) 20 MG/2ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1308","type":"HCPCS"},{"code":"63323073916","type":"NDC"}],"standard_charges":[{"gross_charge":19.88,"discounted_cash":19.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"FAMOTIDINE (PF) 20 MG/2ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1308","type":"HCPCS"},{"code":"63323073912","type":"NDC"}],"standard_charges":[{"gross_charge":19.88,"discounted_cash":19.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"LEVETIRACETAM 500 MG/5ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1953","type":"HCPCS"},{"code":"55150017705","type":"NDC"}],"standard_charges":[{"gross_charge":23.88,"discounted_cash":23.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 ML"}]},{"description":"LACOSAMIDE 200 MG/20ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"C9254","type":"HCPCS"},{"code":"43598008758","type":"NDC"}],"standard_charges":[{"gross_charge":64.7,"discounted_cash":64.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"KETOROLAC TROMETHAMINE 15 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1885","type":"HCPCS"},{"code":"00338006910","type":"NDC"}],"standard_charges":[{"gross_charge":26.32,"discounted_cash":26.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"CHLOROPROCAINE HCL (PF) 3 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2401","type":"HCPCS"},{"code":"00143921010","type":"NDC"}],"standard_charges":[{"gross_charge":25.27,"discounted_cash":25.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"CLINDAMYCIN PHOSPHATE IN D5W 600 MG/50ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0736","type":"HCPCS"},{"code":"00781328909","type":"NDC"}],"standard_charges":[{"gross_charge":63.03,"discounted_cash":63.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 ML"}]},{"description":"CALCIUM GLUCONATE-NACL 1-0.675 GM/50ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0612","type":"HCPCS"},{"code":"65219016210","type":"NDC"}],"standard_charges":[{"gross_charge":65.61,"discounted_cash":65.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"ROPIVACAINE HCL-NACL 0.2-0.9 % (ON-Q) IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2795","type":"HCPCS"},{"code":"73177010914","type":"NDC"}],"standard_charges":[{"gross_charge":958.52,"discounted_cash":958.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 745 ML"}]},{"description":"DOPAMINE-DEXTROSE 1.6-5 MG/ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1265","type":"HCPCS"},{"code":"00338100702","type":"NDC"}],"standard_charges":[{"gross_charge":106.39,"discounted_cash":106.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 ML"}]},{"description":"BUPIVACAINE HCL (PF) 0.5 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0665","type":"HCPCS"},{"code":"00409116202","type":"NDC"}],"standard_charges":[{"gross_charge":16.47,"discounted_cash":16.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"MAGNESIUM SULFATE 4 GM/100ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3475","type":"HCPCS"},{"code":"63323010601","type":"NDC"}],"standard_charges":[{"gross_charge":42.85,"discounted_cash":42.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"ACETAMINOPHEN 1000 MG/100 ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0131","type":"HCPCS"},{"code":"00781315695","type":"NDC"}],"standard_charges":[{"gross_charge":35.44,"discounted_cash":35.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 35 ML"}]},{"description":"MANNITOL 25 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2150","type":"HCPCS"},{"code":"00409403101","type":"NDC"}],"standard_charges":[{"gross_charge":47.19,"discounted_cash":47.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 ML"}]},{"description":"LIDOCAINE HCL (PF) 1 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2003","type":"HCPCS"},{"code":"55150016330","type":"NDC"}],"standard_charges":[{"gross_charge":23.35,"discounted_cash":23.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12 ML"}]},{"description":"LEVETIRACETAM IN NACL 500 MG/100ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1953","type":"HCPCS"},{"code":"36000035240","type":"NDC"}],"standard_charges":[{"gross_charge":46.61,"discounted_cash":46.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"SODIUM CHLORIDE 3 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J7131","type":"HCPCS"},{"code":"00264780510","type":"NDC"}],"standard_charges":[{"gross_charge":26.03,"discounted_cash":26.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"DEXTROSE 5 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J7070","type":"HCPCS"},{"code":"00990792255","type":"NDC"}],"standard_charges":[{"gross_charge":89.73,"discounted_cash":89.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 ML"}]},{"description":"DEXTROSE 5 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J7070","type":"HCPCS"},{"code":"00990792337","type":"NDC"}],"standard_charges":[{"gross_charge":51.29,"discounted_cash":51.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"DEXTROSE 5 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J7070","type":"HCPCS"},{"code":"00990792202","type":"NDC"}],"standard_charges":[{"gross_charge":22.32,"discounted_cash":22.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"KCL IN DEXTROSE-NACL 20-5-0.45 MEQ/L-%-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3480","type":"HCPCS"},{"code":"00990790209","type":"NDC"}],"standard_charges":[{"gross_charge":124.88,"discounted_cash":124.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"}]},{"description":"LACTATED RINGERS IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J7120","type":"HCPCS"},{"code":"00338011703","type":"NDC"}],"standard_charges":[{"gross_charge":53.34,"discounted_cash":53.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 ML"}]},{"description":"DEXTROSE 5 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J7060","type":"HCPCS"},{"code":"00264751020","type":"NDC"}],"standard_charges":[{"gross_charge":19.22,"discounted_cash":19.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 ML"}]},{"description":"LEVETIRACETAM IN NACL 1500 MG/100ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1953","type":"HCPCS"},{"code":"44567050310","type":"NDC"}],"standard_charges":[{"gross_charge":83.23,"discounted_cash":83.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"ROPIVACAINE HCL 5 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2795","type":"HCPCS"},{"code":"70069006325","type":"NDC"}],"standard_charges":[{"gross_charge":19.65,"discounted_cash":19.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 ML"}]},{"description":"VANCOMYCIN HCL IN NACL 1.5-0.9 GM/250ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3370","type":"HCPCS"},{"code":"70092905605","type":"NDC"}],"standard_charges":[{"gross_charge":152.79,"discounted_cash":152.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 ML"}]},{"description":"LACTATED RINGERS IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J7120","type":"HCPCS"},{"code":"00264775020","type":"NDC"}],"standard_charges":[{"gross_charge":14.38,"discounted_cash":14.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"PROPOFOL 200 MG/20ML IV EMUL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2704","type":"HCPCS"},{"code":"00409601025","type":"NDC"}],"standard_charges":[{"gross_charge":25.41,"discounted_cash":25.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6.4 ML"}]},{"description":"DOBUTAMINE-DEXTROSE 1-5 MG/ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1250","type":"HCPCS"},{"code":"00338107302","type":"NDC"}],"standard_charges":[{"gross_charge":354.96,"discounted_cash":354.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 ML"}]},{"description":"PROPOFOL 200 MG/20ML IV EMUL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2704","type":"HCPCS"},{"code":"00069020910","type":"NDC"}],"standard_charges":[{"gross_charge":14.56,"discounted_cash":14.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"FUROSEMIDE 10 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1940","type":"HCPCS"},{"code":"63323028010","type":"NDC"}],"standard_charges":[{"gross_charge":18.41,"discounted_cash":18.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"PROPOFOL 200 MG/20ML IV EMUL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2704","type":"HCPCS"},{"code":"23155034544","type":"NDC"}],"standard_charges":[{"gross_charge":14.38,"discounted_cash":14.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"PROPOFOL 1000 MG/100ML IV EMUL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2704","type":"HCPCS"},{"code":"23155034543","type":"NDC"}],"standard_charges":[{"gross_charge":124.88,"discounted_cash":124.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"BUPIVACAINE HCL (PF) 0.25 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0665","type":"HCPCS"},{"code":"55150016830","type":"NDC"}],"standard_charges":[{"gross_charge":36.56,"discounted_cash":36.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"ZOLEDRONIC ACID 5 MG/100ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3489","type":"HCPCS"},{"code":"67457079410","type":"NDC"}],"standard_charges":[{"gross_charge":208.76,"discounted_cash":208.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"FUROSEMIDE 10 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1940","type":"HCPCS"},{"code":"63323028002","type":"NDC"}],"standard_charges":[{"gross_charge":17.48,"discounted_cash":17.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"ESMOLOL HCL 100 MG/10ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1805","type":"HCPCS"},{"code":"55150019410","type":"NDC"}],"standard_charges":[{"gross_charge":16.28,"discounted_cash":16.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 ML"}]},{"description":"LEVETIRACETAM IN NACL 1000 MG/100ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1953","type":"HCPCS"},{"code":"55150024747","type":"NDC"}],"standard_charges":[{"gross_charge":122.17,"discounted_cash":122.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"BUMETANIDE 0.25 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1939","type":"HCPCS"},{"code":"00641600810","type":"NDC"}],"standard_charges":[{"gross_charge":34.33,"discounted_cash":34.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"NAROPIN 2 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2795","type":"HCPCS"},{"code":"63323028528","type":"NDC"}],"standard_charges":[{"gross_charge":93.1,"discounted_cash":93.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"KETOROLAC TROMETHAMINE 15 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1885","type":"HCPCS"},{"code":"25021070001","type":"NDC"}],"standard_charges":[{"gross_charge":21.68,"discounted_cash":21.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.667 ML"}]},{"description":"KETOROLAC TROMETHAMINE 15 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1885","type":"HCPCS"},{"code":"63323016101","type":"NDC"}],"standard_charges":[{"gross_charge":20.4,"discounted_cash":20.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"POTASSIUM CHLORIDE 20 MEQ/100ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3480","type":"HCPCS"},{"code":"00338070548","type":"NDC"}],"standard_charges":[{"gross_charge":20.42,"discounted_cash":20.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5.139 ML"}]},{"description":"LIDOCAINE HCL (PF) 0.5 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2003","type":"HCPCS"},{"code":"00409427801","type":"NDC"}],"standard_charges":[{"gross_charge":16.15,"discounted_cash":16.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"LEVOFLOXACIN IN D5W 500 MG/100ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1956","type":"HCPCS"},{"code":"00143972124","type":"NDC"}],"standard_charges":[{"gross_charge":40.33,"discounted_cash":40.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"DOPAMINE-DEXTROSE 1.6-5 MG/ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1265","type":"HCPCS"},{"code":"00409780922","type":"NDC"}],"standard_charges":[{"gross_charge":121.37,"discounted_cash":121.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 ML"}]},{"description":"KCL-LACTATED RINGERS-D5W 20 MEQ/L IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3480","type":"HCPCS"},{"code":"00990711109","type":"NDC"}],"standard_charges":[{"gross_charge":91.93,"discounted_cash":91.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"}]},{"description":"MAGNESIUM SULFATE IN D5W 1-5 GM/100ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3475","type":"HCPCS"},{"code":"00338170940","type":"NDC"}],"standard_charges":[{"gross_charge":33.03,"discounted_cash":33.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"LEVETIRACETAM IN NACL 1000 MG/100ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1953","type":"HCPCS"},{"code":"44567050210","type":"NDC"}],"standard_charges":[{"gross_charge":66.64,"discounted_cash":66.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"FUROSEMIDE 10 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1940","type":"HCPCS"},{"code":"36000028425","type":"NDC"}],"standard_charges":[{"gross_charge":28.58,"discounted_cash":28.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"MAGNESIUM SULFATE 4 GM/50ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3475","type":"HCPCS"},{"code":"44567042424","type":"NDC"}],"standard_charges":[{"gross_charge":55.87,"discounted_cash":55.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"VANCOMYCIN HCL 1000 MG/200ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3372","type":"HCPCS"},{"code":"70594004203","type":"NDC"}],"standard_charges":[{"gross_charge":80.98,"discounted_cash":80.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 ML"}]},{"description":"LIDOCAINE HCL (PF) 1 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2003","type":"HCPCS"},{"code":"00409427902","type":"NDC"}],"standard_charges":[{"gross_charge":16.03,"discounted_cash":16.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"MAGNESIUM SULFATE 2 GM/50ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3475","type":"HCPCS"},{"code":"70121171909","type":"NDC"}],"standard_charges":[{"gross_charge":57.83,"discounted_cash":57.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"MAGNESIUM SULFATE 2 GM/50ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3475","type":"HCPCS"},{"code":"00338170840","type":"NDC"}],"standard_charges":[{"gross_charge":58.48,"discounted_cash":58.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"GENTAMICIN IN SALINE 0.8-0.9 MG/ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1580","type":"HCPCS"},{"code":"00338050348","type":"NDC"}],"standard_charges":[{"gross_charge":61.08,"discounted_cash":61.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"POTASSIUM CHLORIDE 20 MEQ/50ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3480","type":"HCPCS"},{"code":"00338070341","type":"NDC"}],"standard_charges":[{"gross_charge":60.43,"discounted_cash":60.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"ACETAMINOPHEN 1000 MG/100 ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0131","type":"HCPCS"},{"code":"36000030660","type":"NDC"}],"standard_charges":[{"gross_charge":49.37,"discounted_cash":49.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"DIPHENHYDRAMINE HCL 50 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1200","type":"HCPCS"},{"code":"76045010210","type":"NDC"}],"standard_charges":[{"gross_charge":22.75,"discounted_cash":22.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 ML"}]},{"description":"HEPARIN SODIUM (PORCINE) 10000 UNIT/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"00409272101","type":"NDC"}],"standard_charges":[{"gross_charge":16.28,"discounted_cash":16.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.034 ML"}]},{"description":"LORAZEPAM 2 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2060","type":"HCPCS"},{"code":"00641604425","type":"NDC"}],"standard_charges":[{"gross_charge":17.77,"discounted_cash":17.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.13 ML"}]},{"description":"CALCIUM GLUCONATE 10 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0612","type":"HCPCS"},{"code":"75834017119","type":"NDC"}],"standard_charges":[{"gross_charge":115.46,"discounted_cash":115.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"GLYCOPYRROLATE 0.4 MG/2ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1596","type":"HCPCS"},{"code":"00517460225","type":"NDC"}],"standard_charges":[{"gross_charge":23.33,"discounted_cash":23.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"MIDAZOLAM HCL (PF) 5 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2250","type":"HCPCS"},{"code":"00409230801","type":"NDC"}],"standard_charges":[{"gross_charge":16.73,"discounted_cash":16.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.1 ML"}]},{"description":"METHOCARBAMOL 1000 MG/10ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2800","type":"HCPCS"},{"code":"63323077810","type":"NDC"}],"standard_charges":[{"gross_charge":51.19,"discounted_cash":51.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"LEVETIRACETAM 500 MG/5ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1953","type":"HCPCS"},{"code":"63323040044","type":"NDC"}],"standard_charges":[{"gross_charge":28.26,"discounted_cash":28.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 ML"}]},{"description":"KETOROLAC TROMETHAMINE 60 MG/2ML IM SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1885","type":"HCPCS"},{"code":"72266011925","type":"NDC"}],"standard_charges":[{"gross_charge":18.13,"discounted_cash":18.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"FLUOROURACIL 1 GM/20ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9190","type":"HCPCS"},{"code":"63323011720","type":"NDC"}],"standard_charges":[{"gross_charge":63.87,"discounted_cash":63.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"FUROSEMIDE 10 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1940","type":"HCPCS"},{"code":"71288020303","type":"NDC"}],"standard_charges":[{"gross_charge":22.94,"discounted_cash":22.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"FUROSEMIDE 10 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1940","type":"HCPCS"},{"code":"63323028016","type":"NDC"}],"standard_charges":[{"gross_charge":19.45,"discounted_cash":19.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"ACETAMINOPHEN 1000 MG/100 ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0134","type":"HCPCS"},{"code":"63323043400","type":"NDC"}],"standard_charges":[{"gross_charge":33.75,"discounted_cash":33.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 18.1 ML"}]},{"description":"HEPARIN SOD (PORCINE) IN D5W 100 UNIT/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"00409452030","type":"NDC"}],"standard_charges":[{"gross_charge":72.52,"discounted_cash":72.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 ML"}]},{"description":"FLUCONAZOLE IN SODIUM CHLORIDE 400-0.9 MG/200ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1450","type":"HCPCS"},{"code":"69784000306","type":"NDC"}],"standard_charges":[{"gross_charge":59.73,"discounted_cash":59.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 ML"}]},{"description":"DEXTROSE 5 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J7070","type":"HCPCS"},{"code":"00338001741","type":"NDC"}],"standard_charges":[{"gross_charge":61.53,"discounted_cash":61.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"AMIODARONE HCL 450 MG/9ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0282","type":"HCPCS"},{"code":"63323061609","type":"NDC"}],"standard_charges":[{"gross_charge":38.46,"discounted_cash":38.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"KETOROLAC TROMETHAMINE 60 MG/2ML IM SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1885","type":"HCPCS"},{"code":"63323016226","type":"NDC"}],"standard_charges":[{"gross_charge":21.77,"discounted_cash":21.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"FENTANYL CITRATE (PF) 250 MCG/5ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3010","type":"HCPCS"},{"code":"00409909425","type":"NDC"}],"standard_charges":[{"gross_charge":17.19,"discounted_cash":17.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 ML"}]},{"description":"OXALIPLATIN 100 MG/20ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9263","type":"HCPCS"},{"code":"60505613207","type":"NDC"}],"standard_charges":[{"gross_charge":38.66,"discounted_cash":38.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"PALONOSETRON HCL 0.25 MG/5ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2469","type":"HCPCS"},{"code":"60505619301","type":"NDC"}],"standard_charges":[{"gross_charge":39.11,"discounted_cash":39.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"FLUCONAZOLE IN SODIUM CHLORIDE 400-0.9 MG/200ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1450","type":"HCPCS"},{"code":"25021018487","type":"NDC"}],"standard_charges":[{"gross_charge":51.44,"discounted_cash":51.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 ML"}]},{"description":"HEPARIN (PORCINE) IN NACL 25000-0.45 UT/500ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"63323051877","type":"NDC"}],"standard_charges":[{"gross_charge":63.88,"discounted_cash":63.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 ML"}]},{"description":"MAGNESIUM SULFATE IN D5W 1-5 GM/100ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3475","type":"HCPCS"},{"code":"63323010801","type":"NDC"}],"standard_charges":[{"gross_charge":41.55,"discounted_cash":41.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"MAGNESIUM SULFATE IN D5W 1-5 GM/100ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3475","type":"HCPCS"},{"code":"63323010826","type":"NDC"}],"standard_charges":[{"gross_charge":41.55,"discounted_cash":41.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"DEXTROSE 5 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J7070","type":"HCPCS"},{"code":"00338001738","type":"NDC"}],"standard_charges":[{"gross_charge":53.34,"discounted_cash":53.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"LEVOFLOXACIN IN D5W 500 MG/100ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1956","type":"HCPCS"},{"code":"55150024447","type":"NDC"}],"standard_charges":[{"gross_charge":41.55,"discounted_cash":41.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"LACTATED RINGERS IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J7120","type":"HCPCS"},{"code":"00990795309","type":"NDC"}],"standard_charges":[{"gross_charge":23.56,"discounted_cash":23.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 ML"}]},{"description":"DEXTROSE 5 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J7070","type":"HCPCS"},{"code":"00990792203","type":"NDC"}],"standard_charges":[{"gross_charge":96.76,"discounted_cash":96.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 ML"}]},{"description":"DEXTROSE 5 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J7070","type":"HCPCS"},{"code":"00264751000","type":"NDC"}],"standard_charges":[{"gross_charge":60.2,"discounted_cash":60.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 850 ML"}]},{"description":"MAGNESIUM SULFATE 2 GM/50ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3475","type":"HCPCS"},{"code":"44567042024","type":"NDC"}],"standard_charges":[{"gross_charge":58.35,"discounted_cash":58.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"FUROSEMIDE 10 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1940","type":"HCPCS"},{"code":"23155047344","type":"NDC"}],"standard_charges":[{"gross_charge":24.37,"discounted_cash":24.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"}]},{"description":"MIDAZOLAM HCL (PF) 5 MG/5ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2250","type":"HCPCS"},{"code":"70069081710","type":"NDC"}],"standard_charges":[{"gross_charge":17.84,"discounted_cash":17.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"POTASSIUM CHLORIDE 20 MEQ/50ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3480","type":"HCPCS"},{"code":"00990707714","type":"NDC"}],"standard_charges":[{"gross_charge":48.68,"discounted_cash":48.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"FUROSEMIDE 10 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1940","type":"HCPCS"},{"code":"63323028036","type":"NDC"}],"standard_charges":[{"gross_charge":19.05,"discounted_cash":19.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"LEVOFLOXACIN IN D5W 500 MG/100ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1956","type":"HCPCS"},{"code":"44567043624","type":"NDC"}],"standard_charges":[{"gross_charge":76.23,"discounted_cash":76.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"FUROSEMIDE 10 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1940","type":"HCPCS"},{"code":"25021031104","type":"NDC"}],"standard_charges":[{"gross_charge":23.35,"discounted_cash":23.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"}]},{"description":"LEVETIRACETAM IN NACL 1000 MG/100ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1953","type":"HCPCS"},{"code":"43598063610","type":"NDC"}],"standard_charges":[{"gross_charge":80.45,"discounted_cash":80.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"VANCOMYCIN HCL 1500 MG/300ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3372","type":"HCPCS"},{"code":"70594004302","type":"NDC"}],"standard_charges":[{"gross_charge":113.72,"discounted_cash":113.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 ML"}]},{"description":"POTASSIUM CHLORIDE 2 MEQ/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3480","type":"HCPCS"},{"code":"63323096510","type":"NDC"}],"standard_charges":[{"gross_charge":26.88,"discounted_cash":26.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"LEVETIRACETAM IN NACL 500 MG/100ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1953","type":"HCPCS"},{"code":"44567050190","type":"NDC"}],"standard_charges":[{"gross_charge":46.76,"discounted_cash":46.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"BUPIVACAINE HCL (PF) 0.5 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0665","type":"HCPCS"},{"code":"55150017030","type":"NDC"}],"standard_charges":[{"gross_charge":28.18,"discounted_cash":28.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"ACETAMINOPHEN 1000 MG/100 ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0131","type":"HCPCS"},{"code":"67457094010","type":"NDC"}],"standard_charges":[{"gross_charge":57.66,"discounted_cash":57.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"VANCOMYCIN HCL 750 MG/150ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3372","type":"HCPCS"},{"code":"70594005603","type":"NDC"}],"standard_charges":[{"gross_charge":78.74,"discounted_cash":78.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 ML"}]},{"description":"DEXTROSE 5 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J7070","type":"HCPCS"},{"code":"00338001731","type":"NDC"}],"standard_charges":[{"gross_charge":56.41,"discounted_cash":56.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"KETOROLAC TROMETHAMINE 15 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1885","type":"HCPCS"},{"code":"63323016116","type":"NDC"}],"standard_charges":[{"gross_charge":20.4,"discounted_cash":20.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"LABETALOL HCL 5 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1921","type":"HCPCS"},{"code":"00143962201","type":"NDC"}],"standard_charges":[{"gross_charge":16.12,"discounted_cash":16.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"LIDOCAINE HCL 1 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2003","type":"HCPCS"},{"code":"55150025110","type":"NDC"}],"standard_charges":[{"gross_charge":16.12,"discounted_cash":16.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"MIDAZOLAM HCL 2 MG/2ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2250","type":"HCPCS"},{"code":"00641620925","type":"NDC"}],"standard_charges":[{"gross_charge":16.59,"discounted_cash":16.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"OCTREOTIDE ACETATE 100 MCG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2354","type":"HCPCS"},{"code":"63323037604","type":"NDC"}],"standard_charges":[{"gross_charge":31.3,"discounted_cash":31.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"OPDUALAG 240-80 MG/20ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9298","type":"HCPCS"},{"code":"00003712511","type":"NDC"}],"standard_charges":[{"gross_charge":151211.86,"discounted_cash":151211.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 ML"}]},{"description":"MORPHINE SULFATE-NACL 100-0.9 MG/100ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2270","type":"HCPCS"},{"code":"70092138036","type":"NDC"}],"standard_charges":[{"gross_charge":82.04,"discounted_cash":82.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"OCTREOTIDE ACETATE 50 MCG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2354","type":"HCPCS"},{"code":"00641617410","type":"NDC"}],"standard_charges":[{"gross_charge":34.72,"discounted_cash":34.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"DUPIXENT 300 MG/2ML SC SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"C9399","type":"HCPCS"},{"code":"00024591401","type":"NDC"}],"standard_charges":[{"gross_charge":5163.73,"discounted_cash":5163.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"OCREVUS 300 MG/10ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2350","type":"HCPCS"},{"code":"50242015001","type":"NDC"}],"standard_charges":[{"gross_charge":121805.49,"discounted_cash":121805.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"IMFINZI 500 MG/10ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9173","type":"HCPCS"},{"code":"00310461150","type":"NDC"}],"standard_charges":[{"gross_charge":63181.52,"discounted_cash":63181.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"PHENYLEPHRINE HCL (PRESSORS) 1 MG/10ML IV SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2371","type":"HCPCS"},{"code":"73177010803","type":"NDC"}],"standard_charges":[{"gross_charge":32.77,"discounted_cash":32.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"DEXAMETHASONE SOD PHOSPHATE PF 10 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1100","type":"HCPCS"},{"code":"63323050616","type":"NDC"}],"standard_charges":[{"gross_charge":19.84,"discounted_cash":19.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.2 ML"}]},{"description":"DEXAMETHASONE SOD PHOSPHATE PF 10 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1100","type":"HCPCS"},{"code":"63323050601","type":"NDC"}],"standard_charges":[{"gross_charge":19.89,"discounted_cash":19.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.2 ML"}]},{"description":"DEXAMETHASONE SOD PHOSPHATE PF 10 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1100","type":"HCPCS"},{"code":"70069002125","type":"NDC"}],"standard_charges":[{"gross_charge":18.34,"discounted_cash":18.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.1 ML"}]},{"description":"DEXAMETHASONE SOD PHOSPHATE PF 10 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1100","type":"HCPCS"},{"code":"55150030425","type":"NDC"}],"standard_charges":[{"gross_charge":24.69,"discounted_cash":24.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.2 ML"}]},{"description":"DEXAMETHASONE SOD PHOSPHATE PF 10 MG/ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1100","type":"HCPCS"},{"code":"76045010910","type":"NDC"}],"standard_charges":[{"gross_charge":23.11,"discounted_cash":23.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.2 ML"}]},{"description":"OCTREOTIDE ACETATE 100 MCG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2354","type":"HCPCS"},{"code":"00641617510","type":"NDC"}],"standard_charges":[{"gross_charge":36.29,"discounted_cash":36.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"HYDROMORPHONE HCL 1 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1171","type":"HCPCS"},{"code":"00409128331","type":"NDC"}],"standard_charges":[{"gross_charge":18.25,"discounted_cash":18.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.1 ML"}]},{"description":"METRONIDAZOLE 500 MG/100ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1836","type":"HCPCS"},{"code":"00409015224","type":"NDC"}],"standard_charges":[{"gross_charge":43.25,"discounted_cash":43.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"METRONIDAZOLE 500 MG/100ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1836","type":"HCPCS"},{"code":"25021013182","type":"NDC"}],"standard_charges":[{"gross_charge":40.33,"discounted_cash":40.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"PHENYLEPHRINE HCL (PRESSORS) 1 MG/10ML IV SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2371","type":"HCPCS"},{"code":"71449000115","type":"NDC"}],"standard_charges":[{"gross_charge":19.34,"discounted_cash":19.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"PHENYLEPHRINE HCL-NACL 1-0.9 MG/10ML-% IV SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2371","type":"HCPCS"},{"code":"70092104646","type":"NDC"}],"standard_charges":[{"gross_charge":19.95,"discounted_cash":19.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"ALUM & MAG HYDROXIDE-SIMETH 1200-1200-120 MG/30ML PO SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"57237031631","type":"NDC"}],"standard_charges":[{"gross_charge":28.32,"discounted_cash":28.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"MINERAL OIL PO OIL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"48433020230","type":"NDC"}],"standard_charges":[{"gross_charge":11.89,"discounted_cash":11.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"IPRATROPIUM-ALBUTEROL 0.5-2.5 MG/3ML IN SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"47335075652","type":"NDC"}],"standard_charges":[{"gross_charge":6.62,"discounted_cash":6.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"ALBUTEROL SULFATE (2.5 MG/3ML) 0.083% IN NEBU","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"J7613","type":"HCPCS"},{"code":"00487950125","type":"NDC"}],"standard_charges":[{"gross_charge":8.33,"discounted_cash":8.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"ALBUTEROL SULFATE (2.5 MG/3ML) 0.083% IN NEBU","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"J7613","type":"HCPCS"},{"code":"00487950103","type":"NDC"}],"standard_charges":[{"gross_charge":8.33,"discounted_cash":8.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"SODIUM CHLORIDE 0.9 % IN NEBU","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00487930133","type":"NDC"}],"standard_charges":[{"gross_charge":8.33,"discounted_cash":8.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"GLYDO 2 % EX PRSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"25021067376","type":"NDC"}],"standard_charges":[{"gross_charge":72.12,"discounted_cash":72.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6 ML"}]},{"description":"GLYDO 2 % EX PRSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"25021067377","type":"NDC"}],"standard_charges":[{"gross_charge":88.08,"discounted_cash":88.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 11 ML"}]},{"description":"MARCAINE/EPINEPHRINE 0.5% -1:200000 IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0665","type":"HCPCS"},{"code":"00362055705","type":"NDC"}],"standard_charges":[{"gross_charge":59.87,"discounted_cash":59.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5.4 ML"}]},{"description":"HYDROMORPHONE HCL 1 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1170","type":"HCPCS"},{"code":"00409128337","type":"NDC"}],"standard_charges":[{"gross_charge":26.87,"discounted_cash":26.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 ML"}]},{"description":"CARDENE IV 40-0.83 MG/200ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2404","type":"HCPCS"},{"code":"43066001610","type":"NDC"}],"standard_charges":[{"gross_charge":319.64,"discounted_cash":319.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 ML"}]},{"description":"HYDROMORPHONE HCL 2 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1170","type":"HCPCS"},{"code":"00409131230","type":"NDC"}],"standard_charges":[{"gross_charge":22.9,"discounted_cash":22.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 ML"}]},{"description":"HYDROMORPHONE HCL 2 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1170","type":"HCPCS"},{"code":"00409131236","type":"NDC"}],"standard_charges":[{"gross_charge":21.65,"discounted_cash":21.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.1 ML"}]},{"description":"ACETAMINOPHEN 650 MG/20.3ML PO SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"81033000230","type":"NDC"}],"standard_charges":[{"gross_charge":20.14,"discounted_cash":20.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10.156 ML"}]},{"description":"DOCUSATE SODIUM 100 MG/10ML PO LIQD","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00904727972","type":"NDC"}],"standard_charges":[{"gross_charge":6.36,"discounted_cash":6.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"DOCUSATE SODIUM 100 MG/10ML PO LIQD","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"63739097610","type":"NDC"}],"standard_charges":[{"gross_charge":12.17,"discounted_cash":12.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"DOCUSATE SODIUM 100 MG/10ML PO LIQD","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00121187000","type":"NDC"}],"standard_charges":[{"gross_charge":8.82,"discounted_cash":8.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"ACETAMINOPHEN 650 MG/20.3ML PO SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"60687074037","type":"NDC"}],"standard_charges":[{"gross_charge":15.89,"discounted_cash":15.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10.95 ML"}]},{"description":"DIPHENHYDRAMINE HCL 12.5 MG/5ML PO LIQD","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"69339015219","type":"NDC"}],"standard_charges":[{"gross_charge":14.94,"discounted_cash":14.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3.333 ML"}]},{"description":"DIPHENHYDRAMINE HCL 12.5 MG/5ML PO LIQD","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"69339015217","type":"NDC"}],"standard_charges":[{"gross_charge":32.24,"discounted_cash":32.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"MAG-AL PLUS 200-200-20 MG/5ML PO LIQD","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00121176130","type":"NDC"}],"standard_charges":[{"gross_charge":14.99,"discounted_cash":14.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"MAG-AL PLUS XS 400-400-40 MG/5ML PO LIQD","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00121176230","type":"NDC"}],"standard_charges":[{"gross_charge":20.63,"discounted_cash":20.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"IBUPROFEN CHILDRENS 100 MG/5ML PO SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"68094060061","type":"NDC"}],"standard_charges":[{"gross_charge":43.01,"discounted_cash":43.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"PULMOZYME 2.5 MG/2.5ML IN SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"50242010040","type":"NDC"}],"standard_charges":[{"gross_charge":1136.38,"discounted_cash":1136.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"MORPHINE SULFATE (PF) 4 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2270","type":"HCPCS"},{"code":"00409189101","type":"NDC"}],"standard_charges":[{"gross_charge":26.94,"discounted_cash":26.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"MORPHINE SULFATE (PF) 4 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2270","type":"HCPCS"},{"code":"00409189123","type":"NDC"}],"standard_charges":[{"gross_charge":42.65,"discounted_cash":42.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"HYDROMORPHONE HCL PF 2 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1170","type":"HCPCS"},{"code":"63323085325","type":"NDC"}],"standard_charges":[{"gross_charge":17.25,"discounted_cash":17.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.1 ML"}]},{"description":"MORPHINE SULFATE 4 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2270","type":"HCPCS"},{"code":"00641612525","type":"NDC"}],"standard_charges":[{"gross_charge":19.75,"discounted_cash":19.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.13 ML"}]},{"description":"MORPHINE SULFATE (PF) 2 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2270","type":"HCPCS"},{"code":"00409189001","type":"NDC"}],"standard_charges":[{"gross_charge":21.1,"discounted_cash":21.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 ML"}]},{"description":"MORPHINE SULFATE (PF) 2 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2270","type":"HCPCS"},{"code":"00409189023","type":"NDC"}],"standard_charges":[{"gross_charge":32.15,"discounted_cash":32.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"MORPHINE SULFATE 2 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2272","type":"HCPCS"},{"code":"76045000411","type":"NDC"}],"standard_charges":[{"gross_charge":30.41,"discounted_cash":30.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"MORPHINE SULFATE-NACL 1-0.9 MG/ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2270","type":"HCPCS"},{"code":"70092161379","type":"NDC"}],"standard_charges":[{"gross_charge":289.07,"discounted_cash":289.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"MIDAZOLAM-SODIUM CHLORIDE 100-0.9 MG/100ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2251","type":"HCPCS"},{"code":"70092141836","type":"NDC"}],"standard_charges":[{"gross_charge":362.33,"discounted_cash":362.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 ML"}]},{"description":"MIDAZOLAM-SODIUM CHLORIDE 100-0.9 MG/100ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2251","type":"HCPCS"},{"code":"44567061110","type":"NDC"}],"standard_charges":[{"gross_charge":249.54,"discounted_cash":249.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 ML"}]},{"description":"METRONIDAZOLE 500 MG/100ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1836","type":"HCPCS"},{"code":"00338105548","type":"NDC"}],"standard_charges":[{"gross_charge":38.77,"discounted_cash":38.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"METRONIDAZOLE 500 MG/100ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1836","type":"HCPCS"},{"code":"00338954124","type":"NDC"}],"standard_charges":[{"gross_charge":33.03,"discounted_cash":33.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"METRONIDAZOLE 500 MG/100ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1836","type":"HCPCS"},{"code":"47335099301","type":"NDC"}],"standard_charges":[{"gross_charge":46.76,"discounted_cash":46.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"HYDROMORPHONE HCL 1 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1170","type":"HCPCS"},{"code":"00641616901","type":"NDC"}],"standard_charges":[{"gross_charge":32.46,"discounted_cash":32.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"HYDROMORPHONE HCL 1 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1170","type":"HCPCS"},{"code":"00641620610","type":"NDC"}],"standard_charges":[{"gross_charge":39.8,"discounted_cash":39.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"HYDROMORPHONE HCL 2 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1170","type":"HCPCS"},{"code":"00409336510","type":"NDC"}],"standard_charges":[{"gross_charge":17.22,"discounted_cash":17.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.1 ML"}]},{"description":"HYDROMORPHONE HCL 2 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1170","type":"HCPCS"},{"code":"00641615125","type":"NDC"}],"standard_charges":[{"gross_charge":18.99,"discounted_cash":18.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.1 ML"}]},{"description":"MORPHINE SULFATE (PF) 2 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2272","type":"HCPCS"},{"code":"63323045201","type":"NDC"}],"standard_charges":[{"gross_charge":28.17,"discounted_cash":28.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"CARDENE IV 40-0.83 MG/200ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2404","type":"HCPCS"},{"code":"43066002810","type":"NDC"}],"standard_charges":[{"gross_charge":266.92,"discounted_cash":266.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 ML"}]},{"description":"GARDASIL 9 0.5 ML IM SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"90651","type":"HCPCS"},{"code":"00006411903","type":"NDC"}],"standard_charges":[{"gross_charge":600.39,"discounted_cash":600.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"MARCAINE/EPINEPHRINE PF 0.25% -1:200000 IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0665","type":"HCPCS"},{"code":"00409174630","type":"NDC"}],"standard_charges":[{"gross_charge":24.34,"discounted_cash":24.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"IPRATROPIUM BROMIDE 0.02 % IN SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00487980101","type":"NDC"}],"standard_charges":[{"gross_charge":9.61,"discounted_cash":9.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 ML"}]},{"description":"SODIUM CHLORIDE 3 % IN NEBU","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00487900330","type":"NDC"}],"standard_charges":[{"gross_charge":14.53,"discounted_cash":14.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"}]},{"description":"IPRATROPIUM-ALBUTEROL 0.5-2.5 MG/3ML IN SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"60687040583","type":"NDC"}],"standard_charges":[{"gross_charge":9.74,"discounted_cash":9.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"ALBUMIN HUMAN 5 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"P9045","type":"HCPCS"},{"code":"68982062302","type":"NDC"}],"standard_charges":[{"gross_charge":292.56,"discounted_cash":292.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 ML"}]},{"description":"ALBUMIN HUMAN 5 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"P9045","type":"HCPCS"},{"code":"68982062303","type":"NDC"}],"standard_charges":[{"gross_charge":438.51,"discounted_cash":438.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 ML"}]},{"description":"MARCAINE SPINAL 0.75-8.25 % IT SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0665","type":"HCPCS"},{"code":"00409176110","type":"NDC"}],"standard_charges":[{"gross_charge":21.45,"discounted_cash":21.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.1 ML"}]},{"description":"BUPIVACAINE SPINAL 0.75-8.25 % IT SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0665","type":"HCPCS"},{"code":"00409361301","type":"NDC"}],"standard_charges":[{"gross_charge":18.67,"discounted_cash":18.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.1 ML"}]},{"description":"PROCRIT 10000 UNIT/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0885","type":"HCPCS"},{"code":"59676031001","type":"NDC"}],"standard_charges":[{"gross_charge":401.99,"discounted_cash":401.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"PROCRIT 4000 UNIT/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0885","type":"HCPCS"},{"code":"59676030401","type":"NDC"}],"standard_charges":[{"gross_charge":299.09,"discounted_cash":299.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.75 ML"}]},{"description":"EPOGEN 4000 UNIT/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0885","type":"HCPCS"},{"code":"55513014810","type":"NDC"}],"standard_charges":[{"gross_charge":308.73,"discounted_cash":308.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.25 ML"}]},{"description":"KENALOG-40 40 MG/ML IJ SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3301","type":"HCPCS"},{"code":"00003029305","type":"NDC"}],"standard_charges":[{"gross_charge":20.69,"discounted_cash":20.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.038 ML"}]},{"description":"TIGAN 100 MG/ML IM SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3250","type":"HCPCS"},{"code":"42023011925","type":"NDC"}],"standard_charges":[{"gross_charge":192.32,"discounted_cash":192.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"ADENOSINE (DIAGNOSTIC) 3 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0153","type":"HCPCS"},{"code":"55150019301","type":"NDC"}],"standard_charges":[{"gross_charge":344.62,"discounted_cash":344.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"SODIUM CHLORIDE 10 % IN NEBU","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00378699889","type":"NDC"}],"standard_charges":[{"gross_charge":6.15,"discounted_cash":6.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"ADENOSINE (DIAGNOSTIC) 3 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0153","type":"HCPCS"},{"code":"23155025832","type":"NDC"}],"standard_charges":[{"gross_charge":38.34,"discounted_cash":38.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"}]},{"description":"BEXSERO 0.5 ML IM SUSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"90620","type":"HCPCS"},{"code":"58160097620","type":"NDC"}],"standard_charges":[{"gross_charge":487.0,"discounted_cash":487.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"OPDIVO 40 MG/4ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9299","type":"HCPCS"},{"code":"00003377211","type":"NDC"}],"standard_charges":[{"gross_charge":5267.07,"discounted_cash":5267.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"DARZALEX 100 MG/5ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9145","type":"HCPCS"},{"code":"57894050505","type":"NDC"}],"standard_charges":[{"gross_charge":12484.87,"discounted_cash":12484.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"ZYVOX 600 MG/300ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2020","type":"HCPCS"},{"code":"00009780702","type":"NDC"}],"standard_charges":[{"gross_charge":65.26,"discounted_cash":65.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 ML"}]},{"description":"ZYVOX 600 MG/300ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2020","type":"HCPCS"},{"code":"00009514004","type":"NDC"}],"standard_charges":[{"gross_charge":65.26,"discounted_cash":65.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 ML"}]},{"description":"DARZALEX 400 MG/20ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9145","type":"HCPCS"},{"code":"57894050520","type":"NDC"}],"standard_charges":[{"gross_charge":15464.33,"discounted_cash":15464.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"DIPRIVAN 200 MG/20ML IV EMUL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2704","type":"HCPCS"},{"code":"63323026929","type":"NDC"}],"standard_charges":[{"gross_charge":12.86,"discounted_cash":12.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.2 ML"}]},{"description":"DIPRIVAN 200 MG/20ML IV EMUL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2704","type":"HCPCS"},{"code":"63323026994","type":"NDC"}],"standard_charges":[{"gross_charge":14.71,"discounted_cash":14.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"DIPRIVAN 500 MG/50ML IV EMUL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2704","type":"HCPCS"},{"code":"63323026950","type":"NDC"}],"standard_charges":[{"gross_charge":76.06,"discounted_cash":76.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 49.215 ML"}]},{"description":"DIPRIVAN 500 MG/50ML IV EMUL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2704","type":"HCPCS"},{"code":"63323026959","type":"NDC"}],"standard_charges":[{"gross_charge":76.14,"discounted_cash":76.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 49.28 ML"}]},{"description":"DIPRIVAN 1000 MG/100ML IV EMUL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2704","type":"HCPCS"},{"code":"63323026969","type":"NDC"}],"standard_charges":[{"gross_charge":15.03,"discounted_cash":15.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.152 ML"}]},{"description":"DIPRIVAN 1000 MG/100ML IV EMUL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2704","type":"HCPCS"},{"code":"63323026965","type":"NDC"}],"standard_charges":[{"gross_charge":140.75,"discounted_cash":140.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 99.225 ML"}]},{"description":"LOVENOX 80 MG/0.8ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"00075801810","type":"NDC"}],"standard_charges":[{"gross_charge":25.95,"discounted_cash":25.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.1 ML"}]},{"description":"ALBUMIN HUMAN 25 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"P9046","type":"HCPCS"},{"code":"68982064302","type":"NDC"}],"standard_charges":[{"gross_charge":445.19,"discounted_cash":445.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"IPRATROPIUM BROMIDE 0.02 % IN SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"76204010030","type":"NDC"}],"standard_charges":[{"gross_charge":7.98,"discounted_cash":7.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 ML"}]},{"description":"IPRATROPIUM BROMIDE 0.02 % IN SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00378797055","type":"NDC"}],"standard_charges":[{"gross_charge":8.24,"discounted_cash":8.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 ML"}]},{"description":"HYDROCODONE-ACETAMINOPHEN 7.5-325 MG/15ML PO SOLN UNIT DOSE","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"60687041771","type":"NDC"}],"standard_charges":[{"gross_charge":33.55,"discounted_cash":33.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"MARCAINE/EPINEPHRINE PF 0.25% -1:200000 IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0665","type":"HCPCS"},{"code":"00409174610","type":"NDC"}],"standard_charges":[{"gross_charge":34.0,"discounted_cash":34.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"SENSORCAINE-MPF/EPINEPHRINE 0.5% -1:200000 IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0665","type":"HCPCS"},{"code":"63323046238","type":"NDC"}],"standard_charges":[{"gross_charge":29.82,"discounted_cash":29.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"MARCAINE/EPINEPHRINE PF 0.5% -1:200000 IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0665","type":"HCPCS"},{"code":"00409174910","type":"NDC"}],"standard_charges":[{"gross_charge":24.04,"discounted_cash":24.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"SENSORCAINE-MPF/EPINEPHRINE 0.5% -1:200000 IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0665","type":"HCPCS"},{"code":"63323046231","type":"NDC"}],"standard_charges":[{"gross_charge":45.94,"discounted_cash":45.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"MARCAINE/EPINEPHRINE PF 0.5% -1:200000 IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0665","type":"HCPCS"},{"code":"00409174929","type":"NDC"}],"standard_charges":[{"gross_charge":57.01,"discounted_cash":57.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"SENSORCAINE-MPF/EPINEPHRINE 0.5% -1:200000 IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0665","type":"HCPCS"},{"code":"63323046217","type":"NDC"}],"standard_charges":[{"gross_charge":32.56,"discounted_cash":32.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"SENSORCAINE-MPF/EPINEPHRINE 0.5% -1:200000 IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0665","type":"HCPCS"},{"code":"63323046237","type":"NDC"}],"standard_charges":[{"gross_charge":32.09,"discounted_cash":32.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"GARDASIL 9 0.5 ML IM SUSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"90651","type":"HCPCS"},{"code":"00006412102","type":"NDC"}],"standard_charges":[{"gross_charge":848.86,"discounted_cash":848.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"SENSORCAINE-MPF/EPINEPHRINE 0.25% -1:200000 IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0665","type":"HCPCS"},{"code":"63323046817","type":"NDC"}],"standard_charges":[{"gross_charge":34.13,"discounted_cash":34.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"SENSORCAINE-MPF/EPINEPHRINE 0.25% -1:200000 IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0665","type":"HCPCS"},{"code":"63323046837","type":"NDC"}],"standard_charges":[{"gross_charge":29.86,"discounted_cash":29.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"}]},{"description":"RECK 123-0.25-0.04- 15 MG/50ML PERIARTICULA SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"70092143350","type":"NDC"}],"standard_charges":[{"gross_charge":49.1,"discounted_cash":49.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 ML"}]},{"description":"HEPARIN NA (PORK) LOCK FLSH PF 10 UNIT/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1642","type":"HCPCS"},{"code":"08290306413","type":"NDC"}],"standard_charges":[{"gross_charge":17.69,"discounted_cash":17.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"SODIUM BICARBONATE 8.4 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3490","type":"HCPCS"},{"code":"63323008950","type":"NDC"}],"standard_charges":[{"gross_charge":17.26,"discounted_cash":17.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"BUPIVACAINE-EPINEPHRINE (PF) 0.25% -1:200000 IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0665","type":"HCPCS"},{"code":"00409904201","type":"NDC"}],"standard_charges":[{"gross_charge":48.24,"discounted_cash":48.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"SODIUM BICARBONATE 4.2 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3490","type":"HCPCS"},{"code":"63323008305","type":"NDC"}],"standard_charges":[{"gross_charge":36.03,"discounted_cash":36.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"MOXIFLOXACIN HCL-BSS 1 MG/ML IZ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"71449009642","type":"NDC"}],"standard_charges":[{"gross_charge":58.59,"discounted_cash":58.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.333 ML"}]},{"description":"NITROPRUSSIDE SODIUM 25 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"C9399","type":"HCPCS"},{"code":"14789001202","type":"NDC"}],"standard_charges":[{"gross_charge":500.67,"discounted_cash":500.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"CARDENE IV 20-0.86 MG/200ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2404","type":"HCPCS"},{"code":"43066002610","type":"NDC"}],"standard_charges":[{"gross_charge":277.02,"discounted_cash":277.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 ML"}]},{"description":"SODIUM CHLORIDE 0.9 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"00264180032","type":"NDC"}],"standard_charges":[{"gross_charge":43.11,"discounted_cash":43.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"HEPARIN NA (PORK) LOCK FLSH PF 10 UNIT/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1642","type":"HCPCS"},{"code":"08290306414","type":"NDC"}],"standard_charges":[{"gross_charge":19.91,"discounted_cash":19.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"SODIUM CHLORIDE (PF) 0.9 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J7030","type":"HCPCS"},{"code":"00409488810","type":"NDC"}],"standard_charges":[{"gross_charge":21.82,"discounted_cash":21.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 9 ML"}]},{"description":"HEPARIN NA (PORK) LOCK FLSH PF 10 UNIT/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1642","type":"HCPCS"},{"code":"63807050055","type":"NDC"}],"standard_charges":[{"gross_charge":16.93,"discounted_cash":16.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"HEPARIN NA (PORK) LOCK FLSH PF 100 UNIT/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1642","type":"HCPCS"},{"code":"08290306424","type":"NDC"}],"standard_charges":[{"gross_charge":22.52,"discounted_cash":22.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"SODIUM CHLORIDE (PF) 0.9 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J7030","type":"HCPCS"},{"code":"63323018610","type":"NDC"}],"standard_charges":[{"gross_charge":19.97,"discounted_cash":19.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"}]},{"description":"NICARDIPINE HCL IN NACL 20-0.9 MG/200ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2404","type":"HCPCS"},{"code":"00143963410","type":"NDC"}],"standard_charges":[{"gross_charge":152.79,"discounted_cash":152.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 ML"}]},{"description":"SODIUM CHLORIDE 0.9 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"00264780009","type":"NDC"}],"standard_charges":[{"gross_charge":54.58,"discounted_cash":54.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"}]},{"description":"HEPARIN NA (PORK) LOCK FLSH PF 10 UNIT/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1642","type":"HCPCS"},{"code":"64253022235","type":"NDC"}],"standard_charges":[{"gross_charge":17.71,"discounted_cash":17.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.5 ML"}]},{"description":"SODIUM CHLORIDE 0.9 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"00338004903","type":"NDC"}],"standard_charges":[{"gross_charge":75.67,"discounted_cash":75.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 ML"}]},{"description":"LEVETIRACETAM 100 MG/ML PO SOLN UNIT DOSE","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"60687024977","type":"NDC"}],"standard_charges":[{"gross_charge":73.12,"discounted_cash":73.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"L.E.T. 4-0.05-0.5 % EX GEL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"70092161243","type":"NDC"}],"standard_charges":[{"gross_charge":231.3,"discounted_cash":231.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"LOVENOX 100 MG/ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"00075062300","type":"NDC"}],"standard_charges":[{"gross_charge":26.52,"discounted_cash":26.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.1 ML"}]},{"description":"FORMOTEROL FUMARATE 20 MCG/2ML IN NEBU","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"J7606","type":"HCPCS"},{"code":"00378163193","type":"NDC"}],"standard_charges":[{"gross_charge":92.05,"discounted_cash":92.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"OXYCODONE HCL 5 MG/5ML PO SOLN UNIT DOSE","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00121482750","type":"NDC"}],"standard_charges":[{"gross_charge":66.43,"discounted_cash":66.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"IODIXANOL 320 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"255","type":"RC"},{"code":"Q9967","type":"HCPCS"},{"code":"65219038305","type":"NDC"}],"standard_charges":[{"gross_charge":32.47,"discounted_cash":32.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"GADOBUTROL 1 MMOL/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"255","type":"RC"},{"code":"A9585","type":"HCPCS"},{"code":"65219028110","type":"NDC"}],"standard_charges":[{"gross_charge":101.64,"discounted_cash":101.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4.7 ML"}]},{"description":"GADOBUTROL 1 MMOL/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"255","type":"RC"},{"code":"A9585","type":"HCPCS"},{"code":"65219028107","type":"NDC"}],"standard_charges":[{"gross_charge":93.04,"discounted_cash":93.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4.3 ML"}]},{"description":"GADOTERATE MEGLUMINE 7.5 MMOL/15ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"255","type":"RC"},{"code":"A9575","type":"HCPCS"},{"code":"65219008415","type":"NDC"}],"standard_charges":[{"gross_charge":297.73,"discounted_cash":297.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"VISIPAQUE 320 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"255","type":"RC"},{"code":"Q9967","type":"HCPCS"},{"code":"00407222321","type":"NDC"}],"standard_charges":[{"gross_charge":412.38,"discounted_cash":412.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 ML"}]},{"description":"VISIPAQUE 320 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"255","type":"RC"},{"code":"Q9967","type":"HCPCS"},{"code":"00407222316","type":"NDC"}],"standard_charges":[{"gross_charge":18.96,"discounted_cash":18.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"VISIPAQUE 320 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"255","type":"RC"},{"code":"Q9967","type":"HCPCS"},{"code":"00407222317","type":"NDC"}],"standard_charges":[{"gross_charge":18.96,"discounted_cash":18.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"VISIPAQUE 320 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"255","type":"RC"},{"code":"Q9967","type":"HCPCS"},{"code":"00407222319","type":"NDC"}],"standard_charges":[{"gross_charge":94.8,"discounted_cash":94.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 ML"}]},{"description":"EOVIST 0.25 MMOL/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"255","type":"RC"},{"code":"A9581","type":"HCPCS"},{"code":"50419032005","type":"NDC"}],"standard_charges":[{"gross_charge":691.95,"discounted_cash":691.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4.5 ML"}]},{"description":"VISIPAQUE 270 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"255","type":"RC"},{"code":"Q9966","type":"HCPCS"},{"code":"00407222219","type":"NDC"}],"standard_charges":[{"gross_charge":483.6,"discounted_cash":483.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 110 ML"}]},{"description":"VISIPAQUE 270 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"255","type":"RC"},{"code":"Q9966","type":"HCPCS"},{"code":"00407222217","type":"NDC"}],"standard_charges":[{"gross_charge":224.2,"discounted_cash":224.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 55 ML"}]},{"description":"VISIPAQUE 270 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"255","type":"RC"},{"code":"Q9966","type":"HCPCS"},{"code":"00407222216","type":"NDC"}],"standard_charges":[{"gross_charge":56.88,"discounted_cash":56.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"OMNIPAQUE 300 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"255","type":"RC"},{"code":"Q9967","type":"HCPCS"},{"code":"00407141361","type":"NDC"}],"standard_charges":[{"gross_charge":10.03,"discounted_cash":10.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"IODIXANOL 320 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"255","type":"RC"},{"code":"Q9967","type":"HCPCS"},{"code":"65219038310","type":"NDC"}],"standard_charges":[{"gross_charge":227.28,"discounted_cash":227.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 70 ML"}]},{"description":"OMNIPAQUE 300 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"255","type":"RC"},{"code":"Q9967","type":"HCPCS"},{"code":"00407141363","type":"NDC"}],"standard_charges":[{"gross_charge":7.37,"discounted_cash":7.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.75 ML"}]},{"description":"CYSTOGRAFIN-DILUTE 18 % UR SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"255","type":"RC"},{"code":"Q9958","type":"HCPCS"},{"code":"00270141030","type":"NDC"}],"standard_charges":[{"gross_charge":5.81,"discounted_cash":5.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"PROHANCE 279.3 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"255","type":"RC"},{"code":"A9579","type":"HCPCS"},{"code":"00270111101","type":"NDC"}],"standard_charges":[{"gross_charge":379.25,"discounted_cash":379.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6 ML"}]},{"description":"OMNIPAQUE 180 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"255","type":"RC"},{"code":"Q9965","type":"HCPCS"},{"code":"00407141110","type":"NDC"}],"standard_charges":[{"gross_charge":43.26,"discounted_cash":43.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"OMNIPAQUE 350 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"255","type":"RC"},{"code":"Q9967","type":"HCPCS"},{"code":"00407141493","type":"NDC"}],"standard_charges":[{"gross_charge":753.66,"discounted_cash":753.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 ML"}]},{"description":"SODIUM CITRATE-CITRIC ACID 500-334 MG/5ML PO SOLN UNIT DOSE","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00121119000","type":"NDC"}],"standard_charges":[{"gross_charge":70.1,"discounted_cash":70.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"NYSTATIN 100000 UNIT/ML MT SUSP BULK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"63739016010","type":"NDC"}],"standard_charges":[{"gross_charge":15.76,"discounted_cash":15.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"ACETAMINOPHEN 160 MG/5ML PO SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"81033000250","type":"NDC"}],"standard_charges":[{"gross_charge":49.63,"discounted_cash":49.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20.313 ML"}]},{"description":"GUAIFENESIN 100 MG/5ML PO LIQUID UNIT DOSE","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00121148800","type":"NDC"}],"standard_charges":[{"gross_charge":16.64,"discounted_cash":16.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"ALBUTEROL SULFATE 1.25 MG/3ML IN NEBU","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00487990401","type":"NDC"}],"standard_charges":[{"gross_charge":13.87,"discounted_cash":13.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"SUCRALFATE 1 GM/10ML PO SUSP UNIT DOSE","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"60687073856","type":"NDC"}],"standard_charges":[{"gross_charge":61.29,"discounted_cash":61.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"LEVETIRACETAM 100 MG/ML PO SOLN UNIT DOSE","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00904726594","type":"NDC"}],"standard_charges":[{"gross_charge":65.67,"discounted_cash":65.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"LEVETIRACETAM 100 MG/ML PO SOLN UNIT DOSE","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00121479950","type":"NDC"}],"standard_charges":[{"gross_charge":32.81,"discounted_cash":32.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"SUCRALFATE 1 GM/10ML PO SUSP UNIT DOSE","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00121097440","type":"NDC"}],"standard_charges":[{"gross_charge":79.9,"discounted_cash":79.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"OMNIPAQUE 300 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"255","type":"RC"},{"code":"Q9967","type":"HCPCS"},{"code":"00407141359","type":"NDC"}],"standard_charges":[{"gross_charge":29.98,"discounted_cash":29.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"MORPHINE SULFATE 10 MG/5ML PO SOLN UNIT DOSE","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"68094000162","type":"NDC"}],"standard_charges":[{"gross_charge":36.48,"discounted_cash":36.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"OMNIPAQUE 240 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"255","type":"RC"},{"code":"Q9966","type":"HCPCS"},{"code":"00407141220","type":"NDC"}],"standard_charges":[{"gross_charge":49.65,"discounted_cash":49.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"OMNIPAQUE 240 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"255","type":"RC"},{"code":"Q9966","type":"HCPCS"},{"code":"00407141210","type":"NDC"}],"standard_charges":[{"gross_charge":47.06,"discounted_cash":47.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"DOTAREM 2.5 MMOL/5ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"255","type":"RC"},{"code":"A9575","type":"HCPCS"},{"code":"67684200100","type":"NDC"}],"standard_charges":[{"gross_charge":53.98,"discounted_cash":53.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"DOTAREM 2.5 MMOL/5ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"255","type":"RC"},{"code":"A9575","type":"HCPCS"},{"code":"67684200000","type":"NDC"}],"standard_charges":[{"gross_charge":5.75,"discounted_cash":5.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.15 ML"}]},{"description":"GADAVIST 1 MMOL/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"255","type":"RC"},{"code":"A9585","type":"HCPCS"},{"code":"50419032513","type":"NDC"}],"standard_charges":[{"gross_charge":229.03,"discounted_cash":229.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7.5 ML"}]},{"description":"GADAVIST 1 MMOL/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"255","type":"RC"},{"code":"A9585","type":"HCPCS"},{"code":"50419032512","type":"NDC"}],"standard_charges":[{"gross_charge":164.08,"discounted_cash":164.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4.4 ML"}]},{"description":"GADAVIST 1 MMOL/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"255","type":"RC"},{"code":"A9585","type":"HCPCS"},{"code":"50419032511","type":"NDC"}],"standard_charges":[{"gross_charge":3.73,"discounted_cash":3.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.1 ML"}]},{"description":"ELUCIREM 0.5 MMOL/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"255","type":"RC"},{"code":"A9573","type":"HCPCS"},{"code":"67684423202","type":"NDC"}],"standard_charges":[{"gross_charge":297.73,"discounted_cash":297.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7.7 ML"}]},{"description":"VUEWAY 0.5 MMOL/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"255","type":"RC"},{"code":"A9573","type":"HCPCS"},{"code":"00270702540","type":"NDC"}],"standard_charges":[{"gross_charge":15.24,"discounted_cash":15.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.4 ML"}]},{"description":"ISOVUE-250 51 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"255","type":"RC"},{"code":"Q9967","type":"HCPCS"},{"code":"00270131702","type":"NDC"}],"standard_charges":[{"gross_charge":1.1,"discounted_cash":1.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"OMNIPAQUE 350 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"255","type":"RC"},{"code":"Q9967","type":"HCPCS"},{"code":"00407141489","type":"NDC"}],"standard_charges":[{"gross_charge":47.34,"discounted_cash":47.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"OMNIPAQUE 350 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"255","type":"RC"},{"code":"Q9967","type":"HCPCS"},{"code":"00407141490","type":"NDC"}],"standard_charges":[{"gross_charge":3.55,"discounted_cash":3.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.357 ML"}]},{"description":"ISOVUE-M 300 61 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"255","type":"RC"},{"code":"Q9967","type":"HCPCS"},{"code":"00270141215","type":"NDC"}],"standard_charges":[{"gross_charge":14.79,"discounted_cash":14.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"MILK OF MAGNESIA CONCENTRATE 2400 MG/10ML PO SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00121094000","type":"NDC"}],"standard_charges":[{"gross_charge":31.1,"discounted_cash":31.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"IBUPROFEN CHILDRENS 100 MG/5ML PO SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00121091400","type":"NDC"}],"standard_charges":[{"gross_charge":34.53,"discounted_cash":34.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"OMNIPAQUE 240 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"255","type":"RC"},{"code":"Q9966","type":"HCPCS"},{"code":"00407141230","type":"NDC"}],"standard_charges":[{"gross_charge":4.23,"discounted_cash":4.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"IBUPROFEN CHILDRENS 100 MG/5ML PO SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"68094049461","type":"NDC"}],"standard_charges":[{"gross_charge":40.73,"discounted_cash":40.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"MORPHINE SULFATE (CONCENTRATE) 100 MG/5ML PO SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"68094004558","type":"NDC"}],"standard_charges":[{"gross_charge":77.23,"discounted_cash":77.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.5 ML"}]},{"description":"VUEWAY 0.5 MMOL/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"255","type":"RC"},{"code":"A9573","type":"HCPCS"},{"code":"00270702038","type":"NDC"}],"standard_charges":[{"gross_charge":3.9,"discounted_cash":3.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.1 ML"}]},{"description":"VUEWAY 0.5 MMOL/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"255","type":"RC"},{"code":"A9573","type":"HCPCS"},{"code":"00270703042","type":"NDC"}],"standard_charges":[{"gross_charge":176.56,"discounted_cash":176.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4.5 ML"}]},{"description":"MULTIHANCE 529 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"255","type":"RC"},{"code":"A9577","type":"HCPCS"},{"code":"00270516413","type":"NDC"}],"standard_charges":[{"gross_charge":1.72,"discounted_cash":1.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.1 ML"}]},{"description":"MULTIHANCE 529 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"255","type":"RC"},{"code":"A9577","type":"HCPCS"},{"code":"00270516414","type":"NDC"}],"standard_charges":[{"gross_charge":148.28,"discounted_cash":148.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8.6 ML"}]},{"description":"MULTIHANCE 529 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"255","type":"RC"},{"code":"A9577","type":"HCPCS"},{"code":"00270516415","type":"NDC"}],"standard_charges":[{"gross_charge":403.14,"discounted_cash":403.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"ISOVUE-300 61 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"255","type":"RC"},{"code":"Q9967","type":"HCPCS"},{"code":"00270131550","type":"NDC"}],"standard_charges":[{"gross_charge":58.54,"discounted_cash":58.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 65 ML"}]},{"description":"ISOVUE-300 61 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"255","type":"RC"},{"code":"Q9967","type":"HCPCS"},{"code":"00270131525","type":"NDC"}],"standard_charges":[{"gross_charge":0.06,"discounted_cash":0.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.039 ML"}]},{"description":"ISOVUE-300 61 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"255","type":"RC"},{"code":"Q9967","type":"HCPCS"},{"code":"00270131535","type":"NDC"}],"standard_charges":[{"gross_charge":4.03,"discounted_cash":4.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"}]},{"description":"ISOVUE-300 61 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"255","type":"RC"},{"code":"Q9967","type":"HCPCS"},{"code":"00270131530","type":"NDC"}],"standard_charges":[{"gross_charge":3.79,"discounted_cash":3.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"}]},{"description":"OPTISON IV SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"255","type":"RC"},{"code":"Q9956","type":"HCPCS"},{"code":"00407270703","type":"NDC"}],"standard_charges":[{"gross_charge":155.71,"discounted_cash":155.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"CLARISCAN 10 MMOL/20ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"255","type":"RC"},{"code":"A9575","type":"HCPCS"},{"code":"00407294305","type":"NDC"}],"standard_charges":[{"gross_charge":540.83,"discounted_cash":540.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"DOTAREM 10 MMOL/20ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"255","type":"RC"},{"code":"A9575","type":"HCPCS"},{"code":"67684200103","type":"NDC"}],"standard_charges":[{"gross_charge":21.43,"discounted_cash":21.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.1 ML"}]},{"description":"MEGESTROL ACETATE 400 MG/10ML PO SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00121094500","type":"NDC"}],"standard_charges":[{"gross_charge":13.82,"discounted_cash":13.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"VALPROIC ACID 250 MG/5ML PO SOLN UNIT DOSE","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00121467500","type":"NDC"}],"standard_charges":[{"gross_charge":21.55,"discounted_cash":21.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"SENNA 8.8 MG/5ML PO SYRP UNIT DOSE","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"68094004962","type":"NDC"}],"standard_charges":[{"gross_charge":45.62,"discounted_cash":45.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"GABAPENTIN 300 MG/6ML PO SOLN UNIT DOSE","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"42192060840","type":"NDC"}],"standard_charges":[{"gross_charge":19.09,"discounted_cash":19.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"ALBUTEROL SULFATE 1.25 MG/3ML IN NEBU","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00487990425","type":"NDC"}],"standard_charges":[{"gross_charge":22.86,"discounted_cash":22.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6 ML"}]},{"description":"MEGESTROL ACETATE 40 MG/ML PO SUSP UNIT DOSE","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"68094006362","type":"NDC"}],"standard_charges":[{"gross_charge":11.37,"discounted_cash":11.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"GUAIFENESIN-DM 100-10 MG/5ML PO SYRP UNIT DOSE","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00121063800","type":"NDC"}],"standard_charges":[{"gross_charge":23.43,"discounted_cash":23.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"NYSTATIN 100000 UNIT/ML MT SUSP BULK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"60687080017","type":"NDC"}],"standard_charges":[{"gross_charge":19.27,"discounted_cash":19.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"VALPROIC ACID 250 MG/5ML PO SOLN UNIT DOSE","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00121135000","type":"NDC"}],"standard_charges":[{"gross_charge":35.02,"discounted_cash":35.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"SUCRALFATE 1 GM/10ML PO SUSP UNIT DOSE","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"50268074514","type":"NDC"}],"standard_charges":[{"gross_charge":64.23,"discounted_cash":64.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"GUAIFENESIN-CODEINE 100-10 MG/5ML PO SOLN UNIT DOSE","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00121177540","type":"NDC"}],"standard_charges":[{"gross_charge":48.81,"discounted_cash":48.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"OXYCODONE HCL 5 MG/5ML PO SOLN UNIT DOSE","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00121482740","type":"NDC"}],"standard_charges":[{"gross_charge":70.51,"discounted_cash":70.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"GUAIFENESIN-DM 100-10 MG/5ML PO SYRP UNIT DOSE","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00121127600","type":"NDC"}],"standard_charges":[{"gross_charge":19.19,"discounted_cash":19.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"SENNA 8.8 MG/5ML PO SYRP UNIT DOSE","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"48433021940","type":"NDC"}],"standard_charges":[{"gross_charge":50.68,"discounted_cash":50.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"GUAIFENESIN 100 MG/5ML PO LIQUID UNIT DOSE","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00121174400","type":"NDC"}],"standard_charges":[{"gross_charge":24.57,"discounted_cash":24.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"NYSTATIN 100000 UNIT/ML MT SUSP BULK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00121086850","type":"NDC"}],"standard_charges":[{"gross_charge":27.51,"discounted_cash":27.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"MIDAZOLAM HCL 2 MG/ML PO SYRP UNIT DOSE","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"68094076262","type":"NDC"}],"standard_charges":[{"gross_charge":30.79,"discounted_cash":30.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"DIAZEPAM 5 MG/5ML PO SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00121090594","type":"NDC"}],"standard_charges":[{"gross_charge":77.45,"discounted_cash":77.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"STERILE TOPICAL L.E.T. GEL 4-0.18-0.5 % EX GEL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"71266629001","type":"NDC"}],"standard_charges":[{"gross_charge":154.98,"discounted_cash":154.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"LACTULOSE 20 GM/30ML PO SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00116400541","type":"NDC"}],"standard_charges":[{"gross_charge":15.53,"discounted_cash":15.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"L.E.T. (RACEPINEPHRINE) 4-0.05-0.5 % EX SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"70092165844","type":"NDC"}],"standard_charges":[{"gross_charge":123.76,"discounted_cash":123.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"DONNATAL 16.2 MG/5ML PO ELIX","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"66689006310","type":"NDC"}],"standard_charges":[{"gross_charge":341.38,"discounted_cash":341.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"MILK OF MAGNESIA 2400 MG/30ML PO SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"69339015317","type":"NDC"}],"standard_charges":[{"gross_charge":26.53,"discounted_cash":26.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"MILK OF MAGNESIA 7.75 % PO SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00121043130","type":"NDC"}],"standard_charges":[{"gross_charge":9.94,"discounted_cash":9.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"MILK OF MAGNESIA 400 MG/5ML PO SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"60687042976","type":"NDC"}],"standard_charges":[{"gross_charge":10.5,"discounted_cash":10.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"MILK OF MAGNESIA 2400 MG/30ML PO SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"63739019610","type":"NDC"}],"standard_charges":[{"gross_charge":43.26,"discounted_cash":43.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"PERFOROMIST 20 MCG/2ML IN NEBU","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"49502060561","type":"NDC"}],"standard_charges":[{"gross_charge":79.12,"discounted_cash":79.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"PERFOROMIST 20 MCG/2ML IN NEBU","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"49502060530","type":"NDC"}],"standard_charges":[{"gross_charge":78.31,"discounted_cash":78.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"SPS (SODIUM POLYSTYRENE SULF) 15 GM/60ML CO SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"46287000660","type":"NDC"}],"standard_charges":[{"gross_charge":235.04,"discounted_cash":235.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 ML"}]},{"description":"ONDANSETRON HCL 4 MG/5ML PO SOLN UNIT DOSE","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"60687025286","type":"NDC"}],"standard_charges":[{"gross_charge":109.35,"discounted_cash":109.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"FORMOTEROL FUMARATE 20 MCG/2ML IN NEBU","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"70748026160","type":"NDC"}],"standard_charges":[{"gross_charge":63.15,"discounted_cash":63.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"FORMOTEROL FUMARATE 20 MCG/2ML IN NEBU","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"70756060870","type":"NDC"}],"standard_charges":[{"gross_charge":96.32,"discounted_cash":96.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"GABAPENTIN 250 MG/5ML PO SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"42192060845","type":"NDC"}],"standard_charges":[{"gross_charge":68.44,"discounted_cash":68.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6 ML"}]},{"description":"GUAIFENESIN-CODEINE 200-20 MG/10ML PO SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00121155040","type":"NDC"}],"standard_charges":[{"gross_charge":60.96,"discounted_cash":60.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"HYDROCODONE-ACETAMINOPHEN 7.5-325 MG/15ML PO SOLN UNIT DOSE","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00121231650","type":"NDC"}],"standard_charges":[{"gross_charge":46.77,"discounted_cash":46.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"SULFAMETHOXAZOLE-TRIMETHOPRIM 200-40 MG/5ML PO SUSP UNIT DOSE","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00121085340","type":"NDC"}],"standard_charges":[{"gross_charge":72.2,"discounted_cash":72.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"FERROUS SULFATE 300 (60 FE) MG/5ML PO SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00121053005","type":"NDC"}],"standard_charges":[{"gross_charge":33.58,"discounted_cash":33.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3.667 ML"}]},{"description":"SODIUM CHLORIDE 7 % IN NEBU","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00487900730","type":"NDC"}],"standard_charges":[{"gross_charge":24.64,"discounted_cash":24.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 ML"}]},{"description":"AMANTADINE HCL 50 MG/5ML PO SOLN UNIT DOSE","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00121064610","type":"NDC"}],"standard_charges":[{"gross_charge":55.42,"discounted_cash":55.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"SODIUM CHLORIDE 3 % IN NEBU","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"76204002260","type":"NDC"}],"standard_charges":[{"gross_charge":13.95,"discounted_cash":13.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"}]},{"description":"SENNA 8.8 MG/5ML PO SYRP UNIT DOSE","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"39328012050","type":"NDC"}],"standard_charges":[{"gross_charge":44.16,"discounted_cash":44.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"METHADONE HCL 5 MG/5ML PO SOLN UNIT DOSE","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"68094003162","type":"NDC"}],"standard_charges":[{"gross_charge":69.95,"discounted_cash":69.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"LEVETIRACETAM 100 MG/ML PO SOLN UNIT DOSE","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"69339015717","type":"NDC"}],"standard_charges":[{"gross_charge":44.77,"discounted_cash":44.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7.5 ML"}]},{"description":"FERROUS SULFATE 300 (60 FE) MG/5ML PO SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"39328015705","type":"NDC"}],"standard_charges":[{"gross_charge":56.88,"discounted_cash":56.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"LIDOCAINE VISCOUS HCL 2 % MT SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00121495040","type":"NDC"}],"standard_charges":[{"gross_charge":38.4,"discounted_cash":38.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"LEVALBUTEROL HCL 1.25 MG/3ML IN NEBU","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"J7620","type":"HCPCS"},{"code":"76204090001","type":"NDC"}],"standard_charges":[{"gross_charge":26.87,"discounted_cash":26.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"IPRATROPIUM-ALBUTEROL 0.5-2.5 MG/3ML IN SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"J7620","type":"HCPCS"},{"code":"76204060060","type":"NDC"}],"standard_charges":[{"gross_charge":7.71,"discounted_cash":7.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"IPRATROPIUM-ALBUTEROL 0.5-2.5 MG/3ML IN SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"76204060030","type":"NDC"}],"standard_charges":[{"gross_charge":7.71,"discounted_cash":7.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"IPRATROPIUM BROMIDE 0.02 % IN SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"76204010001","type":"NDC"}],"standard_charges":[{"gross_charge":9.09,"discounted_cash":9.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 ML"}]},{"description":"IPRATROPIUM-ALBUTEROL 0.5-2.5 MG/3ML IN SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00487020101","type":"NDC"}],"standard_charges":[{"gross_charge":9.97,"discounted_cash":9.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"IPRATROPIUM-ALBUTEROL 0.5-2.5 MG/3ML IN SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00378967193","type":"NDC"}],"standard_charges":[{"gross_charge":11.84,"discounted_cash":11.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"SODIUM CHLORIDE 3 % IN NEBU","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00378699789","type":"NDC"}],"standard_charges":[{"gross_charge":6.31,"discounted_cash":6.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"IPRATROPIUM-ALBUTEROL 0.5-2.5 MG/3ML IN SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00487020103","type":"NDC"}],"standard_charges":[{"gross_charge":8.41,"discounted_cash":8.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"IPRATROPIUM-ALBUTEROL 0.5-2.5 MG/3ML IN SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"J7620","type":"HCPCS"},{"code":"00487020160","type":"NDC"}],"standard_charges":[{"gross_charge":8.41,"discounted_cash":8.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"IPRATROPIUM-ALBUTEROL 0.5-2.5 MG/3ML IN SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"76204060001","type":"NDC"}],"standard_charges":[{"gross_charge":9.04,"discounted_cash":9.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"ALBUTEROL SULFATE (2.5 MG/3ML) 0.083% IN NEBU","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00487950101","type":"NDC"}],"standard_charges":[{"gross_charge":3.88,"discounted_cash":3.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"LACTULOSE 10 GM/15ML PO SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00121115400","type":"NDC"}],"standard_charges":[{"gross_charge":15.17,"discounted_cash":15.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7.6 ML"}]},{"description":"IPRATROPIUM BROMIDE 0.02 % IN SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"60687039483","type":"NDC"}],"standard_charges":[{"gross_charge":8.31,"discounted_cash":8.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 ML"}]},{"description":"IPRATROPIUM BROMIDE 0.02 % IN SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"J7644","type":"HCPCS"},{"code":"00487980130","type":"NDC"}],"standard_charges":[{"gross_charge":8.31,"discounted_cash":8.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 ML"}]},{"description":"POTASSIUM CHLORIDE 20 MEQ/15ML (10%) PO SOLN UNIT DOSE","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"60687062807","type":"NDC"}],"standard_charges":[{"gross_charge":50.03,"discounted_cash":50.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"LIDOCAINE HCL URETHRAL/MUCOSAL 2 % EX PRSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"76329301205","type":"NDC"}],"standard_charges":[{"gross_charge":79.99,"discounted_cash":79.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"MIDAZOLAM HCL 2 MG/ML PO SYRP UNIT DOSE","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"68094076462","type":"NDC"}],"standard_charges":[{"gross_charge":118.94,"discounted_cash":118.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"FORMOTEROL FUMARATE 20 MCG/2ML IN NEBU","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"70748026130","type":"NDC"}],"standard_charges":[{"gross_charge":63.47,"discounted_cash":63.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"FERROUS SULFATE 300 (60 FE) MG/5ML PO SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"50268033624","type":"NDC"}],"standard_charges":[{"gross_charge":48.24,"discounted_cash":48.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"DIPHENHYDRAMINE HCL 12.5 MG/5ML PO ELIX","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00121048900","type":"NDC"}],"standard_charges":[{"gross_charge":42.08,"discounted_cash":42.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3.333 ML"}]},{"description":"MIDAZOLAM HCL 2 MG/ML PO SYRP UNIT DOSE","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"60687057686","type":"NDC"}],"standard_charges":[{"gross_charge":22.52,"discounted_cash":22.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"LOVENOX 100 MG/ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"00075802010","type":"NDC"}],"standard_charges":[{"gross_charge":26.52,"discounted_cash":26.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.1 ML"}]},{"description":"LOVENOX 120 MG/0.8ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"00075802210","type":"NDC"}],"standard_charges":[{"gross_charge":59.5,"discounted_cash":59.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.8 ML"}]},{"description":"ONDANSETRON HCL 4 MG/2ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2405","type":"HCPCS"},{"code":"00409000925","type":"NDC"}],"standard_charges":[{"gross_charge":18.89,"discounted_cash":18.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"LIDOCAINE HCL (CARDIAC) 100 MG/5ML IV SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2003","type":"HCPCS"},{"code":"00409490334","type":"NDC"}],"standard_charges":[{"gross_charge":29.68,"discounted_cash":29.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"LIDOCAINE HCL (CARDIAC) PF 100 MG/5ML IV SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2003","type":"HCPCS"},{"code":"00409132305","type":"NDC"}],"standard_charges":[{"gross_charge":42.02,"discounted_cash":42.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 ML"}]},{"description":"FLUAD 0.5 ML IM SUSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"90653","type":"HCPCS"},{"code":"70461002403","type":"NDC"}],"standard_charges":[{"gross_charge":121.2,"discounted_cash":121.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 ML"}]},{"description":"PROVAYBLUE 50 MG/10ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"Q9968","type":"HCPCS"},{"code":"00517038105","type":"NDC"}],"standard_charges":[{"gross_charge":347.84,"discounted_cash":347.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"METHYLENE BLUE 50 MG/10ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"Q9968","type":"HCPCS"},{"code":"70710183805","type":"NDC"}],"standard_charges":[{"gross_charge":526.28,"discounted_cash":526.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"NESACAINE-MPF 3 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2401","type":"HCPCS"},{"code":"63323047827","type":"NDC"}],"standard_charges":[{"gross_charge":30.14,"discounted_cash":30.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"HYDROMORPHONE HCL-NACL 20-0.9 MG/100ML-% IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1171","type":"HCPCS"},{"code":"70092111675","type":"NDC"}],"standard_charges":[{"gross_charge":211.93,"discounted_cash":211.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"HYDROMORPHONE HCL-NACL 10-0.9 MG/50ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1171","type":"HCPCS"},{"code":"70092128674","type":"NDC"}],"standard_charges":[{"gross_charge":254.69,"discounted_cash":254.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"PROVAYBLUE 50 MG/10ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"Q9968","type":"HCPCS"},{"code":"00517037405","type":"NDC"}],"standard_charges":[{"gross_charge":39.43,"discounted_cash":39.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.4 ML"}]},{"description":"STELARA 130 MG/26ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3358","type":"HCPCS"},{"code":"57894005427","type":"NDC"}],"standard_charges":[{"gross_charge":24642.68,"discounted_cash":24642.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 104 ML"}]},{"description":"ZINPLAVA 1000 MG/40ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0565","type":"HCPCS"},{"code":"00006302500","type":"NDC"}],"standard_charges":[{"gross_charge":3238.6,"discounted_cash":3238.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 11.5 ML"}]},{"description":"CAMPTOSAR 300 MG/15ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9206","type":"HCPCS"},{"code":"00009008202","type":"NDC"}],"standard_charges":[{"gross_charge":311.6,"discounted_cash":311.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"AVASTIN 100 MG/4ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9035","type":"HCPCS"},{"code":"50242006001","type":"NDC"}],"standard_charges":[{"gross_charge":6461.21,"discounted_cash":6461.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"}]},{"description":"LIDOCAINE HCL 100 MG/5ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2003","type":"HCPCS"},{"code":"76329339001","type":"NDC"}],"standard_charges":[{"gross_charge":46.98,"discounted_cash":46.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"AVASTIN 400 MG/16ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9035","type":"HCPCS"},{"code":"50242006101","type":"NDC"}],"standard_charges":[{"gross_charge":15968.25,"discounted_cash":15968.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 16 ML"}]},{"description":"YERVOY 200 MG/40ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9228","type":"HCPCS"},{"code":"00003232822","type":"NDC"}],"standard_charges":[{"gross_charge":62257.63,"discounted_cash":62257.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 14.5 ML"}]},{"description":"NEXTERONE 150-4.21 MG/100ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0283","type":"HCPCS"},{"code":"43066015010","type":"NDC"}],"standard_charges":[{"gross_charge":163.88,"discounted_cash":163.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"NEXTERONE 360-4.14 MG/200ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0283","type":"HCPCS"},{"code":"43066036020","type":"NDC"}],"standard_charges":[{"gross_charge":219.32,"discounted_cash":219.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 ML"}]},{"description":"ALBUKED 25 25 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"P9046","type":"HCPCS"},{"code":"76125079225","type":"NDC"}],"standard_charges":[{"gross_charge":240.51,"discounted_cash":240.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"ALBUKED 25 25 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"P9046","type":"HCPCS"},{"code":"76125079210","type":"NDC"}],"standard_charges":[{"gross_charge":365.54,"discounted_cash":365.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"ALBUTEIN 25 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"P9046","type":"HCPCS"},{"code":"68516521609","type":"NDC"}],"standard_charges":[{"gross_charge":257.14,"discounted_cash":257.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"ALBUTEIN 25 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"P9046","type":"HCPCS"},{"code":"68516521602","type":"NDC"}],"standard_charges":[{"gross_charge":262.92,"discounted_cash":262.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"KEDBUMIN 25 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"P9047","type":"HCPCS"},{"code":"76179002504","type":"NDC"}],"standard_charges":[{"gross_charge":732.7,"discounted_cash":732.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 ML"}]},{"description":"ALBUTEIN 25 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"P9046","type":"HCPCS"},{"code":"68516521600","type":"NDC"}],"standard_charges":[{"gross_charge":257.86,"discounted_cash":257.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"ALBUTEIN 25 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"P9047","type":"HCPCS"},{"code":"68516521601","type":"NDC"}],"standard_charges":[{"gross_charge":265.09,"discounted_cash":265.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"SPEVIGO 450 MG/7.5ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1747","type":"HCPCS"},{"code":"00597003510","type":"NDC"}],"standard_charges":[{"gross_charge":153885.16,"discounted_cash":153885.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"FLEXBUMIN 25 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"P9046","type":"HCPCS"},{"code":"00944049302","type":"NDC"}],"standard_charges":[{"gross_charge":488.08,"discounted_cash":488.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"IMJUDO 300 MG/15ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9347","type":"HCPCS"},{"code":"00310453530","type":"NDC"}],"standard_charges":[{"gross_charge":202888.76,"discounted_cash":202888.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"YERVOY 50 MG/10ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9228","type":"HCPCS"},{"code":"00003232711","type":"NDC"}],"standard_charges":[{"gross_charge":13345.49,"discounted_cash":13345.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"ELAHERE 100 MG/20ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9063","type":"HCPCS"},{"code":"72903085301","type":"NDC"}],"standard_charges":[{"gross_charge":3597.53,"discounted_cash":3597.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"TECENTRIQ 1200 MG/20ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9022","type":"HCPCS"},{"code":"50242091701","type":"NDC"}],"standard_charges":[{"gross_charge":52511.83,"discounted_cash":52511.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"VEGZELMA 400 MG/16ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"Q5129","type":"HCPCS"},{"code":"72606001201","type":"NDC"}],"standard_charges":[{"gross_charge":16146.24,"discounted_cash":16146.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 16 ML"}]},{"description":"XOLAIR 150 MG/ML SC SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2357","type":"HCPCS"},{"code":"50242021501","type":"NDC"}],"standard_charges":[{"gross_charge":3415.42,"discounted_cash":3415.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"XOLAIR 75 MG/0.5ML SC SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2357","type":"HCPCS"},{"code":"50242021403","type":"NDC"}],"standard_charges":[{"gross_charge":2104.43,"discounted_cash":2104.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"XOLAIR 75 MG/0.5ML SC SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2357","type":"HCPCS"},{"code":"50242021401","type":"NDC"}],"standard_charges":[{"gross_charge":1994.86,"discounted_cash":1994.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"LIBTAYO 350 MG/7ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9119","type":"HCPCS"},{"code":"61755000801","type":"NDC"}],"standard_charges":[{"gross_charge":52029.84,"discounted_cash":52029.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7 ML"}]},{"description":"TWINRIX 720-20 ELU-MCG/ML IM SUSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"90636","type":"HCPCS"},{"code":"58160081552","type":"NDC"}],"standard_charges":[{"gross_charge":366.53,"discounted_cash":366.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"PROLIA 60 MG/ML SC SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0897","type":"HCPCS"},{"code":"55513071021","type":"NDC"}],"standard_charges":[{"gross_charge":5397.42,"discounted_cash":5397.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"TECENTRIQ 840 MG/14ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9022","type":"HCPCS"},{"code":"50242091801","type":"NDC"}],"standard_charges":[{"gross_charge":51375.68,"discounted_cash":51375.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"DILAUDID 2 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1171","type":"HCPCS"},{"code":"76045001011","type":"NDC"}],"standard_charges":[{"gross_charge":37.06,"discounted_cash":37.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"INFED 50 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1750","type":"HCPCS"},{"code":"00023608210","type":"NDC"}],"standard_charges":[{"gross_charge":60.47,"discounted_cash":60.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"DEMEROL 25 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2175","type":"HCPCS"},{"code":"00409117630","type":"NDC"}],"standard_charges":[{"gross_charge":40.78,"discounted_cash":40.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"DEMEROL 25 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2175","type":"HCPCS"},{"code":"00409136201","type":"NDC"}],"standard_charges":[{"gross_charge":35.69,"discounted_cash":35.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 ML"}]},{"description":"DEMEROL 50 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2175","type":"HCPCS"},{"code":"00409141801","type":"NDC"}],"standard_charges":[{"gross_charge":37.2,"discounted_cash":37.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 ML"}]},{"description":"DEPO-MEDROL 40 MG/ML IJ SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1010","type":"HCPCS"},{"code":"00009307303","type":"NDC"}],"standard_charges":[{"gross_charge":37.39,"discounted_cash":37.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 ML"}]},{"description":"TEZSPIRE 210 MG/1.91ML SC SOAJ","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2356","type":"HCPCS"},{"code":"55513012301","type":"NDC"}],"standard_charges":[{"gross_charge":13808.2,"discounted_cash":13808.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.91 ML"}]},{"description":"DEPO-MEDROL 40 MG/ML IJ SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1010","type":"HCPCS"},{"code":"00009307301","type":"NDC"}],"standard_charges":[{"gross_charge":27.0,"discounted_cash":27.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.1 ML"}]},{"description":"DEPO-MEDROL 80 MG/ML IJ SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1010","type":"HCPCS"},{"code":"00009347503","type":"NDC"}],"standard_charges":[{"gross_charge":42.2,"discounted_cash":42.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 ML"}]},{"description":"SOLIRIS 300 MG/30ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1300","type":"HCPCS"},{"code":"25682000101","type":"NDC"}],"standard_charges":[{"gross_charge":57747.97,"discounted_cash":57747.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 90 ML"}]},{"description":"PERJETA 420 MG/14ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9306","type":"HCPCS"},{"code":"50242014501","type":"NDC"}],"standard_charges":[{"gross_charge":34130.05,"discounted_cash":34130.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 14 ML"}]},{"description":"HYDROMORPHONE HCL PF 50 MG/5ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1170","type":"HCPCS"},{"code":"00703011303","type":"NDC"}],"standard_charges":[{"gross_charge":43.42,"discounted_cash":43.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1100","type":"HCPCS"},{"code":"63323016516","type":"NDC"}],"standard_charges":[{"gross_charge":20.24,"discounted_cash":20.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1100","type":"HCPCS"},{"code":"63323016501","type":"NDC"}],"standard_charges":[{"gross_charge":17.88,"discounted_cash":17.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 ML"}]},{"description":"DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1100","type":"HCPCS"},{"code":"67457042312","type":"NDC"}],"standard_charges":[{"gross_charge":21.17,"discounted_cash":21.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"DILAUDID 1 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1170","type":"HCPCS"},{"code":"76045000906","type":"NDC"}],"standard_charges":[{"gross_charge":29.79,"discounted_cash":29.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.2 ML"}]},{"description":"DILAUDID 1 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1170","type":"HCPCS"},{"code":"76045000911","type":"NDC"}],"standard_charges":[{"gross_charge":23.2,"discounted_cash":23.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.2 ML"}]},{"description":"ATROPINE SULFATE 0.4 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0461","type":"HCPCS"},{"code":"16729052508","type":"NDC"}],"standard_charges":[{"gross_charge":39.59,"discounted_cash":39.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"ATROPINE SULFATE 0.4 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0461","type":"HCPCS"},{"code":"00517100425","type":"NDC"}],"standard_charges":[{"gross_charge":35.3,"discounted_cash":35.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"ATROPINE SULFATE 1 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0461","type":"HCPCS"},{"code":"16729052608","type":"NDC"}],"standard_charges":[{"gross_charge":37.53,"discounted_cash":37.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.4 ML"}]},{"description":"ATROPINE SULFATE 1 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0461","type":"HCPCS"},{"code":"00517100125","type":"NDC"}],"standard_charges":[{"gross_charge":44.28,"discounted_cash":44.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.4 ML"}]},{"description":"REGADENOSON 0.4 MG/5ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2785","type":"HCPCS"},{"code":"55150044301","type":"NDC"}],"standard_charges":[{"gross_charge":423.71,"discounted_cash":423.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"VEGZELMA 100 MG/4ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"Q5129","type":"HCPCS"},{"code":"72606001101","type":"NDC"}],"standard_charges":[{"gross_charge":5577.51,"discounted_cash":5577.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"}]},{"description":"ADACEL 5-2-15.5 LF-MCG/0.5 IM SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"90715","type":"HCPCS"},{"code":"49281040010","type":"NDC"}],"standard_charges":[{"gross_charge":182.86,"discounted_cash":182.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"BICILLIN L-A 1200000 UNIT/2ML IM SUSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0561","type":"HCPCS"},{"code":"60793070110","type":"NDC"}],"standard_charges":[{"gross_charge":929.3,"discounted_cash":929.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"ARANESP (ALBUMIN FREE) 150 MCG/0.3ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0881","type":"HCPCS"},{"code":"55513002704","type":"NDC"}],"standard_charges":[{"gross_charge":1781.35,"discounted_cash":1781.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.3 ML"}]},{"description":"ARANESP (ALBUMIN FREE) 200 MCG/0.4ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0881","type":"HCPCS"},{"code":"55513002801","type":"NDC"}],"standard_charges":[{"gross_charge":2369.98,"discounted_cash":2369.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.4 ML"}]},{"description":"ARANESP (ALBUMIN FREE) 300 MCG/0.6ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0881","type":"HCPCS"},{"code":"55513011101","type":"NDC"}],"standard_charges":[{"gross_charge":1781.35,"discounted_cash":1781.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.3 ML"}]},{"description":"ARANESP (ALBUMIN FREE) 500 MCG/ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0881","type":"HCPCS"},{"code":"55513003201","type":"NDC"}],"standard_charges":[{"gross_charge":6273.69,"discounted_cash":6273.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"ARANESP (ALBUMIN FREE) 100 MCG/0.5ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0881","type":"HCPCS"},{"code":"55513002504","type":"NDC"}],"standard_charges":[{"gross_charge":486.4,"discounted_cash":486.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.2 ML"}]},{"description":"ONIVYDE 43 MG/10ML IV INJ","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9205","type":"HCPCS"},{"code":"15054004301","type":"NDC"}],"standard_charges":[{"gross_charge":5626.93,"discounted_cash":5626.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"ORPHENADRINE CITRATE 30 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2360","type":"HCPCS"},{"code":"00641618225","type":"NDC"}],"standard_charges":[{"gross_charge":41.46,"discounted_cash":41.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"HEPARIN SODIUM (PORCINE) 1000 UNIT/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"00641039112","type":"NDC"}],"standard_charges":[{"gross_charge":60.44,"discounted_cash":60.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3.6 ML"}]},{"description":"PALONOSETRON HCL 0.25 MG/5ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2469","type":"HCPCS"},{"code":"67457031725","type":"NDC"}],"standard_charges":[{"gross_charge":57.66,"discounted_cash":57.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"MEPERIDINE HCL 50 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2175","type":"HCPCS"},{"code":"00641605325","type":"NDC"}],"standard_charges":[{"gross_charge":24.17,"discounted_cash":24.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 ML"}]},{"description":"HYDRALAZINE HCL 20 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0360","type":"HCPCS"},{"code":"63323061416","type":"NDC"}],"standard_charges":[{"gross_charge":20.0,"discounted_cash":20.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.1 ML"}]},{"description":"IRINOTECAN HCL 100 MG/5ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9206","type":"HCPCS"},{"code":"00143970101","type":"NDC"}],"standard_charges":[{"gross_charge":107.22,"discounted_cash":107.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"GLYCOPYRROLATE PF 0.4 MG/2ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1596","type":"HCPCS"},{"code":"70121169907","type":"NDC"}],"standard_charges":[{"gross_charge":38.73,"discounted_cash":38.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"ARANESP (ALBUMIN FREE) 60 MCG/0.3ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0881","type":"HCPCS"},{"code":"55513002304","type":"NDC"}],"standard_charges":[{"gross_charge":721.85,"discounted_cash":721.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.3 ML"}]},{"description":"LORAZEPAM 2 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2060","type":"HCPCS"},{"code":"00409198530","type":"NDC"}],"standard_charges":[{"gross_charge":21.78,"discounted_cash":21.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.13 ML"}]},{"description":"CEREBYX 500 MG PE/10ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"Q2009","type":"HCPCS"},{"code":"00069600121","type":"NDC"}],"standard_charges":[{"gross_charge":85.63,"discounted_cash":85.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"EXPAREL 1.3 % IJ SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"C9290","type":"HCPCS"},{"code":"65250026604","type":"NDC"}],"standard_charges":[{"gross_charge":332.88,"discounted_cash":332.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"EXPAREL 1.3 % IJ SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"C9290","type":"HCPCS"},{"code":"65250026609","type":"NDC"}],"standard_charges":[{"gross_charge":373.72,"discounted_cash":373.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7 ML"}]},{"description":"EXPAREL 1.3 % IJ SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"C9290","type":"HCPCS"},{"code":"65250013309","type":"NDC"}],"standard_charges":[{"gross_charge":323.98,"discounted_cash":323.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"EXPAREL 1.3 % IJ SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"C9290","type":"HCPCS"},{"code":"65250013304","type":"NDC"}],"standard_charges":[{"gross_charge":323.98,"discounted_cash":323.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"RELISTOR 8 MG/0.4ML SC SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2212","type":"HCPCS"},{"code":"65649055204","type":"NDC"}],"standard_charges":[{"gross_charge":303.65,"discounted_cash":303.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.2 ML"}]},{"description":"FLUBLOK 0.5 ML IM SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"G0008","type":"HCPCS"},{"code":"49281072410","type":"NDC"}],"standard_charges":[{"gross_charge":258.06,"discounted_cash":258.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"TEVIMBRA 100 MG/10ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9329","type":"HCPCS"},{"code":"72579012101","type":"NDC"}],"standard_charges":[{"gross_charge":54665.56,"discounted_cash":54665.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"HYALGAN 20 MG/2ML IX SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J7321","type":"HCPCS"},{"code":"89122072420","type":"NDC"}],"standard_charges":[{"gross_charge":532.06,"discounted_cash":532.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"SUPARTZ FX 25 MG/2.5ML IX SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J7321","type":"HCPCS"},{"code":"89130444401","type":"NDC"}],"standard_charges":[{"gross_charge":560.11,"discounted_cash":560.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"ORTHOVISC 30 MG/2ML IX SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J7324","type":"HCPCS"},{"code":"59676036001","type":"NDC"}],"standard_charges":[{"gross_charge":350.76,"discounted_cash":350.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"EUFLEXXA 20 MG/2ML IX SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J7323","type":"HCPCS"},{"code":"55566410001","type":"NDC"}],"standard_charges":[{"gross_charge":512.27,"discounted_cash":512.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"GAMMAGARD 5 GM/50ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1569","type":"HCPCS"},{"code":"00944270004","type":"NDC"}],"standard_charges":[{"gross_charge":1904.56,"discounted_cash":1904.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"SOMATULINE DEPOT 120 MG/0.5ML SC SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1930","type":"HCPCS"},{"code":"15054112004","type":"NDC"}],"standard_charges":[{"gross_charge":16098.3,"discounted_cash":16098.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"ARANESP (ALBUMIN FREE) 40 MCG/0.4ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0881","type":"HCPCS"},{"code":"55513002104","type":"NDC"}],"standard_charges":[{"gross_charge":486.4,"discounted_cash":486.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.4 ML"}]},{"description":"NEUPOGEN 480 MCG/0.8ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1442","type":"HCPCS"},{"code":"55513020991","type":"NDC"}],"standard_charges":[{"gross_charge":1539.06,"discounted_cash":1539.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.8 ML"}]},{"description":"NEUPOGEN 300 MCG/0.5ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1442","type":"HCPCS"},{"code":"55513092491","type":"NDC"}],"standard_charges":[{"gross_charge":973.16,"discounted_cash":973.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"BICILLIN L-A 2400000 UNIT/4ML IM SUSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0561","type":"HCPCS"},{"code":"60793070210","type":"NDC"}],"standard_charges":[{"gross_charge":1842.67,"discounted_cash":1842.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"}]},{"description":"VECTIBIX 100 MG/5ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9303","type":"HCPCS"},{"code":"55513095401","type":"NDC"}],"standard_charges":[{"gross_charge":16810.96,"discounted_cash":16810.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"VECTIBIX 400 MG/20ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9303","type":"HCPCS"},{"code":"55513095601","type":"NDC"}],"standard_charges":[{"gross_charge":33590.8,"discounted_cash":33590.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"ACTEMRA 80 MG/4ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3262","type":"HCPCS"},{"code":"50242013501","type":"NDC"}],"standard_charges":[{"gross_charge":252.72,"discounted_cash":252.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"ACTEMRA 200 MG/10ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3262","type":"HCPCS"},{"code":"50242013601","type":"NDC"}],"standard_charges":[{"gross_charge":252.72,"discounted_cash":252.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"ACTEMRA 400 MG/20ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3262","type":"HCPCS"},{"code":"50242013701","type":"NDC"}],"standard_charges":[{"gross_charge":2492.51,"discounted_cash":2492.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6.5 ML"}]},{"description":"ERBITUX 200 MG/100ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9055","type":"HCPCS"},{"code":"66733095823","type":"NDC"}],"standard_charges":[{"gross_charge":1452.98,"discounted_cash":1452.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"ERBITUX 100 MG/50ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9055","type":"HCPCS"},{"code":"66733094823","type":"NDC"}],"standard_charges":[{"gross_charge":3259.01,"discounted_cash":3259.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"TYSABRI 300 MG/15ML IV CONC","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2323","type":"HCPCS"},{"code":"64406000801","type":"NDC"}],"standard_charges":[{"gross_charge":23425.93,"discounted_cash":23425.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"ADACEL 5-2-15.5 LF-MCG/0.5 IM SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"90715","type":"HCPCS"},{"code":"49281040020","type":"NDC"}],"standard_charges":[{"gross_charge":182.87,"discounted_cash":182.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"GAMMAGARD 20 GM/200ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1569","type":"HCPCS"},{"code":"00944270006","type":"NDC"}],"standard_charges":[{"gross_charge":3808.04,"discounted_cash":3808.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"GAMMAGARD 30 GM/300ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1569","type":"HCPCS"},{"code":"00944270007","type":"NDC"}],"standard_charges":[{"gross_charge":3824.85,"discounted_cash":3824.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"GAMUNEX-C 5 GM/50ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1561","type":"HCPCS"},{"code":"13533080020","type":"NDC"}],"standard_charges":[{"gross_charge":1292.13,"discounted_cash":1292.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"GAMUNEX-C 20 GM/200ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1561","type":"HCPCS"},{"code":"13533080024","type":"NDC"}],"standard_charges":[{"gross_charge":1269.67,"discounted_cash":1269.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"GAMUNEX-C 10 GM/100ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1561","type":"HCPCS"},{"code":"13533080071","type":"NDC"}],"standard_charges":[{"gross_charge":1250.29,"discounted_cash":1250.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"GAMUNEX-C 40 GM/400ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1561","type":"HCPCS"},{"code":"13533080040","type":"NDC"}],"standard_charges":[{"gross_charge":9186.62,"discounted_cash":9186.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 350 ML"}]},{"description":"GAMMAKED 20 GM/200ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1561","type":"HCPCS"},{"code":"76125090020","type":"NDC"}],"standard_charges":[{"gross_charge":7080.26,"discounted_cash":7080.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 ML"}]},{"description":"GAMMAKED 10 GM/100ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1561","type":"HCPCS"},{"code":"76125090010","type":"NDC"}],"standard_charges":[{"gross_charge":3253.41,"discounted_cash":3253.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"GAMMAKED 5 GM/50ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1561","type":"HCPCS"},{"code":"76125090050","type":"NDC"}],"standard_charges":[{"gross_charge":1633.08,"discounted_cash":1633.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"OCTAGAM 30 GM/300ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1568","type":"HCPCS"},{"code":"68982085005","type":"NDC"}],"standard_charges":[{"gross_charge":9775.55,"discounted_cash":9775.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 ML"}]},{"description":"OCTAGAM 10 GM/100ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1568","type":"HCPCS"},{"code":"68982085003","type":"NDC"}],"standard_charges":[{"gross_charge":3266.78,"discounted_cash":3266.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"OCTAGAM 20 GM/200ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1568","type":"HCPCS"},{"code":"68982085004","type":"NDC"}],"standard_charges":[{"gross_charge":6521.17,"discounted_cash":6521.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 ML"}]},{"description":"ZARXIO 480 MCG/0.8ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"Q5101","type":"HCPCS"},{"code":"61314032610","type":"NDC"}],"standard_charges":[{"gross_charge":651.93,"discounted_cash":651.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.8 ML"}]},{"description":"ZARXIO 480 MCG/0.8ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"Q5101","type":"HCPCS"},{"code":"61314032601","type":"NDC"}],"standard_charges":[{"gross_charge":651.95,"discounted_cash":651.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.8 ML"}]},{"description":"GAMMAGARD 10 GM/100ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1569","type":"HCPCS"},{"code":"00944270005","type":"NDC"}],"standard_charges":[{"gross_charge":1335.47,"discounted_cash":1335.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 35 ML"}]},{"description":"ZARXIO 300 MCG/0.5ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"Q5101","type":"HCPCS"},{"code":"61314031810","type":"NDC"}],"standard_charges":[{"gross_charge":413.27,"discounted_cash":413.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"RITUXAN 500 MG/50ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9312","type":"HCPCS"},{"code":"50242005306","type":"NDC"}],"standard_charges":[{"gross_charge":23516.8,"discounted_cash":23516.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"NEULASTA 6 MG/0.6ML SC SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2506","type":"HCPCS"},{"code":"55513019001","type":"NDC"}],"standard_charges":[{"gross_charge":14000.89,"discounted_cash":14000.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.6 ML"}]},{"description":"NEULASTA ONPRO 6 MG/0.6ML SC PSKT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2506","type":"HCPCS"},{"code":"55513019201","type":"NDC"}],"standard_charges":[{"gross_charge":9329.02,"discounted_cash":9329.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.6 ML"}]},{"description":"XOLAIR 150 MG/ML SC SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2357","type":"HCPCS"},{"code":"50242021503","type":"NDC"}],"standard_charges":[{"gross_charge":8371.19,"discounted_cash":8371.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"MIDAZOLAM-SODIUM CHLORIDE 50-0.9 MG/50ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2251","type":"HCPCS"},{"code":"00143937910","type":"NDC"}],"standard_charges":[{"gross_charge":105.67,"discounted_cash":105.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"MIDAZOLAM-SODIUM CHLORIDE 50-0.9 MG/50ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2251","type":"HCPCS"},{"code":"44567061010","type":"NDC"}],"standard_charges":[{"gross_charge":212.67,"discounted_cash":212.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"FULPHILA 6 MG/0.6ML SC SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"Q5108","type":"HCPCS"},{"code":"67457083306","type":"NDC"}],"standard_charges":[{"gross_charge":4976.02,"discounted_cash":4976.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.6 ML"}]},{"description":"POLOCAINE-MPF 2 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0670","type":"HCPCS"},{"code":"63323029427","type":"NDC"}],"standard_charges":[{"gross_charge":16.13,"discounted_cash":16.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.125 ML"}]},{"description":"RITUXAN HYCELA 1400-23400 MG -UT/11.7ML SC SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9311","type":"HCPCS"},{"code":"50242010801","type":"NDC"}],"standard_charges":[{"gross_charge":26049.81,"discounted_cash":26049.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 11.7 ML"}]},{"description":"XYLOCAINE-MPF/EPINEPHRINE 1 %-1:200000 IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2004","type":"HCPCS"},{"code":"63323048737","type":"NDC"}],"standard_charges":[{"gross_charge":18.2,"discounted_cash":18.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"XYLOCAINE-MPF/EPINEPHRINE 1 %-1:200000 IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2004","type":"HCPCS"},{"code":"63323048717","type":"NDC"}],"standard_charges":[{"gross_charge":22.87,"discounted_cash":22.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"XYLOCAINE-MPF/EPINEPHRINE 1 %-1:200000 IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2004","type":"HCPCS"},{"code":"63323048731","type":"NDC"}],"standard_charges":[{"gross_charge":38.88,"discounted_cash":38.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"XYLOCAINE-MPF/EPINEPHRINE 2 %-1:200000 IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2004","type":"HCPCS"},{"code":"63323048927","type":"NDC"}],"standard_charges":[{"gross_charge":41.86,"discounted_cash":41.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"ATIVAN 2 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2060","type":"HCPCS"},{"code":"00641600125","type":"NDC"}],"standard_charges":[{"gross_charge":18.96,"discounted_cash":18.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.125 ML"}]},{"description":"ATIVAN 4 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2060","type":"HCPCS"},{"code":"00641600325","type":"NDC"}],"standard_charges":[{"gross_charge":25.12,"discounted_cash":25.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 ML"}]},{"description":"EPOGEN 10000 UNIT/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0885","type":"HCPCS"},{"code":"55513014410","type":"NDC"}],"standard_charges":[{"gross_charge":487.6,"discounted_cash":487.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"XYLOCAINE-MPF/EPINEPHRINE 2 %-1:200000 IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2004","type":"HCPCS"},{"code":"63323048917","type":"NDC"}],"standard_charges":[{"gross_charge":40.8,"discounted_cash":40.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"VITAMIN K1 10 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3430","type":"HCPCS"},{"code":"00409915801","type":"NDC"}],"standard_charges":[{"gross_charge":41.08,"discounted_cash":41.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.1 ML"}]},{"description":"KCL (0.149%) IN NACL 20-0.9 MEQ/L-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3480","type":"HCPCS"},{"code":"00990711509","type":"NDC"}],"standard_charges":[{"gross_charge":124.88,"discounted_cash":124.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"}]},{"description":"POTASSIUM CHLORIDE IN NACL 20-0.9 MEQ/L-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3480","type":"HCPCS"},{"code":"00264786500","type":"NDC"}],"standard_charges":[{"gross_charge":54.58,"discounted_cash":54.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"}]},{"description":"KEYTRUDA 100 MG/4ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9271","type":"HCPCS"},{"code":"00006302602","type":"NDC"}],"standard_charges":[{"gross_charge":59002.42,"discounted_cash":59002.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 ML"}]},{"description":"POTASSIUM CHLORIDE IN NACL 40-0.9 MEQ/L-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3480","type":"HCPCS"},{"code":"63323068810","type":"NDC"}],"standard_charges":[{"gross_charge":82.7,"discounted_cash":82.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"}]},{"description":"TENIVAC 5-2 LFU IM INJ","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"90714","type":"HCPCS"},{"code":"49281021510","type":"NDC"}],"standard_charges":[{"gross_charge":152.64,"discounted_cash":152.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"TENIVAC 5-2 LFU IM INJ","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"90714","type":"HCPCS"},{"code":"49281021515","type":"NDC"}],"standard_charges":[{"gross_charge":152.64,"discounted_cash":152.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"PNEUMOVAX 23 25 MCG/0.5ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"90732","type":"HCPCS"},{"code":"00006483703","type":"NDC"}],"standard_charges":[{"gross_charge":334.43,"discounted_cash":334.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"POTASSIUM CHLORIDE IN NACL 40-0.9 MEQ/L-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3480","type":"HCPCS"},{"code":"00338069504","type":"NDC"}],"standard_charges":[{"gross_charge":99.16,"discounted_cash":99.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"}]},{"description":"CORVERT 1 MG/10ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1742","type":"HCPCS"},{"code":"00009379401","type":"NDC"}],"standard_charges":[{"gross_charge":327.19,"discounted_cash":327.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"LEQVIO 284 MG/1.5ML SC SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1306","type":"HCPCS"},{"code":"00078100060","type":"NDC"}],"standard_charges":[{"gross_charge":10192.95,"discounted_cash":10192.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.5 ML"}]},{"description":"VASOSTRICT 40-5 UT/100ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2598","type":"HCPCS"},{"code":"42023021910","type":"NDC"}],"standard_charges":[{"gross_charge":362.93,"discounted_cash":362.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"MORPHINE SULFATE (PF) 4 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2272","type":"HCPCS"},{"code":"63323045401","type":"NDC"}],"standard_charges":[{"gross_charge":38.54,"discounted_cash":38.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"MORPHINE SULFATE 4 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2272","type":"HCPCS"},{"code":"76045000511","type":"NDC"}],"standard_charges":[{"gross_charge":36.17,"discounted_cash":36.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"CLEOCIN PHOSPHATE 600 MG/4ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0736","type":"HCPCS"},{"code":"00009077526","type":"NDC"}],"standard_charges":[{"gross_charge":35.68,"discounted_cash":35.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"}]},{"description":"CLEOCIN PHOSPHATE 900 MG/6ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0736","type":"HCPCS"},{"code":"00009090218","type":"NDC"}],"standard_charges":[{"gross_charge":32.24,"discounted_cash":32.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.667 ML"}]},{"description":"CLEOCIN PHOSPHATE 300 MG/2ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0736","type":"HCPCS"},{"code":"00009087026","type":"NDC"}],"standard_charges":[{"gross_charge":51.91,"discounted_cash":51.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"}]},{"description":"SENSORCAINE-MPF 0.25 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0665","type":"HCPCS"},{"code":"63323046438","type":"NDC"}],"standard_charges":[{"gross_charge":17.49,"discounted_cash":17.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"KCL (0.298%) IN NACL 40-0.9 MEQ/L-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3480","type":"HCPCS"},{"code":"00990711609","type":"NDC"}],"standard_charges":[{"gross_charge":84.7,"discounted_cash":84.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"}]},{"description":"KEYTRUDA 100 MG/4ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9271","type":"HCPCS"},{"code":"00006302604","type":"NDC"}],"standard_charges":[{"gross_charge":58616.92,"discounted_cash":58616.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 ML"}]},{"description":"OPDIVO 100 MG/10ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9299","type":"HCPCS"},{"code":"00003377412","type":"NDC"}],"standard_charges":[{"gross_charge":31517.47,"discounted_cash":31517.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"FLUCELVAX 0.5 ML IM SUSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"90661","type":"HCPCS"},{"code":"70461065403","type":"NDC"}],"standard_charges":[{"gross_charge":132.36,"discounted_cash":132.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"ONDANSETRON HCL 4 MG/2ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2405","type":"HCPCS"},{"code":"23155054741","type":"NDC"}],"standard_charges":[{"gross_charge":20.1,"discounted_cash":20.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"ONDANSETRON HCL 4 MG/2ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2405","type":"HCPCS"},{"code":"23155054742","type":"NDC"}],"standard_charges":[{"gross_charge":20.93,"discounted_cash":20.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"ONDANSETRON HCL 4 MG/2ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2405","type":"HCPCS"},{"code":"36000001225","type":"NDC"}],"standard_charges":[{"gross_charge":26.38,"discounted_cash":26.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"ONDANSETRON HCL 4 MG/2ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2405","type":"HCPCS"},{"code":"23155054842","type":"NDC"}],"standard_charges":[{"gross_charge":22.2,"discounted_cash":22.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"ONDANSETRON HCL 4 MG/2ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2405","type":"HCPCS"},{"code":"60505613005","type":"NDC"}],"standard_charges":[{"gross_charge":18.3,"discounted_cash":18.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"ONDANSETRON HCL 4 MG/2ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2405","type":"HCPCS"},{"code":"00641607825","type":"NDC"}],"standard_charges":[{"gross_charge":26.64,"discounted_cash":26.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"ONDANSETRON HCL 4 MG/2ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2405","type":"HCPCS"},{"code":"55150012502","type":"NDC"}],"standard_charges":[{"gross_charge":30.15,"discounted_cash":30.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"ONDANSETRON HCL 4 MG/2ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2405","type":"HCPCS"},{"code":"23155054841","type":"NDC"}],"standard_charges":[{"gross_charge":29.86,"discounted_cash":29.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"ONDANSETRON HCL 4 MG/2ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2405","type":"HCPCS"},{"code":"00409475503","type":"NDC"}],"standard_charges":[{"gross_charge":18.89,"discounted_cash":18.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"XYLOCAINE-MPF 0.5 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2003","type":"HCPCS"},{"code":"63323049157","type":"NDC"}],"standard_charges":[{"gross_charge":38.74,"discounted_cash":38.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"HALAVEN 1 MG/2ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9179","type":"HCPCS"},{"code":"62856038901","type":"NDC"}],"standard_charges":[{"gross_charge":9773.93,"discounted_cash":9773.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.7 ML"}]},{"description":"XGEVA 120 MG/1.7ML SC SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0897","type":"HCPCS"},{"code":"55513073001","type":"NDC"}],"standard_charges":[{"gross_charge":9914.41,"discounted_cash":9914.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.7 ML"}]},{"description":"VYVGART HYTRULO 180-2000 MG-UNIT/ML SC SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9334","type":"HCPCS"},{"code":"73475310203","type":"NDC"}],"standard_charges":[{"gross_charge":46549.01,"discounted_cash":46549.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5.6 ML"}]},{"description":"COSENTYX 125 MG/5ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3247","type":"HCPCS"},{"code":"00078116861","type":"NDC"}],"standard_charges":[{"gross_charge":6380.61,"discounted_cash":6380.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"ALBUKED 5 5 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"P9045","type":"HCPCS"},{"code":"76125079025","type":"NDC"}],"standard_charges":[{"gross_charge":241.95,"discounted_cash":241.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 ML"}]},{"description":"ALBUTEIN 5 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"P9045","type":"HCPCS"},{"code":"68516521409","type":"NDC"}],"standard_charges":[{"gross_charge":260.03,"discounted_cash":260.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 ML"}]},{"description":"ALBUTEIN 5 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"P9045","type":"HCPCS"},{"code":"68516521402","type":"NDC"}],"standard_charges":[{"gross_charge":781.06,"discounted_cash":781.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"}]},{"description":"ALBUTEIN 5 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"P9045","type":"HCPCS"},{"code":"68516521401","type":"NDC"}],"standard_charges":[{"gross_charge":269.07,"discounted_cash":269.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 ML"}]},{"description":"FLEXBUMIN 5 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"P9045","type":"HCPCS"},{"code":"00944049505","type":"NDC"}],"standard_charges":[{"gross_charge":323.29,"discounted_cash":323.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 ML"}]},{"description":"ALBUTEIN 5 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"P9045","type":"HCPCS"},{"code":"68516521902","type":"NDC"}],"standard_charges":[{"gross_charge":393.95,"discounted_cash":393.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 ML"}]},{"description":"ALBUTEIN 5 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"P9045","type":"HCPCS"},{"code":"68516521804","type":"NDC"}],"standard_charges":[{"gross_charge":267.26,"discounted_cash":267.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 ML"}]},{"description":"FLEXBUMIN 5 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"P9045","type":"HCPCS"},{"code":"00944049506","type":"NDC"}],"standard_charges":[{"gross_charge":323.29,"discounted_cash":323.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 ML"}]},{"description":"UDENYCA ONBODY 6 MG/0.6ML SC SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"Q5111","type":"HCPCS"},{"code":"70114013001","type":"NDC"}],"standard_charges":[{"gross_charge":9871.06,"discounted_cash":9871.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.6 ML"}]},{"description":"VASOSTRICT 20 UNIT/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2598","type":"HCPCS"},{"code":"42023016410","type":"NDC"}],"standard_charges":[{"gross_charge":38.68,"discounted_cash":38.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.1 ML"}]},{"description":"ROBAXIN 1000 MG/10ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2800","type":"HCPCS"},{"code":"00641610310","type":"NDC"}],"standard_charges":[{"gross_charge":42.54,"discounted_cash":42.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"FLUARIX 0.5 ML IM SUSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"90656","type":"HCPCS"},{"code":"58160088452","type":"NDC"}],"standard_charges":[{"gross_charge":66.52,"discounted_cash":66.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"FLULAVAL 0.5 ML IM SUSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"90688","type":"HCPCS"},{"code":"19515081052","type":"NDC"}],"standard_charges":[{"gross_charge":72.71,"discounted_cash":72.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"FLUZONE 0.5 ML IM SUSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"90656","type":"HCPCS"},{"code":"49281042450","type":"NDC"}],"standard_charges":[{"gross_charge":83.91,"discounted_cash":83.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"FLUZONE HIGH-DOSE 0.5 ML IM SUSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"90662","type":"HCPCS"},{"code":"49281012465","type":"NDC"}],"standard_charges":[{"gross_charge":258.42,"discounted_cash":258.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"SENSORCAINE-MPF 0.25 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0665","type":"HCPCS"},{"code":"63323046437","type":"NDC"}],"standard_charges":[{"gross_charge":17.58,"discounted_cash":17.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"OMNIPAQUE 12 MG/ML PO SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"255","type":"RC"},{"code":"J3490","type":"HCPCS"},{"code":"00407141612","type":"NDC"}],"standard_charges":[{"gross_charge":4.77,"discounted_cash":4.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 17.5 ML"}]},{"description":"SENSORCAINE-MPF 0.25 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0665","type":"HCPCS"},{"code":"63323046417","type":"NDC"}],"standard_charges":[{"gross_charge":16.75,"discounted_cash":16.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.6 ML"}]},{"description":"SENSORCAINE-MPF 0.5 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0665","type":"HCPCS"},{"code":"63323046639","type":"NDC"}],"standard_charges":[{"gross_charge":16.92,"discounted_cash":16.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.4 ML"}]},{"description":"SYNVISC 16 MG/2ML IX SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J7325","type":"HCPCS"},{"code":"58468009001","type":"NDC"}],"standard_charges":[{"gross_charge":670.59,"discounted_cash":670.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"SYNVISC ONE 48 MG/6ML IX SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J7325","type":"HCPCS"},{"code":"58468009003","type":"NDC"}],"standard_charges":[{"gross_charge":309.11,"discounted_cash":309.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.75 ML"}]},{"description":"GRANIX 300 MCG/0.5ML SC SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1447","type":"HCPCS"},{"code":"63459091011","type":"NDC"}],"standard_charges":[{"gross_charge":436.14,"discounted_cash":436.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"GRANIX 300 MCG/0.5ML SC SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1447","type":"HCPCS"},{"code":"63459091036","type":"NDC"}],"standard_charges":[{"gross_charge":779.97,"discounted_cash":779.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"GRANIX 300 MCG/0.5ML SC SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1447","type":"HCPCS"},{"code":"63459091017","type":"NDC"}],"standard_charges":[{"gross_charge":780.0,"discounted_cash":780.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"GRANIX 480 MCG/0.8ML SC SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1447","type":"HCPCS"},{"code":"63459091217","type":"NDC"}],"standard_charges":[{"gross_charge":1232.9,"discounted_cash":1232.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.8 ML"}]},{"description":"GRANIX 480 MCG/0.8ML SC SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1447","type":"HCPCS"},{"code":"63459091211","type":"NDC"}],"standard_charges":[{"gross_charge":667.39,"discounted_cash":667.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.8 ML"}]},{"description":"GAZYVA 1000 MG/40ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9301","type":"HCPCS"},{"code":"50242007001","type":"NDC"}],"standard_charges":[{"gross_charge":6010.02,"discounted_cash":6010.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"}]},{"description":"MONOVISC 88 MG/4ML IX SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J7327","type":"HCPCS"},{"code":"59676082001","type":"NDC"}],"standard_charges":[{"gross_charge":1741.47,"discounted_cash":1741.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"}]},{"description":"CYRAMZA 100 MG/10ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9308","type":"HCPCS"},{"code":"00002766901","type":"NDC"}],"standard_charges":[{"gross_charge":3299.74,"discounted_cash":3299.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"FERRLECIT 12.5 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2916","type":"HCPCS"},{"code":"00024279410","type":"NDC"}],"standard_charges":[{"gross_charge":95.61,"discounted_cash":95.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"FERRLECIT 12.5 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2916","type":"HCPCS"},{"code":"00024279210","type":"NDC"}],"standard_charges":[{"gross_charge":95.61,"discounted_cash":95.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"MARGENZA 250 MG/10ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9353","type":"HCPCS"},{"code":"74527002202","type":"NDC"}],"standard_charges":[{"gross_charge":60725.31,"discounted_cash":60725.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 54 ML"}]},{"description":"OPDIVO 120 MG/12ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9299","type":"HCPCS"},{"code":"00003375614","type":"NDC"}],"standard_charges":[{"gross_charge":18552.44,"discounted_cash":18552.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12 ML"}]},{"description":"RIABNI 100 MG/10ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"Q5123","type":"HCPCS"},{"code":"55513022401","type":"NDC"}],"standard_charges":[{"gross_charge":2925.3,"discounted_cash":2925.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"JEMPERLI 500 MG/10ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9272","type":"HCPCS"},{"code":"00173089803","type":"NDC"}],"standard_charges":[{"gross_charge":57544.21,"discounted_cash":57544.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"RYBREVANT 350 MG/7ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9061","type":"HCPCS"},{"code":"57894050101","type":"NDC"}],"standard_charges":[{"gross_charge":53555.52,"discounted_cash":53555.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 21 ML"}]},{"description":"ZYNRELEF 200-6 MG/7ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"C9088","type":"HCPCS"},{"code":"47426030301","type":"NDC"}],"standard_charges":[{"gross_charge":272.41,"discounted_cash":272.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3.5 ML"}]},{"description":"DURACLON 100 MCG/ML EP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0735","type":"HCPCS"},{"code":"67457021810","type":"NDC"}],"standard_charges":[{"gross_charge":24.4,"discounted_cash":24.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.4 ML"}]},{"description":"PROCRIT 40000 UNIT/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0885","type":"HCPCS"},{"code":"59676034001","type":"NDC"}],"standard_charges":[{"gross_charge":843.81,"discounted_cash":843.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"MORPHINE SULFATE 10 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2270","type":"HCPCS"},{"code":"00641612725","type":"NDC"}],"standard_charges":[{"gross_charge":18.84,"discounted_cash":18.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.1 ML"}]},{"description":"RETACRIT 2000 UNIT/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"Q5106","type":"HCPCS"},{"code":"00069130510","type":"NDC"}],"standard_charges":[{"gross_charge":83.26,"discounted_cash":83.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"RETACRIT 3000 UNIT/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"Q5106","type":"HCPCS"},{"code":"00069130610","type":"NDC"}],"standard_charges":[{"gross_charge":117.17,"discounted_cash":117.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"RETACRIT 4000 UNIT/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"Q5106","type":"HCPCS"},{"code":"00069130710","type":"NDC"}],"standard_charges":[{"gross_charge":63.69,"discounted_cash":63.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 ML"}]},{"description":"RETACRIT 10000 UNIT/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"Q5106","type":"HCPCS"},{"code":"00069130810","type":"NDC"}],"standard_charges":[{"gross_charge":183.99,"discounted_cash":183.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"RETACRIT 40000 UNIT/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"Q5106","type":"HCPCS"},{"code":"00069130904","type":"NDC"}],"standard_charges":[{"gross_charge":351.97,"discounted_cash":351.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 ML"}]},{"description":"EPINEPHRINE 1 MG/10ML IV SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0171","type":"HCPCS"},{"code":"76329331801","type":"NDC"}],"standard_charges":[{"gross_charge":64.03,"discounted_cash":64.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"FULPHILA 6 MG/0.6ML SC SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"Q5108","type":"HCPCS"},{"code":"83257000541","type":"NDC"}],"standard_charges":[{"gross_charge":5234.68,"discounted_cash":5234.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.6 ML"}]},{"description":"RIABNI 500 MG/50ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"Q5123","type":"HCPCS"},{"code":"55513032601","type":"NDC"}],"standard_charges":[{"gross_charge":7289.84,"discounted_cash":7289.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"MENQUADFI 0.5 ML IM SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"90734","type":"HCPCS"},{"code":"49281059005","type":"NDC"}],"standard_charges":[{"gross_charge":470.42,"discounted_cash":470.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"BOOSTRIX 5-2.5-18.5 LF-MCG/0.5 IM SUSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"90715","type":"HCPCS"},{"code":"58160084252","type":"NDC"}],"standard_charges":[{"gross_charge":148.11,"discounted_cash":148.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"PREVNAR 20 0.5 ML IM SUSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"90677","type":"HCPCS"},{"code":"00005200002","type":"NDC"}],"standard_charges":[{"gross_charge":683.33,"discounted_cash":683.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"MARCAINE PRESERVATIVE FREE 0.5 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0665","type":"HCPCS"},{"code":"00409156029","type":"NDC"}],"standard_charges":[{"gross_charge":17.66,"discounted_cash":17.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"SENSORCAINE-MPF 0.5 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0665","type":"HCPCS"},{"code":"63323046638","type":"NDC"}],"standard_charges":[{"gross_charge":19.65,"discounted_cash":19.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.5 ML"}]},{"description":"SENSORCAINE-MPF 0.5 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0665","type":"HCPCS"},{"code":"63323046617","type":"NDC"}],"standard_charges":[{"gross_charge":16.85,"discounted_cash":16.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"SENSORCAINE-MPF 0.5 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0665","type":"HCPCS"},{"code":"63323046637","type":"NDC"}],"standard_charges":[{"gross_charge":16.55,"discounted_cash":16.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"LOVENOX 30 MG/0.3ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"00075062430","type":"NDC"}],"standard_charges":[{"gross_charge":42.16,"discounted_cash":42.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.3 ML"}]},{"description":"LOVENOX 30 MG/0.3ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"00075801310","type":"NDC"}],"standard_charges":[{"gross_charge":42.16,"discounted_cash":42.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.3 ML"}]},{"description":"LOVENOX 40 MG/0.4ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"00075801410","type":"NDC"}],"standard_charges":[{"gross_charge":35.22,"discounted_cash":35.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.4 ML"}]},{"description":"LOVENOX 40 MG/0.4ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"00075062040","type":"NDC"}],"standard_charges":[{"gross_charge":35.22,"discounted_cash":35.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.4 ML"}]},{"description":"LOVENOX 60 MG/0.6ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"00075062160","type":"NDC"}],"standard_charges":[{"gross_charge":26.33,"discounted_cash":26.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.1 ML"}]},{"description":"LOVENOX 60 MG/0.6ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"00075801610","type":"NDC"}],"standard_charges":[{"gross_charge":26.34,"discounted_cash":26.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.1 ML"}]},{"description":"LOVENOX 80 MG/0.8ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"00075062280","type":"NDC"}],"standard_charges":[{"gross_charge":43.18,"discounted_cash":43.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.8 ML"}]},{"description":"XYLOCAINE-MPF 1 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2003","type":"HCPCS"},{"code":"63323049237","type":"NDC"}],"standard_charges":[{"gross_charge":15.76,"discounted_cash":15.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.2 ML"}]},{"description":"XYLOCAINE-MPF 1 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2003","type":"HCPCS"},{"code":"63323049226","type":"NDC"}],"standard_charges":[{"gross_charge":19.1,"discounted_cash":19.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"XYLOCAINE-MPF 1 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2003","type":"HCPCS"},{"code":"63323049236","type":"NDC"}],"standard_charges":[{"gross_charge":16.7,"discounted_cash":16.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.3 ML"}]},{"description":"XYLOCAINE-MPF 1 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2003","type":"HCPCS"},{"code":"63323049257","type":"NDC"}],"standard_charges":[{"gross_charge":16.36,"discounted_cash":16.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.2 ML"}]},{"description":"XYLOCAINE-MPF 1 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2003","type":"HCPCS"},{"code":"63323049231","type":"NDC"}],"standard_charges":[{"gross_charge":38.19,"discounted_cash":38.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"XYLOCAINE-MPF 1 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2003","type":"HCPCS"},{"code":"63323049297","type":"NDC"}],"standard_charges":[{"gross_charge":37.27,"discounted_cash":37.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"XYLOCAINE-MPF 2 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2003","type":"HCPCS"},{"code":"63323049507","type":"NDC"}],"standard_charges":[{"gross_charge":17.64,"discounted_cash":17.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"ZOSYN 3-0.375 GM/50ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2543","type":"HCPCS"},{"code":"00338963624","type":"NDC"}],"standard_charges":[{"gross_charge":83.57,"discounted_cash":83.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"KCL (0.149%) IN NACL 20-0.45 MEQ/L-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3480","type":"HCPCS"},{"code":"00990925739","type":"NDC"}],"standard_charges":[{"gross_charge":124.88,"discounted_cash":124.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"}]},{"description":"POTASSIUM CHLORIDE IN NACL 20-0.45 MEQ/L-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3480","type":"HCPCS"},{"code":"00338070434","type":"NDC"}],"standard_charges":[{"gross_charge":124.88,"discounted_cash":124.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"}]},{"description":"POTASSIUM CHLORIDE IN NACL 20-0.45 MEQ/L-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3480","type":"HCPCS"},{"code":"63323068310","type":"NDC"}],"standard_charges":[{"gross_charge":54.58,"discounted_cash":54.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"}]},{"description":"CYRAMZA 500 MG/50ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9308","type":"HCPCS"},{"code":"00002767801","type":"NDC"}],"standard_charges":[{"gross_charge":36811.43,"discounted_cash":36811.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"AMIODARONE HCL 150 MG/3ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0282","type":"HCPCS"},{"code":"00143987525","type":"NDC"}],"standard_charges":[{"gross_charge":26.46,"discounted_cash":26.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"AMIODARONE HCL 150 MG/3ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0282","type":"HCPCS"},{"code":"67457015303","type":"NDC"}],"standard_charges":[{"gross_charge":44.88,"discounted_cash":44.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"AMIODARONE HCL 150 MG/3ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0282","type":"HCPCS"},{"code":"63323061603","type":"NDC"}],"standard_charges":[{"gross_charge":40.57,"discounted_cash":40.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"AMIODARONE HCL 150 MG/3ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0282","type":"HCPCS"},{"code":"00143987510","type":"NDC"}],"standard_charges":[{"gross_charge":35.74,"discounted_cash":35.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"ZYNRELEF 400-12 MG/14ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"C9088","type":"HCPCS"},{"code":"47426030102","type":"NDC"}],"standard_charges":[{"gross_charge":422.3,"discounted_cash":422.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7 ML"}]},{"description":"PREVNAR 20 0.5 ML IM SUSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"90677","type":"HCPCS"},{"code":"00005200010","type":"NDC"}],"standard_charges":[{"gross_charge":661.76,"discounted_cash":661.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"MARCAINE PRESERVATIVE FREE 0.25 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0665","type":"HCPCS"},{"code":"00409155910","type":"NDC"}],"standard_charges":[{"gross_charge":20.21,"discounted_cash":20.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"DOTAREM 10 MMOL/20ML IV SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"255","type":"RC"},{"code":"A9575","type":"HCPCS"},{"code":"67684300103","type":"NDC"}],"standard_charges":[{"gross_charge":252.29,"discounted_cash":252.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"DOTAREM 7.5 MMOL/15ML IV SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"255","type":"RC"},{"code":"A9575","type":"HCPCS"},{"code":"67684300102","type":"NDC"}],"standard_charges":[{"gross_charge":158.79,"discounted_cash":158.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 ML"}]},{"description":"DOTAREM 5 MMOL/10ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"255","type":"RC"},{"code":"A9575","type":"HCPCS"},{"code":"67684200101","type":"NDC"}],"standard_charges":[{"gross_charge":94.09,"discounted_cash":94.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"NEOMYCIN-POLYMYXIN-DEXAMETH 3.5-10000-0.1 OP SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"61314063006","type":"NDC"}],"standard_charges":[{"gross_charge":127.47,"discounted_cash":127.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"PREDNISOLONE ACETATE 1 % OP SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"70748033202","type":"NDC"}],"standard_charges":[{"gross_charge":222.72,"discounted_cash":222.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"PHENYLEPHRINE HCL 10 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"70756061430","type":"NDC"}],"standard_charges":[{"gross_charge":316.44,"discounted_cash":316.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"GATIFLOXACIN 0.5 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"61314067225","type":"NDC"}],"standard_charges":[{"gross_charge":372.27,"discounted_cash":372.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 ML"}]},{"description":"MOXIFLOXACIN HCL 0.5 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"16714064301","type":"NDC"}],"standard_charges":[{"gross_charge":419.71,"discounted_cash":419.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"PREDNISOLONE SODIUM PHOSPHATE 1 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"24208071510","type":"NDC"}],"standard_charges":[{"gross_charge":436.94,"discounted_cash":436.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"DESMOPRESSIN ACETATE SPRAY 0.01 % NA SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"60505081500","type":"NDC"}],"standard_charges":[{"gross_charge":427.2,"discounted_cash":427.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"TOBRAMYCIN-DEXAMETHASONE 0.3-0.1 % OP SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"24208029525","type":"NDC"}],"standard_charges":[{"gross_charge":208.92,"discounted_cash":208.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 ML"}]},{"description":"ATROPINE SULFATE 1 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"60219174802","type":"NDC"}],"standard_charges":[{"gross_charge":298.67,"discounted_cash":298.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"TIMOLOL HEMIHYDRATE 0.5 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"70069069601","type":"NDC"}],"standard_charges":[{"gross_charge":612.11,"discounted_cash":612.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"NEOMYCIN-POLYMYXIN-HC 3.5-10000-1 OT SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"24208063562","type":"NDC"}],"standard_charges":[{"gross_charge":300.65,"discounted_cash":300.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"PREDNISOLONE ACETATE 1 % OP SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"60758011905","type":"NDC"}],"standard_charges":[{"gross_charge":210.18,"discounted_cash":210.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"PREDNISOLONE ACETATE 1 % OP SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"61314063705","type":"NDC"}],"standard_charges":[{"gross_charge":201.61,"discounted_cash":201.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"REFRESH TEARS 0.5 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00023079815","type":"NDC"}],"standard_charges":[{"gross_charge":126.89,"discounted_cash":126.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"EPINEPHRINE HCL (NASAL) 0.1 % NA SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"54288012301","type":"NDC"}],"standard_charges":[{"gross_charge":307.42,"discounted_cash":307.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"FLUOROMETHOLONE 0.1 % OP SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"60758088005","type":"NDC"}],"standard_charges":[{"gross_charge":417.35,"discounted_cash":417.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"TRIFLURIDINE 1 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"61314004475","type":"NDC"}],"standard_charges":[{"gross_charge":1088.48,"discounted_cash":1088.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7.5 ML"}]},{"description":"CIPROFLOXACIN-DEXAMETHASONE 0.3-0.1 % OT SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"62756042790","type":"NDC"}],"standard_charges":[{"gross_charge":1014.44,"discounted_cash":1014.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7.5 ML"}]},{"description":"CIPROFLOXACIN-DEXAMETHASONE 0.3-0.1 % OT SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"16714062801","type":"NDC"}],"standard_charges":[{"gross_charge":633.93,"discounted_cash":633.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7.5 ML"}]},{"description":"BRIMONIDINE TARTRATE 0.15 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"60505056401","type":"NDC"}],"standard_charges":[{"gross_charge":344.63,"discounted_cash":344.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"DORZOLAMIDE HCL-TIMOLOL MAL 2-0.5 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"71921022610","type":"NDC"}],"standard_charges":[{"gross_charge":185.74,"discounted_cash":185.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"CIPROFLOXACIN HCL 0.3 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"69315030802","type":"NDC"}],"standard_charges":[{"gross_charge":158.4,"discounted_cash":158.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 ML"}]},{"description":"CALCITONIN (SALMON) 200 UNIT/ACT NA SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"60505082306","type":"NDC"}],"standard_charges":[{"gross_charge":332.21,"discounted_cash":332.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3.7 ML"}]},{"description":"BRIMONIDINE TARTRATE 0.15 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"61314014405","type":"NDC"}],"standard_charges":[{"gross_charge":433.34,"discounted_cash":433.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"PHENYLEPHRINE HCL 2.5 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"70756062925","type":"NDC"}],"standard_charges":[{"gross_charge":262.59,"discounted_cash":262.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"MOXIFLOXACIN HCL 0.5 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"60505058204","type":"NDC"}],"standard_charges":[{"gross_charge":373.05,"discounted_cash":373.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"BRIMONIDINE TARTRATE 0.1 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"82182032105","type":"NDC"}],"standard_charges":[{"gross_charge":588.12,"discounted_cash":588.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"TROPICAMIDE-CYCLOPENTOLATE-PE 1-1-2.5 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"71449009245","type":"NDC"}],"standard_charges":[{"gross_charge":318.42,"discounted_cash":318.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"MOXIFLOXACIN HCL 0.5 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00832141003","type":"NDC"}],"standard_charges":[{"gross_charge":216.41,"discounted_cash":216.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"DEXAMETHASONE SODIUM PHOSPHATE 0.1 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"24208072002","type":"NDC"}],"standard_charges":[{"gross_charge":365.23,"discounted_cash":365.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"ACTIDOSE-AQUA 25 GM/120ML PO LIQD","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00574052174","type":"NDC"}],"standard_charges":[{"gross_charge":261.41,"discounted_cash":261.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 240 ML"}]},{"description":"LOPERAMIDE HCL 1 MG/7.5ML PO SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00904683620","type":"NDC"}],"standard_charges":[{"gross_charge":16.16,"discounted_cash":16.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"POLYMYXIN B-TRIMETHOPRIM 10000-0.1 UNIT/ML-% OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"61314062810","type":"NDC"}],"standard_charges":[{"gross_charge":66.06,"discounted_cash":66.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"BRIMONIDINE TARTRATE 0.2 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"61314014310","type":"NDC"}],"standard_charges":[{"gross_charge":63.15,"discounted_cash":63.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"LIDOCAINE HCL URETHRAL/MUCOSAL 2 % EX PRSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"76329301305","type":"NDC"}],"standard_charges":[{"gross_charge":101.7,"discounted_cash":101.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"LIDOCAINE HCL 4 % EX SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00527600480","type":"NDC"}],"standard_charges":[{"gross_charge":150.14,"discounted_cash":150.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"TROPICAMIDE 1 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"61314035502","type":"NDC"}],"standard_charges":[{"gross_charge":76.11,"discounted_cash":76.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"OXCARBAZEPINE 300 MG/5ML PO SUSP UNIT DOSE","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"65162064978","type":"NDC"}],"standard_charges":[{"gross_charge":17.97,"discounted_cash":17.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 ML"}]},{"description":"ARTIFICIAL TEARS OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"50268004315","type":"NDC"}],"standard_charges":[{"gross_charge":95.06,"discounted_cash":95.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"LEVALBUTEROL HCL 1.25 MG/3ML IN NEBU","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"J7620","type":"HCPCS"},{"code":"00093414856","type":"NDC"}],"standard_charges":[{"gross_charge":32.29,"discounted_cash":32.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"TIMOLOL MALEATE 0.5 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"61314022705","type":"NDC"}],"standard_charges":[{"gross_charge":76.43,"discounted_cash":76.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"LIDOCAINE VISCOUS HCL 2 % MT SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"62135071242","type":"NDC"}],"standard_charges":[{"gross_charge":50.99,"discounted_cash":50.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3.333 ML"}]},{"description":"DORZOLAMIDE HCL-TIMOLOL MAL 2-0.5 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"24208048610","type":"NDC"}],"standard_charges":[{"gross_charge":131.19,"discounted_cash":131.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"TIMOLOL MALEATE 0.5 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"64980051405","type":"NDC"}],"standard_charges":[{"gross_charge":81.94,"discounted_cash":81.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"TROPICAMIDE 1 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"24208058564","type":"NDC"}],"standard_charges":[{"gross_charge":249.37,"discounted_cash":249.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"PRED MILD 0.12 % OP SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"11980017405","type":"NDC"}],"standard_charges":[{"gross_charge":889.54,"discounted_cash":889.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"CIPROFLOXACIN HCL 0.3 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"61314065625","type":"NDC"}],"standard_charges":[{"gross_charge":69.46,"discounted_cash":69.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 ML"}]},{"description":"ACETYLCYSTEINE 20 % IN SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00517760425","type":"NDC"}],"standard_charges":[{"gross_charge":109.35,"discounted_cash":109.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"PILOCARPINE HCL 1 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"61314020315","type":"NDC"}],"standard_charges":[{"gross_charge":366.5,"discounted_cash":366.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"ACETYLCYSTEINE 20 % IN SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"63323069444","type":"NDC"}],"standard_charges":[{"gross_charge":49.28,"discounted_cash":49.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"DICLOFENAC SODIUM 0.1 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"61314001405","type":"NDC"}],"standard_charges":[{"gross_charge":87.45,"discounted_cash":87.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"TIMOLOL MALEATE 0.5 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"60758080105","type":"NDC"}],"standard_charges":[{"gross_charge":83.72,"discounted_cash":83.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"DORZOLAMIDE HCL 2 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"61314001910","type":"NDC"}],"standard_charges":[{"gross_charge":120.88,"discounted_cash":120.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"LATANOPROST 0.005 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"61314054701","type":"NDC"}],"standard_charges":[{"gross_charge":59.58,"discounted_cash":59.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 ML"}]},{"description":"BUDESONIDE 0.5 MG/2ML IN SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"69097031953","type":"NDC"}],"standard_charges":[{"gross_charge":93.05,"discounted_cash":93.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"}]},{"description":"ARTIFICIAL TEARS 0.2-0.2-1 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"57896018105","type":"NDC"}],"standard_charges":[{"gross_charge":32.35,"discounted_cash":32.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"ALPHAGAN P 0.1 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00023932105","type":"NDC"}],"standard_charges":[{"gross_charge":1079.28,"discounted_cash":1079.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"GAVILYTE-C 240 G PO SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"43386006019","type":"NDC"}],"standard_charges":[{"gross_charge":173.08,"discounted_cash":173.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4000 ML"}]},{"description":"DEEP SEA NASAL SPRAY 0.65 % NA SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00904386575","type":"NDC"}],"standard_charges":[{"gross_charge":18.61,"discounted_cash":18.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 44 ML"}]},{"description":"PULMICORT 0.25 MG/2ML IN SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00186198804","type":"NDC"}],"standard_charges":[{"gross_charge":131.38,"discounted_cash":131.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"TOBRAMYCIN-DEXAMETHASONE 0.3-0.1 % OP SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00574403125","type":"NDC"}],"standard_charges":[{"gross_charge":153.22,"discounted_cash":153.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 ML"}]},{"description":"DORZOLAMIDE HCL 2 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"24208048510","type":"NDC"}],"standard_charges":[{"gross_charge":142.36,"discounted_cash":142.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"CEFPODOXIME PROXETIL 100 MG/5ML PO SUSR BULK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"16714040302","type":"NDC"}],"standard_charges":[{"gross_charge":78.74,"discounted_cash":78.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"TOBRAMYCIN 0.3 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"70069013101","type":"NDC"}],"standard_charges":[{"gross_charge":76.11,"discounted_cash":76.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"ALBUTEROL SULFATE (2.5 MG/3ML) 0.083% IN NEBU","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"76204020030","type":"NDC"}],"standard_charges":[{"gross_charge":7.32,"discounted_cash":7.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"IPRATROPIUM BROMIDE 0.03 % NA SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"60505082601","type":"NDC"}],"standard_charges":[{"gross_charge":135.4,"discounted_cash":135.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"LIDOCAINE HCL 4 % EX SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"70954051810","type":"NDC"}],"standard_charges":[{"gross_charge":127.14,"discounted_cash":127.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"OXYMETAZOLINE HCL 0.05 % NA SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"11523116705","type":"NDC"}],"standard_charges":[{"gross_charge":139.77,"discounted_cash":139.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"BSS IO SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00065079515","type":"NDC"}],"standard_charges":[{"gross_charge":20.93,"discounted_cash":20.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.25 ML"}]},{"description":"CEFDINIR 250 MG/5ML PO SUSR UNIT DOSE","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"68180072305","type":"NDC"}],"standard_charges":[{"gross_charge":23.89,"discounted_cash":23.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6 ML"}]},{"description":"CEFDINIR 250 MG/5ML PO SUSR UNIT DOSE","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"65862021901","type":"NDC"}],"standard_charges":[{"gross_charge":23.89,"discounted_cash":23.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6 ML"}]},{"description":"BUDESONIDE 0.5 MG/2ML IN SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"68180098430","type":"NDC"}],"standard_charges":[{"gross_charge":41.55,"discounted_cash":41.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"}]},{"description":"CIPROFLOXACIN HCL 0.3 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"61314065605","type":"NDC"}],"standard_charges":[{"gross_charge":59.91,"discounted_cash":59.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"BRIMONIDINE TARTRATE 0.2 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"61314014305","type":"NDC"}],"standard_charges":[{"gross_charge":50.51,"discounted_cash":50.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"LIDOCAINE HCL 4 % EX SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"60432046551","type":"NDC"}],"standard_charges":[{"gross_charge":266.56,"discounted_cash":266.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"CEFDINIR 125 MG/5ML PO SUSR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"67877054798","type":"NDC"}],"standard_charges":[{"gross_charge":31.33,"discounted_cash":31.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12 ML"}]},{"description":"TROPICAMIDE 1 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"70069012101","type":"NDC"}],"standard_charges":[{"gross_charge":94.33,"discounted_cash":94.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"FLEET PEDIATRIC RECTAL ENEMA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00132020220","type":"NDC"}],"standard_charges":[{"gross_charge":27.95,"discounted_cash":27.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 66 ML"}]},{"description":"LEVALBUTEROL HCL 1.25 MG/3ML IN NEBU","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"J7620","type":"HCPCS"},{"code":"76204090025","type":"NDC"}],"standard_charges":[{"gross_charge":14.73,"discounted_cash":14.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"CARBAMIDE PEROXIDE 6.5 % OT SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00074736201","type":"NDC"}],"standard_charges":[{"gross_charge":67.12,"discounted_cash":67.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"CYCLOPENTOLATE HCL 1 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"61314039603","type":"NDC"}],"standard_charges":[{"gross_charge":138.07,"discounted_cash":138.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"GENTAMICIN SULFATE 0.3 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"61314063305","type":"NDC"}],"standard_charges":[{"gross_charge":61.69,"discounted_cash":61.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"MAGIC MOUTHWASH SUSP UNIT DOSE","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"65628005004","type":"NDC"}],"standard_charges":[{"gross_charge":96.21,"discounted_cash":96.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"OSELTAMIVIR PHOSPHATE 6 MG/ML PO SUSR BULK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"27241013909","type":"NDC"}],"standard_charges":[{"gross_charge":25.02,"discounted_cash":25.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 ML"}]},{"description":"CEPHALEXIN 250 MG/5ML PO SUSR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00093417773","type":"NDC"}],"standard_charges":[{"gross_charge":19.35,"discounted_cash":19.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"ALBUTEROL SULFATE (2.5 MG/3ML) 0.083% IN NEBU","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"76204020001","type":"NDC"}],"standard_charges":[{"gross_charge":8.65,"discounted_cash":8.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"ALBUTEROL SULFATE (2.5 MG/3ML) 0.083% IN NEBU","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"J7613","type":"HCPCS"},{"code":"00378827093","type":"NDC"}],"standard_charges":[{"gross_charge":8.65,"discounted_cash":8.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"ALBUTEROL SULFATE (2.5 MG/3ML) 0.083% IN NEBU","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"76204020060","type":"NDC"}],"standard_charges":[{"gross_charge":7.71,"discounted_cash":7.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"LIDOCAINE VISCOUS HCL 2 % MT SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00054350049","type":"NDC"}],"standard_charges":[{"gross_charge":14.68,"discounted_cash":14.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"BSS PLUS IO SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00065080050","type":"NDC"}],"standard_charges":[{"gross_charge":44.78,"discounted_cash":44.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"BSS IO SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00065079550","type":"NDC"}],"standard_charges":[{"gross_charge":11.3,"discounted_cash":11.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"SENNA 8.8 MG/5ML PO SYRP UNIT DOSE","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"57896047208","type":"NDC"}],"standard_charges":[{"gross_charge":11.68,"discounted_cash":11.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"BRIMONIDINE TARTRATE 0.2 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"70069023201","type":"NDC"}],"standard_charges":[{"gross_charge":50.35,"discounted_cash":50.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"BSS PLUS IO SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00065080094","type":"NDC"}],"standard_charges":[{"gross_charge":6.15,"discounted_cash":6.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"LIDOCAINE VISCOUS HCL 2 % MT SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"72888012526","type":"NDC"}],"standard_charges":[{"gross_charge":10.17,"discounted_cash":10.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3.333 ML"}]},{"description":"ALBUTEROL SULFATE (2.5 MG/3ML) 0.083% IN NEBU","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00378827052","type":"NDC"}],"standard_charges":[{"gross_charge":7.4,"discounted_cash":7.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"LIDOCAINE HCL URETHRAL/MUCOSAL 2 % EX PRSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"76329301105","type":"NDC"}],"standard_charges":[{"gross_charge":82.91,"discounted_cash":82.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"IPRATROPIUM BROMIDE 0.03 % NA SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"16714052601","type":"NDC"}],"standard_charges":[{"gross_charge":329.6,"discounted_cash":329.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"LATANOPROST 0.005 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"24208046325","type":"NDC"}],"standard_charges":[{"gross_charge":50.83,"discounted_cash":50.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 ML"}]},{"description":"BUDESONIDE 0.5 MG/2ML IN SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"60687052483","type":"NDC"}],"standard_charges":[{"gross_charge":56.15,"discounted_cash":56.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"BUDESONIDE 0.25 MG/2ML IN SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00487960101","type":"NDC"}],"standard_charges":[{"gross_charge":63.21,"discounted_cash":63.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"CYCLOPENTOLATE HCL 1 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"24208073506","type":"NDC"}],"standard_charges":[{"gross_charge":236.11,"discounted_cash":236.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"BUDESONIDE 0.25 MG/2ML IN SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00093681573","type":"NDC"}],"standard_charges":[{"gross_charge":114.24,"discounted_cash":114.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"DORZOLAMIDE HCL-TIMOLOL MAL 2-0.5 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"70069005101","type":"NDC"}],"standard_charges":[{"gross_charge":129.08,"discounted_cash":129.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"OLOPATADINE HCL 0.1 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"70069001701","type":"NDC"}],"standard_charges":[{"gross_charge":63.47,"discounted_cash":63.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"KETOROLAC TROMETHAMINE 0.5 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"61314012605","type":"NDC"}],"standard_charges":[{"gross_charge":86.15,"discounted_cash":86.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"KETOROLAC TROMETHAMINE 0.5 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"42571013725","type":"NDC"}],"standard_charges":[{"gross_charge":95.71,"discounted_cash":95.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"CEFPODOXIME PROXETIL 100 MG/5ML PO SUSR BULK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"64980040350","type":"NDC"}],"standard_charges":[{"gross_charge":114.33,"discounted_cash":114.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"OSELTAMIVIR PHOSPHATE 6 MG/ML PO SUSR BULK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00093818064","type":"NDC"}],"standard_charges":[{"gross_charge":57.73,"discounted_cash":57.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"OFLOXACIN 0.3 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"60505056000","type":"NDC"}],"standard_charges":[{"gross_charge":121.3,"discounted_cash":121.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"KETOTIFEN FUMARATE 0.035 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"72485061710","type":"NDC"}],"standard_charges":[{"gross_charge":99.11,"discounted_cash":99.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"PROPARACAINE HCL 0.5 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"24208073006","type":"NDC"}],"standard_charges":[{"gross_charge":222.85,"discounted_cash":222.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"D-VITE PEDIATRIC 10 MCG/ML PO LIQD","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"71399740105","type":"NDC"}],"standard_charges":[{"gross_charge":5.25,"discounted_cash":5.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"VITAMIN D INFANT 10 MCG/ML PO LIQD","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"69618001959","type":"NDC"}],"standard_charges":[{"gross_charge":5.3,"discounted_cash":5.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"FE-VITE IRON 75 (15 FE) MG/ML PO SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"71399748005","type":"NDC"}],"standard_charges":[{"gross_charge":8.86,"discounted_cash":8.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.867 ML"}]},{"description":"H-CHLOR 12 0.125 % EX SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"39328006412","type":"NDC"}],"standard_charges":[{"gross_charge":96.58,"discounted_cash":96.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 473 ML"}]},{"description":"HYSEPT 25 0.25 % EX SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"39328006325","type":"NDC"}],"standard_charges":[{"gross_charge":38.36,"discounted_cash":38.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"DAKINS (1/2 STRENGTH) 0.25 % EX SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00436093616","type":"NDC"}],"standard_charges":[{"gross_charge":117.91,"discounted_cash":117.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 473 ML"}]},{"description":"PROPARACAINE HCL 0.5 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"61314001601","type":"NDC"}],"standard_charges":[{"gross_charge":223.94,"discounted_cash":223.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"TIMOLOL MALEATE 0.25 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"64980051305","type":"NDC"}],"standard_charges":[{"gross_charge":43.87,"discounted_cash":43.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"TIMOLOL MALEATE 0.5 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"64980051415","type":"NDC"}],"standard_charges":[{"gross_charge":132.88,"discounted_cash":132.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"OFLOXACIN 0.3 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"70756060730","type":"NDC"}],"standard_charges":[{"gross_charge":118.87,"discounted_cash":118.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"MINERAL OIL RE ENEM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"53329001311","type":"NDC"}],"standard_charges":[{"gross_charge":45.81,"discounted_cash":45.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 133 ML"}]},{"description":"POVIDONE-IODINE 10 % EX SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00904110309","type":"NDC"}],"standard_charges":[{"gross_charge":5.06,"discounted_cash":5.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 9 ML"}]},{"description":"OXYMETAZOLINE HCL 0.05 % NA SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"45802041059","type":"NDC"}],"standard_charges":[{"gross_charge":24.38,"discounted_cash":24.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"GENTEAL TEARS 0.1-0.2-0.3 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00065042636","type":"NDC"}],"standard_charges":[{"gross_charge":100.65,"discounted_cash":100.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"CEFDINIR 125 MG/5ML PO SUSR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"65862021860","type":"NDC"}],"standard_charges":[{"gross_charge":61.1,"discounted_cash":61.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12 ML"}]},{"description":"AZELASTINE HCL 0.1 % NA SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"42291009430","type":"NDC"}],"standard_charges":[{"gross_charge":95.54,"discounted_cash":95.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"LEVALBUTEROL HCL 0.63 MG/3ML IN NEBU","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"J7612","type":"HCPCS"},{"code":"76204080001","type":"NDC"}],"standard_charges":[{"gross_charge":25.79,"discounted_cash":25.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"HEPARIN SODIUM (PORCINE) 1000 UNIT/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"25021040067","type":"NDC"}],"standard_charges":[{"gross_charge":19.67,"discounted_cash":19.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.8 ML"}]},{"description":"FLUOROURACIL 5 GM/100ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9190","type":"HCPCS"},{"code":"71288015476","type":"NDC"}],"standard_charges":[{"gross_charge":84.2,"discounted_cash":84.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 13 ML"}]},{"description":"LIDOCAINE-EPINEPHRINE 1 %-1:100000 IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2004","type":"HCPCS"},{"code":"00409317802","type":"NDC"}],"standard_charges":[{"gross_charge":39.31,"discounted_cash":39.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"SUCCINYLCHOLINE CHLORIDE 20 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0330","type":"HCPCS"},{"code":"70069078325","type":"NDC"}],"standard_charges":[{"gross_charge":35.6,"discounted_cash":35.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"HEPARIN SODIUM (PORCINE) 1000 UNIT/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"67457038599","type":"NDC"}],"standard_charges":[{"gross_charge":31.16,"discounted_cash":31.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"DEXAMETHASONE SODIUM PHOSPHATE 120 MG/30ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1100","type":"HCPCS"},{"code":"55150023930","type":"NDC"}],"standard_charges":[{"gross_charge":18.33,"discounted_cash":18.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"BUPIVACAINE HCL 0.5 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0665","type":"HCPCS"},{"code":"00143932910","type":"NDC"}],"standard_charges":[{"gross_charge":16.43,"discounted_cash":16.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"BUPIVACAINE HCL 0.5 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0665","type":"HCPCS"},{"code":"00409116301","type":"NDC"}],"standard_charges":[{"gross_charge":15.67,"discounted_cash":15.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.28 ML"}]},{"description":"BUPIVACAINE HCL 0.5 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0665","type":"HCPCS"},{"code":"55150025050","type":"NDC"}],"standard_charges":[{"gross_charge":16.56,"discounted_cash":16.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"LIDOCAINE HCL 1 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2003","type":"HCPCS"},{"code":"00143957710","type":"NDC"}],"standard_charges":[{"gross_charge":16.0,"discounted_cash":16.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"LIDOCAINE HCL 1 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2003","type":"HCPCS"},{"code":"55150025220","type":"NDC"}],"standard_charges":[{"gross_charge":26.73,"discounted_cash":26.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 16 ML"}]},{"description":"LIDOCAINE HCL 2 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2003","type":"HCPCS"},{"code":"55150025410","type":"NDC"}],"standard_charges":[{"gross_charge":16.69,"discounted_cash":16.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"INCRUSE ELLIPTA 62.5 MCG/ACT IN AEPB","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00173087306","type":"NDC"}],"standard_charges":[{"gross_charge":82.63,"discounted_cash":82.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"FLUOROURACIL 5 GM/100ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9190","type":"HCPCS"},{"code":"63323011761","type":"NDC"}],"standard_charges":[{"gross_charge":54.91,"discounted_cash":54.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"PEG-3350/ELECTROLYTES 236 G PO SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"10572010001","type":"NDC"}],"standard_charges":[{"gross_charge":215.96,"discounted_cash":215.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4000 ML"}]},{"description":"MURO 128 2 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"24208027615","type":"NDC"}],"standard_charges":[{"gross_charge":133.83,"discounted_cash":133.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"IODINE STRONG 5 % PO SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"999","type":"RC"},{"code":"48433023015","type":"NDC"}],"standard_charges":[{"gross_charge":20.94,"discounted_cash":20.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.2 ML"}]},{"description":"GERI-MOX 200-200-20 MG/5ML PO SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"57896063912","type":"NDC"}],"standard_charges":[{"gross_charge":9.73,"discounted_cash":9.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"MINTOX MAXIMUM STRENGTH 400-400-40 MG/5ML PO SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00904572514","type":"NDC"}],"standard_charges":[{"gross_charge":6.59,"discounted_cash":6.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"CYCLOMYDRIL 0.2-1 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00065035902","type":"NDC"}],"standard_charges":[{"gross_charge":291.99,"discounted_cash":291.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"INFANTS GAS RELIEF 20 MG/0.3ML PO SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"69618005951","type":"NDC"}],"standard_charges":[{"gross_charge":3.92,"discounted_cash":3.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.3 ML"}]},{"description":"SIMETHICONE DROPS INFANTS 20 MG/0.3ML PO SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00536130375","type":"NDC"}],"standard_charges":[{"gross_charge":4.06,"discounted_cash":4.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.6 ML"}]},{"description":"MORPHINE SULFATE (CONCENTRATE) 100 MG/5ML PO SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00406800330","type":"NDC"}],"standard_charges":[{"gross_charge":12.13,"discounted_cash":12.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.75 ML"}]},{"description":"MAXITROL 0.1 % OP SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"82667010005","type":"NDC"}],"standard_charges":[{"gross_charge":629.69,"discounted_cash":629.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"GOLYTELY 236 G PO SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"52268010001","type":"NDC"}],"standard_charges":[{"gross_charge":215.96,"discounted_cash":215.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4000 ML"}]},{"description":"GAVILYTE-G 236 G PO SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"43386009019","type":"NDC"}],"standard_charges":[{"gross_charge":215.96,"discounted_cash":215.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4000 ML"}]},{"description":"MURINE EAR 6.5 % OT SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"78112073623","type":"NDC"}],"standard_charges":[{"gross_charge":58.61,"discounted_cash":58.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"CYCLOGYL 1 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00065039605","type":"NDC"}],"standard_charges":[{"gross_charge":336.5,"discounted_cash":336.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"PEG-3350/ELECTROLYTES 236 G PO SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"64380076621","type":"NDC"}],"standard_charges":[{"gross_charge":215.96,"discounted_cash":215.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4000 ML"}]},{"description":"MIDAZOLAM HCL 5 MG/5ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2250","type":"HCPCS"},{"code":"00641605910","type":"NDC"}],"standard_charges":[{"gross_charge":16.27,"discounted_cash":16.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"ONDANSETRON HCL 40 MG/20ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2405","type":"HCPCS"},{"code":"00641607901","type":"NDC"}],"standard_charges":[{"gross_charge":19.11,"discounted_cash":19.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"SUCCINYLCHOLINE CHLORIDE 20 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0330","type":"HCPCS"},{"code":"70069030125","type":"NDC"}],"standard_charges":[{"gross_charge":18.53,"discounted_cash":18.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"SUCCINYLCHOLINE CHLORIDE 20 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0330","type":"HCPCS"},{"code":"71288071911","type":"NDC"}],"standard_charges":[{"gross_charge":21.89,"discounted_cash":21.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 ML"}]},{"description":"MIDAZOLAM HCL 2 MG/2ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2250","type":"HCPCS"},{"code":"00641605725","type":"NDC"}],"standard_charges":[{"gross_charge":16.59,"discounted_cash":16.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"BUPIVACAINE HCL 0.25 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0665","type":"HCPCS"},{"code":"00409116001","type":"NDC"}],"standard_charges":[{"gross_charge":15.93,"discounted_cash":15.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"LIDOCAINE HCL 2 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2003","type":"HCPCS"},{"code":"00409427702","type":"NDC"}],"standard_charges":[{"gross_charge":16.18,"discounted_cash":16.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"LABETALOL HCL 5 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1921","type":"HCPCS"},{"code":"00143932001","type":"NDC"}],"standard_charges":[{"gross_charge":16.0,"discounted_cash":16.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.4 ML"}]},{"description":"LABETALOL HCL 5 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1921","type":"HCPCS"},{"code":"00143962301","type":"NDC"}],"standard_charges":[{"gross_charge":37.69,"discounted_cash":37.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 ML"}]},{"description":"HEPARIN SODIUM (PORCINE) 1000 UNIT/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"71288042096","type":"NDC"}],"standard_charges":[{"gross_charge":15.73,"discounted_cash":15.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"BUPIVACAINE HCL 0.25 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0665","type":"HCPCS"},{"code":"55150024950","type":"NDC"}],"standard_charges":[{"gross_charge":16.04,"discounted_cash":16.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"LIDOCAINE HCL 1 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2003","type":"HCPCS"},{"code":"00409427601","type":"NDC"}],"standard_charges":[{"gross_charge":15.69,"discounted_cash":15.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 ML"}]},{"description":"LIDOCAINE-EPINEPHRINE 1 %-1:100000 IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2004","type":"HCPCS"},{"code":"00409000710","type":"NDC"}],"standard_charges":[{"gross_charge":24.69,"discounted_cash":24.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6 ML"}]},{"description":"LABETALOL HCL 5 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1920","type":"HCPCS"},{"code":"72266010301","type":"NDC"}],"standard_charges":[{"gross_charge":76.95,"discounted_cash":76.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 ML"}]},{"description":"ONDANSETRON HCL 40 MG/20ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2405","type":"HCPCS"},{"code":"23155054931","type":"NDC"}],"standard_charges":[{"gross_charge":21.06,"discounted_cash":21.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"NEOSTIGMINE METHYLSULFATE 10 MG/10ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2710","type":"HCPCS"},{"code":"00641614910","type":"NDC"}],"standard_charges":[{"gross_charge":18.43,"discounted_cash":18.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"BUMETANIDE 0.25 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3490","type":"HCPCS"},{"code":"68462047054","type":"NDC"}],"standard_charges":[{"gross_charge":27.24,"discounted_cash":27.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"}]},{"description":"CISPLATIN 100 MG/100ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9060","type":"HCPCS"},{"code":"25021025351","type":"NDC"}],"standard_charges":[{"gross_charge":355.56,"discounted_cash":355.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 43 ML"}]},{"description":"CISPLATIN 200 MG/200ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9060","type":"HCPCS"},{"code":"63323010364","type":"NDC"}],"standard_charges":[{"gross_charge":290.22,"discounted_cash":290.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 35 ML"}]},{"description":"LIDOCAINE-EPINEPHRINE 2 %-1:100000 IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2004","type":"HCPCS"},{"code":"00409014710","type":"NDC"}],"standard_charges":[{"gross_charge":25.97,"discounted_cash":25.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 ML"}]},{"description":"MIDAZOLAM HCL 5 MG/5ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2250","type":"HCPCS"},{"code":"00641621010","type":"NDC"}],"standard_charges":[{"gross_charge":17.02,"discounted_cash":17.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"LIDOCAINE-EPINEPHRINE 2 %-1:100000 IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2004","type":"HCPCS"},{"code":"00409318201","type":"NDC"}],"standard_charges":[{"gross_charge":16.8,"discounted_cash":16.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"DEXAMETHASONE SODIUM PHOSPHATE 20 MG/5ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1100","type":"HCPCS"},{"code":"63323016526","type":"NDC"}],"standard_charges":[{"gross_charge":17.66,"discounted_cash":17.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"DEXAMETHASONE SODIUM PHOSPHATE 20 MG/5ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1100","type":"HCPCS"},{"code":"63323016505","type":"NDC"}],"standard_charges":[{"gross_charge":17.66,"discounted_cash":17.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"LIDOCAINE HCL 1 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2003","type":"HCPCS"},{"code":"00409427602","type":"NDC"}],"standard_charges":[{"gross_charge":15.89,"discounted_cash":15.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.75 ML"}]},{"description":"ONDANSETRON HCL 40 MG/20ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2405","type":"HCPCS"},{"code":"00409475901","type":"NDC"}],"standard_charges":[{"gross_charge":17.65,"discounted_cash":17.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"CLINDAMYCIN PHOSPHATE IN D5W 600 MG/50ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0737","type":"HCPCS"},{"code":"00338361224","type":"NDC"}],"standard_charges":[{"gross_charge":43.5,"discounted_cash":43.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"LIDOCAINE HCL 2 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2003","type":"HCPCS"},{"code":"00409427701","type":"NDC"}],"standard_charges":[{"gross_charge":16.31,"discounted_cash":16.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"FLUCONAZOLE IN SODIUM CHLORIDE 200-0.9 MG/100ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1450","type":"HCPCS"},{"code":"00338604648","type":"NDC"}],"standard_charges":[{"gross_charge":56.52,"discounted_cash":56.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 ML"}]},{"description":"DEXAMETHASONE SODIUM PHOSPHATE 100 MG/10ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1100","type":"HCPCS"},{"code":"63323051610","type":"NDC"}],"standard_charges":[{"gross_charge":18.15,"discounted_cash":18.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.8 ML"}]},{"description":"CISPLATIN 100 MG/100ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9060","type":"HCPCS"},{"code":"16729028838","type":"NDC"}],"standard_charges":[{"gross_charge":99.58,"discounted_cash":99.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 ML"}]},{"description":"CARBOPLATIN 600 MG/60ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9045","type":"HCPCS"},{"code":"55150038601","type":"NDC"}],"standard_charges":[{"gross_charge":110.44,"discounted_cash":110.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6.2 ML"}]},{"description":"HYOSYNE 0.125 MG/ML PO SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"54838050615","type":"NDC"}],"standard_charges":[{"gross_charge":22.2,"discounted_cash":22.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"DEXTROMETHORPHAN POLISTIREX ER 30 MG/5ML PO SUER","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"45802043321","type":"NDC"}],"standard_charges":[{"gross_charge":13.43,"discounted_cash":13.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"LORAZEPAM INTENSOL 2 MG/ML PO CONC","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00054353244","type":"NDC"}],"standard_charges":[{"gross_charge":5.48,"discounted_cash":5.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 ML"}]},{"description":"CITROMA 1.745 GM/30ML PO SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00869016638","type":"NDC"}],"standard_charges":[{"gross_charge":25.71,"discounted_cash":25.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 296 ML"}]},{"description":"SORE THROAT SPRAY 1.4 % MT LIQD","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00904630521","type":"NDC"}],"standard_charges":[{"gross_charge":2.3,"discounted_cash":2.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"SUPREP BOWEL PREP KIT 17.5-3.13-1.6 GM/177ML PO SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"52268001201","type":"NDC"}],"standard_charges":[{"gross_charge":252.02,"discounted_cash":252.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 177 ML"}]},{"description":"GNP ALL DAY ALLERGY CHILDRENS 1 MG/ML PO SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"46122020326","type":"NDC"}],"standard_charges":[{"gross_charge":4.35,"discounted_cash":4.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 ML"}]},{"description":"BETADINE OPHTHALMIC PREP 5 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00065041130","type":"NDC"}],"standard_charges":[{"gross_charge":93.91,"discounted_cash":93.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"EYE ITCH RELIEF 0.035 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00536125240","type":"NDC"}],"standard_charges":[{"gross_charge":93.93,"discounted_cash":93.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"ALAWAY 0.035 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"24208060110","type":"NDC"}],"standard_charges":[{"gross_charge":142.04,"discounted_cash":142.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"GNP FLUTICASONE PROPIONATE 50 MCG/ACT NA SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"46122068435","type":"NDC"}],"standard_charges":[{"gross_charge":100.18,"discounted_cash":100.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 11.1 ML"}]},{"description":"NEOMYCIN-POLYMYXIN-HC 3.5-10000-1 OT SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"61314064610","type":"NDC"}],"standard_charges":[{"gross_charge":354.32,"discounted_cash":354.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"ONELAX MAGNESIUM CITRATE 1.745 GM/30ML PO SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"71399788901","type":"NDC"}],"standard_charges":[{"gross_charge":14.87,"discounted_cash":14.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 ML"}]},{"description":"ONELAX MAGNESIUM CITRATE 1.745 GM/30ML PO SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"71399005101","type":"NDC"}],"standard_charges":[{"gross_charge":40.21,"discounted_cash":40.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 296 ML"}]},{"description":"FLEET OIL RE ENEM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00132030140","type":"NDC"}],"standard_charges":[{"gross_charge":39.44,"discounted_cash":39.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 133 ML"}]},{"description":"12 HOUR DECONGESTANT 0.05 % NA SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"69618005051","type":"NDC"}],"standard_charges":[{"gross_charge":43.5,"discounted_cash":43.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"GNP NO DRIP NASAL SPRAY 0.05 % NA SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"24385035210","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":42.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"SALINE NASAL SPRAY 0.65 % NA SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"45802035758","type":"NDC"}],"standard_charges":[{"gross_charge":19.92,"discounted_cash":19.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 45 ML"}]},{"description":"NASAL DECONGESTANT SPRAY 0.05 % NA SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00904742730","type":"NDC"}],"standard_charges":[{"gross_charge":40.95,"discounted_cash":40.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"VICKS SINEX MOISTURIZING 0.05 % NA SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"23900002326","type":"NDC"}],"standard_charges":[{"gross_charge":111.1,"discounted_cash":111.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"VICKS SINEX 12 HOUR DECONGEST 0.05 % NA SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"37000080301","type":"NDC"}],"standard_charges":[{"gross_charge":67.12,"discounted_cash":67.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"AFRIN NODRIP EXTRA MOISTURE 0.05 % NA SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"41100001511","type":"NDC"}],"standard_charges":[{"gross_charge":116.69,"discounted_cash":116.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"GNP NASAL SPRAY 0.05 % NA SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"46122016510","type":"NDC"}],"standard_charges":[{"gross_charge":23.11,"discounted_cash":23.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"NASAL DECONGESTANT SPRAY 0.05 % NA SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00904743535","type":"NDC"}],"standard_charges":[{"gross_charge":34.26,"discounted_cash":34.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"NEO-SYNEPHRINE COLD/ALLRG MILD 0.25 % NA SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00225080047","type":"NDC"}],"standard_charges":[{"gross_charge":54.24,"discounted_cash":54.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"NEO-SYNEPHRINE COLD/ALLRGY REG 0.5 % NA SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00225080547","type":"NDC"}],"standard_charges":[{"gross_charge":54.24,"discounted_cash":54.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"NEO-SYNEPHRINE COLD/ALLRGY EXT 1 % NA SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00225081047","type":"NDC"}],"standard_charges":[{"gross_charge":60.31,"discounted_cash":60.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"EAR DROPS 6.5 % OT SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00904662735","type":"NDC"}],"standard_charges":[{"gross_charge":31.71,"discounted_cash":31.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"GNP EARWAX REMOVAL DROPS 6.5 % OT SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"46122055705","type":"NDC"}],"standard_charges":[{"gross_charge":21.52,"discounted_cash":21.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"POLYVINYL ALCOHOL 1.4 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"50268067815","type":"NDC"}],"standard_charges":[{"gross_charge":121.06,"discounted_cash":121.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"IPRATROPIUM BROMIDE 0.06 % NA SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"60505082701","type":"NDC"}],"standard_charges":[{"gross_charge":135.4,"discounted_cash":135.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"BRIMONIDINE TARTRATE 0.2 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"70069023101","type":"NDC"}],"standard_charges":[{"gross_charge":46.46,"discounted_cash":46.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"FT NASAL SPRAY 0.05 % NA SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"70677103701","type":"NDC"}],"standard_charges":[{"gross_charge":39.04,"discounted_cash":39.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"BETADINE 5 % EX SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"67618016003","type":"NDC"}],"standard_charges":[{"gross_charge":97.56,"discounted_cash":97.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 88.7 ML"}]},{"description":"BETADINE 10 % EX SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"67618015017","type":"NDC"}],"standard_charges":[{"gross_charge":6.88,"discounted_cash":6.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"MOXIFLOXACIN HCL 0.5 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00781713593","type":"NDC"}],"standard_charges":[{"gross_charge":91.8,"discounted_cash":91.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"GNP MAGNESIUM CITRATE 1.745 GM/30ML PO SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"46122074038","type":"NDC"}],"standard_charges":[{"gross_charge":166.56,"discounted_cash":166.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 296 ML"}]},{"description":"GNP MAGNESIUM CITRATE 1.745 GM/30ML PO SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"46122074138","type":"NDC"}],"standard_charges":[{"gross_charge":166.56,"discounted_cash":166.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 296 ML"}]},{"description":"GEBAUERS PAIN EASE EX AERO","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00386000803","type":"NDC"}],"standard_charges":[{"gross_charge":260.11,"discounted_cash":260.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 116 ML"}]},{"description":"DIPHENHYDRAMINE HCL 12.5 MG/5ML PO LIQD","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00904698516","type":"NDC"}],"standard_charges":[{"gross_charge":2.68,"discounted_cash":2.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3.333 ML"}]},{"description":"DIPHENHYDRAMINE HCL 12.5 MG/5ML PO LIQD","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00904698520","type":"NDC"}],"standard_charges":[{"gross_charge":4.02,"discounted_cash":4.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3.333 ML"}]},{"description":"TRUEPLUS GLUCOSE 15 GM/32ML PO GEL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"56151162501","type":"NDC"}],"standard_charges":[{"gross_charge":50.65,"discounted_cash":50.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 64 ML"}]},{"description":"GNP INFANT GAS RELIEF 20 MG/0.3ML PO SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"46122054703","type":"NDC"}],"standard_charges":[{"gross_charge":4.66,"discounted_cash":4.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.6 ML"}]},{"description":"NEBUSAL 3 % IN NEBU","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"50190014263","type":"NDC"}],"standard_charges":[{"gross_charge":14.03,"discounted_cash":14.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"EYE DROPS 0.05 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00536121794","type":"NDC"}],"standard_charges":[{"gross_charge":24.07,"discounted_cash":24.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"VISINE RED EYE COMFORT 0.05 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"69968035501","type":"NDC"}],"standard_charges":[{"gross_charge":65.17,"discounted_cash":65.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"ANTACID/ANTIGAS 400-400-40 MG/10ML PO SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00536131783","type":"NDC"}],"standard_charges":[{"gross_charge":3.35,"discounted_cash":3.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3.333 ML"}]},{"description":"GERI-LANTA 200-200-20 MG/5ML PO SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"57896062912","type":"NDC"}],"standard_charges":[{"gross_charge":2.9,"discounted_cash":2.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3.333 ML"}]},{"description":"ANTACID REGULAR STRENGTH 200-200-20 MG/5ML PO SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00536129383","type":"NDC"}],"standard_charges":[{"gross_charge":10.9,"discounted_cash":10.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"GNP ANTACID REGULAR STRENGTH 200-200-20 MG/5ML PO SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"46122043340","type":"NDC"}],"standard_charges":[{"gross_charge":5.47,"discounted_cash":5.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"GNP ANTACID & ANTI-GAS 200-200-20 MG/5ML PO SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"46122043440","type":"NDC"}],"standard_charges":[{"gross_charge":9.73,"discounted_cash":9.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"BUDESONIDE 1 MG/2ML IN SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"69097032153","type":"NDC"}],"standard_charges":[{"gross_charge":63.79,"discounted_cash":63.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"DORZOLAMIDE HCL-TIMOLOL MAL 2-0.5 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"65862094601","type":"NDC"}],"standard_charges":[{"gross_charge":167.34,"discounted_cash":167.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"OFLOXACIN 0.3 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"64980051505","type":"NDC"}],"standard_charges":[{"gross_charge":126.38,"discounted_cash":126.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"OFLOXACIN 0.3 % OT SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"69238161503","type":"NDC"}],"standard_charges":[{"gross_charge":125.84,"discounted_cash":125.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"CIPROFLOXACIN HCL 0.3 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"69315030805","type":"NDC"}],"standard_charges":[{"gross_charge":118.0,"discounted_cash":118.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"MOXIFLOXACIN HCL 0.5 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"72266015801","type":"NDC"}],"standard_charges":[{"gross_charge":144.0,"discounted_cash":144.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"HALOPERIDOL LACTATE 2 MG/ML PO CONC UNIT DOSE","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00121058115","type":"NDC"}],"standard_charges":[{"gross_charge":20.32,"discounted_cash":20.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"KETOROLAC TROMETHAMINE 0.5 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"42571013726","type":"NDC"}],"standard_charges":[{"gross_charge":108.52,"discounted_cash":108.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"KETOROLAC TROMETHAMINE 0.5 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"61314012610","type":"NDC"}],"standard_charges":[{"gross_charge":101.04,"discounted_cash":101.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"KETOROLAC TROMETHAMINE 0.5 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"60505100301","type":"NDC"}],"standard_charges":[{"gross_charge":85.5,"discounted_cash":85.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"OLOPATADINE HCL 0.1 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"70512052005","type":"NDC"}],"standard_charges":[{"gross_charge":115.15,"discounted_cash":115.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"DICLOFENAC SODIUM 0.1 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"24208045705","type":"NDC"}],"standard_charges":[{"gross_charge":17.46,"discounted_cash":17.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"LATANOPROST 0.005 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"70069042103","type":"NDC"}],"standard_charges":[{"gross_charge":58.29,"discounted_cash":58.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 ML"}]},{"description":"CYCLOPENTOLATE HCL 1 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"61314039601","type":"NDC"}],"standard_charges":[{"gross_charge":68.65,"discounted_cash":68.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"FT MAGNESIUM CITRATE 1.745 GM/30ML PO SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"70677111101","type":"NDC"}],"standard_charges":[{"gross_charge":30.54,"discounted_cash":30.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 296 ML"}]},{"description":"AMPICILLIN SODIUM 2 G IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0290","type":"HCPCS"},{"code":"55150011420","type":"NDC"}],"standard_charges":[{"gross_charge":44.48,"discounted_cash":44.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"GUAIFENESIN-CODEINE 100-10 MG/5ML PO SOLN UNIT DOSE","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00121077516","type":"NDC"}],"standard_charges":[{"gross_charge":12.46,"discounted_cash":12.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"ALBUTEROL SULFATE (2.5 MG/3ML) 0.083% IN NEBU","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00378827055","type":"NDC"}],"standard_charges":[{"gross_charge":8.8,"discounted_cash":8.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"NYSTATIN-TRIAMCINOLONE 100000-0.1 UNIT/GM-% EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"45802024414","type":"NDC"}],"standard_charges":[{"gross_charge":57.64,"discounted_cash":57.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 GR"}]},{"description":"CLOTRIMAZOLE-BETAMETHASONE 1-0.05 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00168025815","type":"NDC"}],"standard_charges":[{"gross_charge":139.04,"discounted_cash":139.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 GR"}]},{"description":"ZINC OXIDE 20 % EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"75834017001","type":"NDC"}],"standard_charges":[{"gross_charge":80.47,"discounted_cash":80.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 28.4 GR"}]},{"description":"CLOBETASOL PROPIONATE 0.05 % EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00713065615","type":"NDC"}],"standard_charges":[{"gross_charge":55.69,"discounted_cash":55.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 GR"}]},{"description":"TRIAMCINOLONE ACETONIDE 0.5 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"45802006535","type":"NDC"}],"standard_charges":[{"gross_charge":59.34,"discounted_cash":59.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 GR"}]},{"description":"NYSTATIN 100000 UNIT/GM EX POWD","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"68382037001","type":"NDC"}],"standard_charges":[{"gross_charge":106.48,"discounted_cash":106.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 GR"}]},{"description":"FLUOCINONIDE 0.05 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"51672138601","type":"NDC"}],"standard_charges":[{"gross_charge":131.02,"discounted_cash":131.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 GR"}]},{"description":"NYSTATIN 100000 UNIT/GM EX POWD","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"69315030660","type":"NDC"}],"standard_charges":[{"gross_charge":385.95,"discounted_cash":385.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 GR"}]},{"description":"ERYTHROMYCIN 5 MG/GM OP OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00574402435","type":"NDC"}],"standard_charges":[{"gross_charge":121.79,"discounted_cash":121.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3.5 GR"}]},{"description":"ALBUTEROL SULFATE HFA 108 (90 BASE) MCG/ACT IN AERS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00781729685","type":"NDC"}],"standard_charges":[{"gross_charge":127.94,"discounted_cash":127.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6.7 GR"}]},{"description":"MUPIROCIN 2 % EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"50268056815","type":"NDC"}],"standard_charges":[{"gross_charge":45.96,"discounted_cash":45.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 GR"}]},{"description":"GENTAMICIN SULFATE 0.1 % EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00713068215","type":"NDC"}],"standard_charges":[{"gross_charge":108.8,"discounted_cash":108.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 GR"}]},{"description":"TRIAMCINOLONE ACETONIDE 0.5 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"16714098701","type":"NDC"}],"standard_charges":[{"gross_charge":117.17,"discounted_cash":117.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 GR"}]},{"description":"HYDROCORTISONE (PERIANAL) 2.5 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"62559043130","type":"NDC"}],"standard_charges":[{"gross_charge":117.42,"discounted_cash":117.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 GR"}]},{"description":"KETOCONAZOLE 2 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00168009915","type":"NDC"}],"standard_charges":[{"gross_charge":107.45,"discounted_cash":107.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 GR"}]},{"description":"HYDROCORTISONE 1 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"45802043803","type":"NDC"}],"standard_charges":[{"gross_charge":29.48,"discounted_cash":29.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 28 GR"}]},{"description":"HYDROCORTISONE 1 % EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"45802027603","type":"NDC"}],"standard_charges":[{"gross_charge":34.24,"discounted_cash":34.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 28 GR"}]},{"description":"DICLOFENAC SODIUM 1 % EX GEL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00536129497","type":"NDC"}],"standard_charges":[{"gross_charge":130.7,"discounted_cash":130.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 GR"}]},{"description":"DICLOFENAC SODIUM 1 % EX GEL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"45802095301","type":"NDC"}],"standard_charges":[{"gross_charge":109.64,"discounted_cash":109.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 GR"}]},{"description":"DIBUCAINE 1 % EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00536121195","type":"NDC"}],"standard_charges":[{"gross_charge":55.34,"discounted_cash":55.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 28 GR"}]},{"description":"LIDOCAINE 5 % EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"51672302009","type":"NDC"}],"standard_charges":[{"gross_charge":81.95,"discounted_cash":81.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 35.44 GR"}]},{"description":"LIDOCAINE 5 % EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"16714087801","type":"NDC"}],"standard_charges":[{"gross_charge":164.79,"discounted_cash":164.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 35.44 GR"}]},{"description":"MUPIROCIN 2 % EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"45802011222","type":"NDC"}],"standard_charges":[{"gross_charge":86.83,"discounted_cash":86.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 22 GR"}]},{"description":"LIDOCAINE 5 % EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"67877047379","type":"NDC"}],"standard_charges":[{"gross_charge":121.64,"discounted_cash":121.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 35.44 GR"}]},{"description":"SILVER SULFADIAZINE 1 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"59762013102","type":"NDC"}],"standard_charges":[{"gross_charge":112.88,"discounted_cash":112.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 GR"}]},{"description":"SILVER SULFADIAZINE 1 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"67877012425","type":"NDC"}],"standard_charges":[{"gross_charge":112.88,"discounted_cash":112.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 GR"}]},{"description":"CLOTRIMAZOLE 1 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"51672200201","type":"NDC"}],"standard_charges":[{"gross_charge":39.36,"discounted_cash":39.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 GR"}]},{"description":"TRIAMCINOLONE ACETONIDE 0.1 % EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"45802005535","type":"NDC"}],"standard_charges":[{"gross_charge":38.2,"discounted_cash":38.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 GR"}]},{"description":"BETAMETHASONE DIPROPIONATE 0.05 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00168005546","type":"NDC"}],"standard_charges":[{"gross_charge":379.4,"discounted_cash":379.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 45 GR"}]},{"description":"CLOBETASOL PROPIONATE 0.05 % EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"42291007715","type":"NDC"}],"standard_charges":[{"gross_charge":41.36,"discounted_cash":41.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 GR"}]},{"description":"NYSTATIN 100000 UNIT/GM EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"45802005935","type":"NDC"}],"standard_charges":[{"gross_charge":63.96,"discounted_cash":63.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 GR"}]},{"description":"SILVER SULFADIAZINE 1 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"67877012450","type":"NDC"}],"standard_charges":[{"gross_charge":103.74,"discounted_cash":103.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 GR"}]},{"description":"ACTIDOSE WITH SORBITOL 25 GM/120ML PO SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00574052074","type":"NDC"}],"standard_charges":[{"gross_charge":261.41,"discounted_cash":261.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 240 ML"}]},{"description":"BIOTENE DRY MOUTH MT LIQD","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"48582080220","type":"NDC"}],"standard_charges":[{"gross_charge":59.58,"discounted_cash":59.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 237 ML"}]},{"description":"AMOXICILLIN 400 MG/5ML PO SUSR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"65862007150","type":"NDC"}],"standard_charges":[{"gross_charge":15.67,"discounted_cash":15.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6.25 ML"}]},{"description":"HYSEPT 50 0.5 % EX SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"39328006250","type":"NDC"}],"standard_charges":[{"gross_charge":163.63,"discounted_cash":163.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 473 ML"}]},{"description":"ARNUITY ELLIPTA 100 MCG/ACT IN AEPB","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00173087414","type":"NDC"}],"standard_charges":[{"gross_charge":387.55,"discounted_cash":387.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 14 UN"}]},{"description":"ANORO ELLIPTA 62.5-25 MCG/ACT IN AEPB","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00173086910","type":"NDC"}],"standard_charges":[{"gross_charge":1410.63,"discounted_cash":1410.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 UN"}]},{"description":"ANORO ELLIPTA 62.5-25 MCG/ACT IN AEPB","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00173086906","type":"NDC"}],"standard_charges":[{"gross_charge":373.13,"discounted_cash":373.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 14 UN"}]},{"description":"GNP ARTHRITIS PAIN 1 % EX GEL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"46122064654","type":"NDC"}],"standard_charges":[{"gross_charge":114.5,"discounted_cash":114.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 GR"}]},{"description":"VENTOLIN HFA 108 (90 BASE) MCG/ACT IN AERS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00173068224","type":"NDC"}],"standard_charges":[{"gross_charge":188.17,"discounted_cash":188.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 GR"}]},{"description":"DESITIN DAILY DEFENSE 13 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"74300000301","type":"NDC"}],"standard_charges":[{"gross_charge":79.61,"discounted_cash":79.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 113 GR"}]},{"description":"BANOPHEN 2-0.1 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00904535431","type":"NDC"}],"standard_charges":[{"gross_charge":35.43,"discounted_cash":35.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 28 GR"}]},{"description":"ANTI-ITCH 2-0.1 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"51672208902","type":"NDC"}],"standard_charges":[{"gross_charge":39.53,"discounted_cash":39.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 28.4 GR"}]},{"description":"CLOBETASOL PROPIONATE 0.05 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"51672125802","type":"NDC"}],"standard_charges":[{"gross_charge":117.9,"discounted_cash":117.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 GR"}]},{"description":"CLINDAMYCIN PHOS (TWICE-DAILY) 1 % EX GEL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"21922002705","type":"NDC"}],"standard_charges":[{"gross_charge":106.24,"discounted_cash":106.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 GR"}]},{"description":"LIDOCAINE 5 % EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"64380078932","type":"NDC"}],"standard_charges":[{"gross_charge":137.64,"discounted_cash":137.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 35.44 GR"}]},{"description":"CLOBETASOL PROPIONATE 0.05 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"68180095601","type":"NDC"}],"standard_charges":[{"gross_charge":87.77,"discounted_cash":87.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 GR"}]},{"description":"METRONIDAZOLE 0.75 % EX GEL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"51672411606","type":"NDC"}],"standard_charges":[{"gross_charge":140.73,"discounted_cash":140.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 45 GR"}]},{"description":"NYSTATIN-TRIAMCINOLONE 100000-0.1 UNIT/GM-% EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"51672126302","type":"NDC"}],"standard_charges":[{"gross_charge":85.83,"discounted_cash":85.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 GR"}]},{"description":"HYDROCORTISONE 1 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"51672201301","type":"NDC"}],"standard_charges":[{"gross_charge":36.31,"discounted_cash":36.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 14.2 GR"}]},{"description":"NYSTATIN 100000 UNIT/GM EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"45802004811","type":"NDC"}],"standard_charges":[{"gross_charge":100.89,"discounted_cash":100.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 GR"}]},{"description":"NYSTATIN 100000 UNIT/GM EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"45802005911","type":"NDC"}],"standard_charges":[{"gross_charge":100.89,"discounted_cash":100.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 GR"}]},{"description":"NYSTATIN 100000 UNIT/GM EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00713067831","type":"NDC"}],"standard_charges":[{"gross_charge":98.46,"discounted_cash":98.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 GR"}]},{"description":"CLOTRIMAZOLE 1 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"45802043401","type":"NDC"}],"standard_charges":[{"gross_charge":49.38,"discounted_cash":49.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 GR"}]},{"description":"ESTRADIOL 0.1 MG/GM VA CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00093354143","type":"NDC"}],"standard_charges":[{"gross_charge":125.39,"discounted_cash":125.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 42.5 GR"}]},{"description":"FLUTICASONE PROPIONATE 50 MCG/ACT NA SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"60505082901","type":"NDC"}],"standard_charges":[{"gross_charge":103.29,"discounted_cash":103.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 16 GR"}]},{"description":"FLUTICASONE PROPIONATE 50 MCG/ACT NA SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00054327099","type":"NDC"}],"standard_charges":[{"gross_charge":139.58,"discounted_cash":139.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 16 GR"}]},{"description":"LIDOCAINE 4 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"39328002455","type":"NDC"}],"standard_charges":[{"gross_charge":44.44,"discounted_cash":44.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 GR"}]},{"description":"CLOTRIMAZOLE 1 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"68462018117","type":"NDC"}],"standard_charges":[{"gross_charge":156.54,"discounted_cash":156.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 GR"}]},{"description":"KETOCONAZOLE 2 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"51672129802","type":"NDC"}],"standard_charges":[{"gross_charge":140.74,"discounted_cash":140.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 GR"}]},{"description":"CAPSAICIN 0.1 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00536126456","type":"NDC"}],"standard_charges":[{"gross_charge":139.04,"discounted_cash":139.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 42.5 GR"}]},{"description":"CLOTRIMAZOLE 1 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"51672127502","type":"NDC"}],"standard_charges":[{"gross_charge":98.95,"discounted_cash":98.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 GR"}]},{"description":"AYR SALINE NASAL NA GEL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00225052547","type":"NDC"}],"standard_charges":[{"gross_charge":44.06,"discounted_cash":44.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 14.1 GR"}]},{"description":"TRELEGY ELLIPTA 100-62.5-25 MCG/ACT IN AEPB","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00173088714","type":"NDC"}],"standard_charges":[{"gross_charge":927.14,"discounted_cash":927.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 28 UN"}]},{"description":"CHLORASEPTIC SORE THROAT 6-10 MG MT LOZG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"78112001106","type":"NDC"}],"standard_charges":[{"gross_charge":5.94,"discounted_cash":5.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"CEPACOL EXTRA STRENGTH 15-2.6 MG MT LOZG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"63824073216","type":"NDC"}],"standard_charges":[{"gross_charge":6.2,"discounted_cash":6.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"TRIPLE ANTIBIOTIC EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00904880567","type":"NDC"}],"standard_charges":[{"gross_charge":5.01,"discounted_cash":5.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"TRIPLE ANTIBIOTIC 3.5-400-5000 EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"45802014370","type":"NDC"}],"standard_charges":[{"gross_charge":5.58,"discounted_cash":5.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"HURRICAINE ONE 20 % MT SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00283061026","type":"NDC"}],"standard_charges":[{"gross_charge":153.9,"discounted_cash":153.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"BACITRACIN ZINC 500 UNIT/GM EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00904702367","type":"NDC"}],"standard_charges":[{"gross_charge":4.54,"discounted_cash":4.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"BACITRACIN ZINC 500 UNIT/GM EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"57896014514","type":"NDC"}],"standard_charges":[{"gross_charge":3.76,"discounted_cash":3.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"BACITRACIN 500 UNIT/GM EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00904740267","type":"NDC"}],"standard_charges":[{"gross_charge":4.64,"discounted_cash":4.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"BACITRACIN 500 UNIT/GM EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"45802006070","type":"NDC"}],"standard_charges":[{"gross_charge":5.37,"discounted_cash":5.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"BACITRACIN 500 UNIT/GM EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"68001047748","type":"NDC"}],"standard_charges":[{"gross_charge":6.1,"discounted_cash":6.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"SORE THROAT 15-3.6 MG MT LOZG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00904625549","type":"NDC"}],"standard_charges":[{"gross_charge":7.65,"discounted_cash":7.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"MEROPENEM 500 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2185","type":"HCPCS"},{"code":"00781300095","type":"NDC"}],"standard_charges":[{"gross_charge":39.14,"discounted_cash":39.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"VOLTAREN ARTHRITIS PAIN 1 % EX GEL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00067815203","type":"NDC"}],"standard_charges":[{"gross_charge":8.96,"discounted_cash":8.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 GR"}]},{"description":"PRIVIGEN 40 GM/400ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1459","type":"HCPCS"},{"code":"44206043940","type":"NDC"}],"standard_charges":[{"gross_charge":10347.68,"discounted_cash":10347.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 ML"}]},{"description":"ADRENALIN-NACL 4-0.9 MG/250ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"J3490","type":"HCPCS"},{"code":"42023031510","type":"NDC"}],"standard_charges":[{"gross_charge":169.95,"discounted_cash":169.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 ML"}]},{"description":"DOBUTAMINE-DEXTROSE 2-5 MG/ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1250","type":"HCPCS"},{"code":"00409234732","type":"NDC"}],"standard_charges":[{"gross_charge":122.66,"discounted_cash":122.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 ML"}]},{"description":"ISOVUE-370 76 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"255","type":"RC"},{"code":"Q9967","type":"HCPCS"},{"code":"00270131637","type":"NDC"}],"standard_charges":[{"gross_charge":94.8,"discounted_cash":94.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"ISOVUE-370 76 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"255","type":"RC"},{"code":"Q9967","type":"HCPCS"},{"code":"00270131604","type":"NDC"}],"standard_charges":[{"gross_charge":103.27,"discounted_cash":103.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 105 ML"}]},{"description":"RECOMBIVAX HB 10 MCG/ML IJ SUSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"90746","type":"HCPCS"},{"code":"00006409402","type":"NDC"}],"standard_charges":[{"gross_charge":106.74,"discounted_cash":106.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"ISOVUE-370 76 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"255","type":"RC"},{"code":"Q9967","type":"HCPCS"},{"code":"00270131652","type":"NDC"}],"standard_charges":[{"gross_charge":2.06,"discounted_cash":2.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"ISOVUE-370 76 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"255","type":"RC"},{"code":"Q9967","type":"HCPCS"},{"code":"00270131635","type":"NDC"}],"standard_charges":[{"gross_charge":0.1,"discounted_cash":0.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.086 ML"}]},{"description":"PRIVIGEN 5 GM/50ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1459","type":"HCPCS"},{"code":"44206043605","type":"NDC"}],"standard_charges":[{"gross_charge":1770.45,"discounted_cash":1770.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"PRIVIGEN 20 GM/200ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1459","type":"HCPCS"},{"code":"44206043820","type":"NDC"}],"standard_charges":[{"gross_charge":5871.53,"discounted_cash":5871.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 ML"}]},{"description":"OCTAGAM 5 GM/100ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1568","type":"HCPCS"},{"code":"68982084003","type":"NDC"}],"standard_charges":[{"gross_charge":505.35,"discounted_cash":505.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"PRIVIGEN 10 GM/100ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1459","type":"HCPCS"},{"code":"44206043710","type":"NDC"}],"standard_charges":[{"gross_charge":2783.84,"discounted_cash":2783.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"DOTAREM 7.5 MMOL/15ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"255","type":"RC"},{"code":"A9575","type":"HCPCS"},{"code":"67684200102","type":"NDC"}],"standard_charges":[{"gross_charge":1.88,"discounted_cash":1.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.2 ML"}]},{"description":"DEFINITY 6.52 MG/ML IV SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"255","type":"RC"},{"code":"Q9957","type":"HCPCS"},{"code":"11994001104","type":"NDC"}],"standard_charges":[{"gross_charge":508.07,"discounted_cash":508.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"HYDROMORPHONE 1 MG/ML (50 ML) IN NACL PCA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"J1171","type":"HCPCS"},{"code":"70092129474","type":"NDC"}],"standard_charges":[{"gross_charge":179.49,"discounted_cash":179.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"BACITRACIN 500 UNIT/GM EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"45802006001","type":"NDC"}],"standard_charges":[{"gross_charge":21.16,"discounted_cash":21.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 14 GR"}]},{"description":"BACITRACIN ZINC 500 UNIT/GM EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00536126328","type":"NDC"}],"standard_charges":[{"gross_charge":24.72,"discounted_cash":24.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 28 GR"}]},{"description":"BACITRACIN 500 UNIT/GM EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"45802006003","type":"NDC"}],"standard_charges":[{"gross_charge":30.08,"discounted_cash":30.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 28 GR"}]},{"description":"LIDOCAINE 5 % EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"33342040530","type":"NDC"}],"standard_charges":[{"gross_charge":102.84,"discounted_cash":102.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 GR"}]},{"description":"CLOTRIMAZOLE-BETAMETHASONE 1-0.05 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"16714049601","type":"NDC"}],"standard_charges":[{"gross_charge":94.33,"discounted_cash":94.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 GR"}]},{"description":"SILVER SULFADIAZINE 1 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"67877012420","type":"NDC"}],"standard_charges":[{"gross_charge":120.33,"discounted_cash":120.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 GR"}]},{"description":"CLOBETASOL PROPIONATE 0.05 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"51672125801","type":"NDC"}],"standard_charges":[{"gross_charge":144.88,"discounted_cash":144.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 GR"}]},{"description":"MUPIROCIN 2 % EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"68462018022","type":"NDC"}],"standard_charges":[{"gross_charge":49.05,"discounted_cash":49.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 22 GR"}]},{"description":"MUPIROCIN 2 % EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"51672131200","type":"NDC"}],"standard_charges":[{"gross_charge":41.92,"discounted_cash":41.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 22 GR"}]},{"description":"TRIAMCINOLONE ACETONIDE 0.1 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"51672128202","type":"NDC"}],"standard_charges":[{"gross_charge":49.38,"discounted_cash":49.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 GR"}]},{"description":"POLYETHYLENE GLYCOL 3350 17 GM/SCOOP PO POWD","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"45802086801","type":"NDC"}],"standard_charges":[{"gross_charge":44.29,"discounted_cash":44.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 119 GR"}]},{"description":"AMMONIUM LACTATE 12 % EX LOTN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00904598426","type":"NDC"}],"standard_charges":[{"gross_charge":61.3,"discounted_cash":61.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 226 GR"}]},{"description":"MENTHOL-ZINC OXIDE 0.44-20.625 % EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"10135070104","type":"NDC"}],"standard_charges":[{"gross_charge":51.35,"discounted_cash":51.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 113 GR"}]},{"description":"TRIPLE ANTIBIOTIC 3.5-400-5000 EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"45802014303","type":"NDC"}],"standard_charges":[{"gross_charge":41.97,"discounted_cash":41.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 28 GR"}]},{"description":"TRIPLE ANTIBIOTIC 3.5-400-5000 EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"53329008701","type":"NDC"}],"standard_charges":[{"gross_charge":37.1,"discounted_cash":37.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 28.4 GR"}]},{"description":"HYDROCORTISONE 1 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"51672201302","type":"NDC"}],"standard_charges":[{"gross_charge":51.49,"discounted_cash":51.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 28.4 GR"}]},{"description":"TRIPLE ANTIBIOTIC 3.5-400-5000 EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"45802014301","type":"NDC"}],"standard_charges":[{"gross_charge":33.35,"discounted_cash":33.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 14 GR"}]},{"description":"HYDROCORTISONE 1 % EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00168002031","type":"NDC"}],"standard_charges":[{"gross_charge":78.04,"discounted_cash":78.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 28.35 GR"}]},{"description":"DIPHENHYDRAMINE-ZINC ACETATE 2-0.1 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"45802035803","type":"NDC"}],"standard_charges":[{"gross_charge":25.32,"discounted_cash":25.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 28 GR"}]},{"description":"TRIAMCINOLONE ACETONIDE 0.1 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"45802006435","type":"NDC"}],"standard_charges":[{"gross_charge":25.34,"discounted_cash":25.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 GR"}]},{"description":"ZINC OXIDE 20 % EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00536131628","type":"NDC"}],"standard_charges":[{"gross_charge":36.49,"discounted_cash":36.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 GR"}]},{"description":"DICLOFENAC SODIUM 1 % EX GEL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"58602060407","type":"NDC"}],"standard_charges":[{"gross_charge":132.32,"discounted_cash":132.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 GR"}]},{"description":"AQUAPHOR ADVANCED THERAPY EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"72140063377","type":"NDC"}],"standard_charges":[{"gross_charge":129.4,"discounted_cash":129.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 85 GR"}]},{"description":"STYE 31.9-57.7 % OP OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"63736014308","type":"NDC"}],"standard_charges":[{"gross_charge":81.48,"discounted_cash":81.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3.5 GR"}]},{"description":"SOOTHE NIGHTTIME OP OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"10119002239","type":"NDC"}],"standard_charges":[{"gross_charge":111.41,"discounted_cash":111.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3.5 GR"}]},{"description":"LUBRIFRESH P.M. OP OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00904648838","type":"NDC"}],"standard_charges":[{"gross_charge":75.13,"discounted_cash":75.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3.5 GR"}]},{"description":"GENTEAL TEARS NIGHT-TIME OP OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00065051801","type":"NDC"}],"standard_charges":[{"gross_charge":108.69,"discounted_cash":108.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3.5 GR"}]},{"description":"CLOTRIMAZOLE ANTI-FUNGAL 1 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00536126526","type":"NDC"}],"standard_charges":[{"gross_charge":40.0,"discounted_cash":40.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 45 GR"}]},{"description":"GNP ATHLETES FOOT 1 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"24385020501","type":"NDC"}],"standard_charges":[{"gross_charge":34.69,"discounted_cash":34.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 14.2 GR"}]},{"description":"GNP ATHLETES FOOT 1 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"24385020503","type":"NDC"}],"standard_charges":[{"gross_charge":43.14,"discounted_cash":43.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 28.4 GR"}]},{"description":"ANTIFUNGAL (CLOTRIMAZOLE) 1 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"68001047547","type":"NDC"}],"standard_charges":[{"gross_charge":44.95,"discounted_cash":44.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 28.4 GR"}]},{"description":"GNP HYDROCORTISONE MAX ST 1 % EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"24385027603","type":"NDC"}],"standard_charges":[{"gross_charge":28.06,"discounted_cash":28.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 28.4 GR"}]},{"description":"AMOXICILLIN 250 MG/5ML PO SUSR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00143988980","type":"NDC"}],"standard_charges":[{"gross_charge":14.87,"discounted_cash":14.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"CALAMINE 8-8 % EX LOTN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00904253321","type":"NDC"}],"standard_charges":[{"gross_charge":29.04,"discounted_cash":29.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 177 ML"}]},{"description":"LIDOCAINE VISCOUS HCL 2 % MT SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"60432046400","type":"NDC"}],"standard_charges":[{"gross_charge":14.1,"discounted_cash":14.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6 ML"}]},{"description":"EYE WASH OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00536122497","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":42.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 118 ML"}]},{"description":"IPRATROPIUM BROMIDE 0.06 % NA SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"16714052701","type":"NDC"}],"standard_charges":[{"gross_charge":316.62,"discounted_cash":316.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"DORZOLAMIDE HCL-TIMOLOL MAL 2-0.5 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"42571014726","type":"NDC"}],"standard_charges":[{"gross_charge":291.45,"discounted_cash":291.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"SSKI 1 GM/ML PO SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"71740011230","type":"NDC"}],"standard_charges":[{"gross_charge":22.9,"discounted_cash":22.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.1 ML"}]},{"description":"DEXAMETHASONE INTENSOL 1 MG/ML PO CONC","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00054317644","type":"NDC"}],"standard_charges":[{"gross_charge":47.58,"discounted_cash":47.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"}]},{"description":"XALATAN 0.005 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00013830304","type":"NDC"}],"standard_charges":[{"gross_charge":1063.87,"discounted_cash":1063.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 ML"}]},{"description":"AZELASTINE HCL 137 MCG/SPRAY NA SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"65162067684","type":"NDC"}],"standard_charges":[{"gross_charge":101.76,"discounted_cash":101.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"AZELASTINE HCL 137 MCG/SPRAY NA SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"59651021430","type":"NDC"}],"standard_charges":[{"gross_charge":151.28,"discounted_cash":151.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"AKTEN 3.5 % OP GEL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"82584079225","type":"NDC"}],"standard_charges":[{"gross_charge":195.32,"discounted_cash":195.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"METHADONE HCL INTENSOL 10 MG/ML PO CONC","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00054355344","type":"NDC"}],"standard_charges":[{"gross_charge":15.25,"discounted_cash":15.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"CEFDINIR 250 MG/5ML PO SUSR UNIT DOSE","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"68180072304","type":"NDC"}],"standard_charges":[{"gross_charge":31.33,"discounted_cash":31.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6 ML"}]},{"description":"DIPHENHYDRAMINE HCL 12.5 MG/5ML PO ELIX","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00121097800","type":"NDC"}],"standard_charges":[{"gross_charge":60.96,"discounted_cash":60.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"MAGIC MOUTHWASH SUSP UNIT DOSE","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"65628005001","type":"NDC"}],"standard_charges":[{"gross_charge":80.8,"discounted_cash":80.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"AZELASTINE HCL 0.1 % NA SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"60505083305","type":"NDC"}],"standard_charges":[{"gross_charge":94.57,"discounted_cash":94.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"ATROPINE SULFATE 1 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"60505622600","type":"NDC"}],"standard_charges":[{"gross_charge":161.74,"discounted_cash":161.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"BACITRACIN 500 UNIT/GM EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00536125628","type":"NDC"}],"standard_charges":[{"gross_charge":44.52,"discounted_cash":44.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 GR"}]},{"description":"BACITRACIN 500 UNIT/GM EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00713028031","type":"NDC"}],"standard_charges":[{"gross_charge":31.67,"discounted_cash":31.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 28.4 GR"}]},{"description":"HURRICAINE 20 % MT AERO","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00283067902","type":"NDC"}],"standard_charges":[{"gross_charge":294.24,"discounted_cash":294.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 57 GR"}]},{"description":"ICY HOT ADVANCED PAIN RELIEF 16-11 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"41167008016","type":"NDC"}],"standard_charges":[{"gross_charge":73.48,"discounted_cash":73.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 56 GR"}]},{"description":"NYSTOP 100000 UNIT/GM EX POWD","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00574200830","type":"NDC"}],"standard_charges":[{"gross_charge":107.7,"discounted_cash":107.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 GR"}]},{"description":"NYSTOP 100000 UNIT/GM EX POWD","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00574200802","type":"NDC"}],"standard_charges":[{"gross_charge":112.58,"discounted_cash":112.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 GR"}]},{"description":"NYAMYC 100000 UNIT/GM EX POWD","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00832046515","type":"NDC"}],"standard_charges":[{"gross_charge":152.41,"discounted_cash":152.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 GR"}]},{"description":"NYSTOP 100000 UNIT/GM EX POWD","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00574200815","type":"NDC"}],"standard_charges":[{"gross_charge":70.27,"discounted_cash":70.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 GR"}]},{"description":"NITROGLYCERIN 0.4 MG/SPRAY TL SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"28595012049","type":"NDC"}],"standard_charges":[{"gross_charge":1296.74,"discounted_cash":1296.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4.9 GR"}]},{"description":"ERYTHROMYCIN 5 MG/GM OP OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00574402450","type":"NDC"}],"standard_charges":[{"gross_charge":109.17,"discounted_cash":109.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 GR"}]},{"description":"ERYTHROMYCIN 5 MG/GM OP OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00574402439","type":"NDC"}],"standard_charges":[{"gross_charge":107.82,"discounted_cash":107.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3.5 GR"}]},{"description":"NITROGLYCERIN 0.4 MG/SPRAY TL SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"45802021001","type":"NDC"}],"standard_charges":[{"gross_charge":1252.15,"discounted_cash":1252.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4.9 GR"}]},{"description":"BUDESONIDE-FORMOTEROL FUMARATE 160-4.5 MCG/ACT IN AERO","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00310737020","type":"NDC"}],"standard_charges":[{"gross_charge":913.38,"discounted_cash":913.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10.2 GR"}]},{"description":"FLUTICASONE PROPIONATE 50 MCG/ACT NA SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00536118365","type":"NDC"}],"standard_charges":[{"gross_charge":107.33,"discounted_cash":107.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15.8 GR"}]},{"description":"BACITRACIN ZINC 500 UNIT/GM EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"51672207501","type":"NDC"}],"standard_charges":[{"gross_charge":43.14,"discounted_cash":43.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 14.2 GR"}]},{"description":"OFLOXACIN 0.3 % OT SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"24208041005","type":"NDC"}],"standard_charges":[{"gross_charge":414.21,"discounted_cash":414.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"KETOROLAC TROMETHAMINE 0.4 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"60758077305","type":"NDC"}],"standard_charges":[{"gross_charge":332.2,"discounted_cash":332.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"ATROPINE SULFATE 1 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"60219174903","type":"NDC"}],"standard_charges":[{"gross_charge":363.07,"discounted_cash":363.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"BSS IO SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00065179504","type":"NDC"}],"standard_charges":[{"gross_charge":101.94,"discounted_cash":101.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 ML"}]},{"description":"ALBUTEROL SULFATE (2.5 MG/3ML) 0.083% IN NEBU","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"76204020025","type":"NDC"}],"standard_charges":[{"gross_charge":6.54,"discounted_cash":6.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"ALBUTEROL SULFATE (2.5 MG/3ML) 0.083% IN NEBU","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"60687039583","type":"NDC"}],"standard_charges":[{"gross_charge":5.33,"discounted_cash":5.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.5 ML"}]},{"description":"TROPICAMIDE 1 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"61314035501","type":"NDC"}],"standard_charges":[{"gross_charge":119.21,"discounted_cash":119.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"OFLOXACIN 0.3 % OT SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"70756060915","type":"NDC"}],"standard_charges":[{"gross_charge":101.67,"discounted_cash":101.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"PILOCARPINE HCL 2 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"70069019101","type":"NDC"}],"standard_charges":[{"gross_charge":294.16,"discounted_cash":294.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"PILOCARPINE HCL 2 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"61314020415","type":"NDC"}],"standard_charges":[{"gross_charge":290.23,"discounted_cash":290.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"NEOMYCIN-POLYMYXIN-DEXAMETH 3.5-10000-0.1 OP SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"24208083060","type":"NDC"}],"standard_charges":[{"gross_charge":119.89,"discounted_cash":119.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"OFLOXACIN 0.3 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"24208043405","type":"NDC"}],"standard_charges":[{"gross_charge":170.4,"discounted_cash":170.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"DORZOLAMIDE HCL 2 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"42571014126","type":"NDC"}],"standard_charges":[{"gross_charge":282.43,"discounted_cash":282.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"TETRACAINE HCL 0.5 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00065074114","type":"NDC"}],"standard_charges":[{"gross_charge":111.14,"discounted_cash":111.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"}]},{"description":"BUDESONIDE 0.5 MG/2ML IN SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00487970101","type":"NDC"}],"standard_charges":[{"gross_charge":52.97,"discounted_cash":52.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"MOXIFLOXACIN HCL 0.5 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"62332050503","type":"NDC"}],"standard_charges":[{"gross_charge":150.8,"discounted_cash":150.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"MOXIFLOXACIN HCL 0.5 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"68180042201","type":"NDC"}],"standard_charges":[{"gross_charge":142.2,"discounted_cash":142.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"EYE STREAM OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00065053001","type":"NDC"}],"standard_charges":[{"gross_charge":166.97,"discounted_cash":166.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"BUDESONIDE 0.5 MG/2ML IN SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"69097031987","type":"NDC"}],"standard_charges":[{"gross_charge":36.53,"discounted_cash":36.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"BUDESONIDE 0.5 MG/2ML IN SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00093681673","type":"NDC"}],"standard_charges":[{"gross_charge":36.53,"discounted_cash":36.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"ACETYLCYSTEINE 20 % IN SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"63323069404","type":"NDC"}],"standard_charges":[{"gross_charge":42.91,"discounted_cash":42.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"LATANOPROST 0.005 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"59762033302","type":"NDC"}],"standard_charges":[{"gross_charge":39.66,"discounted_cash":39.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 ML"}]},{"description":"VANCOMYCIN HCL 50 MG/ML PO SOLR UNIT DOSE","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"67877075181","type":"NDC"}],"standard_charges":[{"gross_charge":38.24,"discounted_cash":38.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 ML"}]},{"description":"GENTAMICIN SULFATE 0.3 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"60758018805","type":"NDC"}],"standard_charges":[{"gross_charge":67.36,"discounted_cash":67.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"DIPHENOXYLATE-ATROPINE 2.5-0.025 MG/5ML PO LIQD UNIT DOSE","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00054319446","type":"NDC"}],"standard_charges":[{"gross_charge":57.57,"discounted_cash":57.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"DORZOLAMIDE HCL-TIMOLOL MAL 2-0.5 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"61314003002","type":"NDC"}],"standard_charges":[{"gross_charge":167.88,"discounted_cash":167.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"PILOCARPINE HCL 1 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"70069018101","type":"NDC"}],"standard_charges":[{"gross_charge":329.74,"discounted_cash":329.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"TETRACAINE HCL 0.5 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"68682092005","type":"NDC"}],"standard_charges":[{"gross_charge":226.06,"discounted_cash":226.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"PROVOCHOLINE IN KIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"64281011006","type":"NDC"}],"standard_charges":[{"gross_charge":766.93,"discounted_cash":766.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 18 ML"}]},{"description":"GENTAMICIN SULFATE 0.3 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"24208058060","type":"NDC"}],"standard_charges":[{"gross_charge":297.22,"discounted_cash":297.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"LIDOCAINE HCL 4 % MT SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"76329630005","type":"NDC"}],"standard_charges":[{"gross_charge":237.2,"discounted_cash":237.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"}]},{"description":"CYCLOPENTOLATE HCL 1 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"24208073501","type":"NDC"}],"standard_charges":[{"gross_charge":102.3,"discounted_cash":102.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"NYSTATIN 100000 UNIT/GM EX POWD","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"69315030630","type":"NDC"}],"standard_charges":[{"gross_charge":322.3,"discounted_cash":322.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 GR"}]},{"description":"AMOXICILLIN-POT CLAVULANATE 400-57 MG/5ML PO SUSR UNIT DOSE","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00781610446","type":"NDC"}],"standard_charges":[{"gross_charge":19.51,"discounted_cash":19.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10.938 ML"}]},{"description":"METRONIDAZOLE 0.75 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00168032346","type":"NDC"}],"standard_charges":[{"gross_charge":370.05,"discounted_cash":370.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 45 GR"}]},{"description":"REFRESH LACRI-LUBE OP OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00023031204","type":"NDC"}],"standard_charges":[{"gross_charge":147.36,"discounted_cash":147.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3.5 GR"}]},{"description":"SYMBICORT 160-4.5 MCG/ACT IN AERO","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00186037020","type":"NDC"}],"standard_charges":[{"gross_charge":941.92,"discounted_cash":941.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10.2 GR"}]},{"description":"SYMBICORT 80-4.5 MCG/ACT IN AERO","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00186037228","type":"NDC"}],"standard_charges":[{"gross_charge":323.06,"discounted_cash":323.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6.9 GR"}]},{"description":"BACITRACIN ZINC 500 UNIT/GM EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"51672207502","type":"NDC"}],"standard_charges":[{"gross_charge":43.21,"discounted_cash":43.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 28.4 GR"}]},{"description":"TOBRADEX 0.3-0.1 % OP OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00078087601","type":"NDC"}],"standard_charges":[{"gross_charge":1201.67,"discounted_cash":1201.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3.5 GR"}]},{"description":"CETACAINE 2-2-14 % EX AERO","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"10223020103","type":"NDC"}],"standard_charges":[{"gross_charge":757.8,"discounted_cash":757.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 GR"}]},{"description":"SANTYL 250 UNIT/GM EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"50484001030","type":"NDC"}],"standard_charges":[{"gross_charge":1254.08,"discounted_cash":1254.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 GR"}]},{"description":"ARTHRITIS PAIN RELIEVING 0.075 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00536111825","type":"NDC"}],"standard_charges":[{"gross_charge":59.97,"discounted_cash":59.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 57 GR"}]},{"description":"ESTRACE 0.1 MG/GM VA CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00430375414","type":"NDC"}],"standard_charges":[{"gross_charge":1415.13,"discounted_cash":1415.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 42.5 GR"}]},{"description":"PREMARIN 0.625 MG/GM VA CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00046087221","type":"NDC"}],"standard_charges":[{"gross_charge":1856.26,"discounted_cash":1856.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 GR"}]},{"description":"SILVADENE 1 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"61570013140","type":"NDC"}],"standard_charges":[{"gross_charge":269.71,"discounted_cash":269.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 GR"}]},{"description":"SILVADENE 1 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"61570013125","type":"NDC"}],"standard_charges":[{"gross_charge":82.91,"discounted_cash":82.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 GR"}]},{"description":"SSD 1 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"43598021055","type":"NDC"}],"standard_charges":[{"gross_charge":120.17,"discounted_cash":120.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 GR"}]},{"description":"LIDOCAINE-PRILOCAINE 2.5-2.5 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"62332058204","type":"NDC"}],"standard_charges":[{"gross_charge":91.58,"discounted_cash":91.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 GR"}]},{"description":"SYMBICORT 160-4.5 MCG/ACT IN AERO","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00186037028","type":"NDC"}],"standard_charges":[{"gross_charge":330.32,"discounted_cash":330.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6 GR"}]},{"description":"LIDOCAINE-PRILOCAINE 2.5-2.5 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00168035755","type":"NDC"}],"standard_charges":[{"gross_charge":115.07,"discounted_cash":115.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 GR"}]},{"description":"DESENEX 2 % EX POWD","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00316022515","type":"NDC"}],"standard_charges":[{"gross_charge":58.45,"discounted_cash":58.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 43 GR"}]},{"description":"SUCCINYLCHOLINE CHLORIDE 200 MG/10ML IV SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0330","type":"HCPCS"},{"code":"71286601102","type":"NDC"}],"standard_charges":[{"gross_charge":24.6,"discounted_cash":24.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"INSULIN ASPART 100 UNIT/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1815","type":"HCPCS"},{"code":"73070010011","type":"NDC"}],"standard_charges":[{"gross_charge":20.16,"discounted_cash":20.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.08 ML"}]},{"description":"PROCHLORPERAZINE EDISYLATE 10 MG/2ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0780","type":"HCPCS"},{"code":"25021079002","type":"NDC"}],"standard_charges":[{"gross_charge":30.8,"discounted_cash":30.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"MYCOPHENOLATE MOFETIL 200 MG/ML PO SUSR UNIT DOSE","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J7517","type":"HCPCS"},{"code":"23155084851","type":"NDC"}],"standard_charges":[{"gross_charge":127.14,"discounted_cash":127.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7.5 ML"}]},{"description":"INSULIN GLARGINE-YFGN 100 UNIT/ML SC SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1815","type":"HCPCS"},{"code":"83257001411","type":"NDC"}],"standard_charges":[{"gross_charge":18.3,"discounted_cash":18.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.03 ML"}]},{"description":"MYCOPHENOLATE MOFETIL 200 MG/ML PO SUSR UNIT DOSE","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J7517","type":"HCPCS"},{"code":"67877023022","type":"NDC"}],"standard_charges":[{"gross_charge":165.08,"discounted_cash":165.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.3 ML"}]},{"description":"GASTROGRAFIN 66-10 % PO SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"Q9963","type":"HCPCS"},{"code":"00270044535","type":"NDC"}],"standard_charges":[{"gross_charge":9.57,"discounted_cash":9.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"GASTROGRAFIN 66-10 % PO SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"Q9963","type":"HCPCS"},{"code":"00270044540","type":"NDC"}],"standard_charges":[{"gross_charge":67.55,"discounted_cash":67.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"HUMULIN 70/30 (70-30) 100 UNIT/ML SC SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1815","type":"HCPCS"},{"code":"00002871501","type":"NDC"}],"standard_charges":[{"gross_charge":30.59,"discounted_cash":30.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.68 ML"}]},{"description":"HUMULIN R 100 UNIT/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1815","type":"HCPCS"},{"code":"00002821501","type":"NDC"}],"standard_charges":[{"gross_charge":16.23,"discounted_cash":16.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.03 ML"}]},{"description":"FLEET ENEMA RE ENEM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00132020140","type":"NDC"}],"standard_charges":[{"gross_charge":22.49,"discounted_cash":22.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 133 ML"}]},{"description":"CALCIUM CARBONATE ANTACID 1250 MG/5ML (500 MG/5ML ELEMENTAL) PO SUSP UNIT DOSE","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00121076616","type":"NDC"}],"standard_charges":[{"gross_charge":4.64,"discounted_cash":4.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.4 ML"}]},{"description":"MICRO GUARD 2 % EX POWD","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"11701003816","type":"NDC"}],"standard_charges":[{"gross_charge":94.98,"discounted_cash":94.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 85 GR"}]},{"description":"NITRO-BID 2 % TD OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00281032608","type":"NDC"}],"standard_charges":[{"gross_charge":38.59,"discounted_cash":38.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 GR"}]},{"description":"7 DAY VAGINAL 2 % VA CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"51672203506","type":"NDC"}],"standard_charges":[{"gross_charge":58.85,"discounted_cash":58.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 45 GR"}]},{"description":"BAZA ANTIFUNGAL 2 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"11701004514","type":"NDC"}],"standard_charges":[{"gross_charge":76.33,"discounted_cash":76.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 142 GR"}]},{"description":"CLOTRIMAZOLE-BETAMETHASONE 1-0.05 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"51672404801","type":"NDC"}],"standard_charges":[{"gross_charge":141.81,"discounted_cash":141.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 GR"}]},{"description":"NYSTATIN 100000 UNIT/GM EX POWD","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"69315030615","type":"NDC"}],"standard_charges":[{"gross_charge":162.51,"discounted_cash":162.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 GR"}]},{"description":"ALBUTEROL SULFATE HFA 108 (90 BASE) MCG/ACT IN AERS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"69097014260","type":"NDC"}],"standard_charges":[{"gross_charge":135.25,"discounted_cash":135.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6.7 GR"}]},{"description":"ESTRADIOL 0.1 MG/GM VA CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"66993000210","type":"NDC"}],"standard_charges":[{"gross_charge":555.68,"discounted_cash":555.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 42.5 GR"}]},{"description":"BACITRACIN-POLYMYXIN B 500-10000 UNIT/GM OP OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"24208055555","type":"NDC"}],"standard_charges":[{"gross_charge":99.62,"discounted_cash":99.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3.5 GR"}]},{"description":"NEOMYCIN-POLYMYXIN-DEXAMETH 3.5-10000-0.1 OP OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"61314063136","type":"NDC"}],"standard_charges":[{"gross_charge":160.18,"discounted_cash":160.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3.5 GR"}]},{"description":"NEOMYCIN-POLYMYXIN-DEXAMETH 3.5-10000-0.1 OP OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"24208079535","type":"NDC"}],"standard_charges":[{"gross_charge":155.81,"discounted_cash":155.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3.5 GR"}]},{"description":"CLOBETASOL PROPIONATE 0.05 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00168016315","type":"NDC"}],"standard_charges":[{"gross_charge":135.72,"discounted_cash":135.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 GR"}]},{"description":"MUPIROCIN 2 % EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"81033002050","type":"NDC"}],"standard_charges":[{"gross_charge":37.66,"discounted_cash":37.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 GR"}]},{"description":"ALBUTEROL SULFATE HFA 108 (90 BASE) MCG/ACT IN AERS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00054074287","type":"NDC"}],"standard_charges":[{"gross_charge":38.7,"discounted_cash":38.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"ERYTHROMYCIN 5 MG/GM OP OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"24208091019","type":"NDC"}],"standard_charges":[{"gross_charge":117.11,"discounted_cash":117.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 GR"}]},{"description":"ALBUTEROL SULFATE HFA 108 (90 BASE) MCG/ACT IN AERS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"68180096301","type":"NDC"}],"standard_charges":[{"gross_charge":139.88,"discounted_cash":139.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8.5 GR"}]},{"description":"PROCTOZONE-HC 2.5 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"64980032430","type":"NDC"}],"standard_charges":[{"gross_charge":95.55,"discounted_cash":95.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 GR"}]},{"description":"PROCTOFOAM HC 1-1 % EX FOAM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00037682210","type":"NDC"}],"standard_charges":[{"gross_charge":1076.01,"discounted_cash":1076.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 GR"}]},{"description":"GNP DICLOFENAC SODIUM 1 % EX GEL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"46122075252","type":"NDC"}],"standard_charges":[{"gross_charge":99.92,"discounted_cash":99.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 GR"}]},{"description":"SSD 1 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"43598021025","type":"NDC"}],"standard_charges":[{"gross_charge":87.37,"discounted_cash":87.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 GR"}]},{"description":"SILVADENE 1 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"61570013150","type":"NDC"}],"standard_charges":[{"gross_charge":155.0,"discounted_cash":155.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 GR"}]},{"description":"SILVADENE 1 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"61570013155","type":"NDC"}],"standard_charges":[{"gross_charge":121.79,"discounted_cash":121.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 GR"}]},{"description":"SILVADENE 1 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"61570013120","type":"NDC"}],"standard_charges":[{"gross_charge":131.02,"discounted_cash":131.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 GR"}]},{"description":"FIRST AID ANTISEPTIC 10 % EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00536127180","type":"NDC"}],"standard_charges":[{"gross_charge":27.45,"discounted_cash":27.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 28.4 GR"}]},{"description":"CALPROTECT 0.44-20.6 % EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"69618006782","type":"NDC"}],"standard_charges":[{"gross_charge":66.79,"discounted_cash":66.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 113 GR"}]},{"description":"HEMORRHOIDAL 0.25-14-74.9 % RE OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00536128806","type":"NDC"}],"standard_charges":[{"gross_charge":43.88,"discounted_cash":43.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 57 GR"}]},{"description":"GNP LIDOCAINE PAIN RELIEVING 4 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"46122061410","type":"NDC"}],"standard_charges":[{"gross_charge":46.1,"discounted_cash":46.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 76.5 GR"}]},{"description":"RECTASMOOTHE 5 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"69315030130","type":"NDC"}],"standard_charges":[{"gross_charge":117.73,"discounted_cash":117.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 GR"}]},{"description":"ANECREAM 4 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"24357070106","type":"NDC"}],"standard_charges":[{"gross_charge":49.62,"discounted_cash":49.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 GR"}]},{"description":"GNP TRIPLE ANTIBIOTIC EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"46122041405","type":"NDC"}],"standard_charges":[{"gross_charge":28.96,"discounted_cash":28.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 14.2 GR"}]},{"description":"TRIPLE ANTIBIOTIC 5-400-5000 EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"68001048346","type":"NDC"}],"standard_charges":[{"gross_charge":36.2,"discounted_cash":36.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 14.2 GR"}]},{"description":"GNP TRIPLE ANTIBIOTIC EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"46122041403","type":"NDC"}],"standard_charges":[{"gross_charge":31.07,"discounted_cash":31.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 28.4 GR"}]},{"description":"AMERICAINE 20 % EX AERO","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"63736037882","type":"NDC"}],"standard_charges":[{"gross_charge":57.2,"discounted_cash":57.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 57 GR"}]},{"description":"ERYTHROMYCIN 5 MG/GM OP OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"24208091055","type":"NDC"}],"standard_charges":[{"gross_charge":147.36,"discounted_cash":147.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3.5 GR"}]},{"description":"ENGERIX-B 10 MCG/0.5ML IJ SUSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"90746","type":"HCPCS"},{"code":"58160082052","type":"NDC"}],"standard_charges":[{"gross_charge":157.07,"discounted_cash":157.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"ENGERIX-B 20 MCG/ML IJ SUSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"90746","type":"HCPCS"},{"code":"58160082152","type":"NDC"}],"standard_charges":[{"gross_charge":193.68,"discounted_cash":193.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"PANTOPRAZOLE SODIUM 40 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2470","type":"HCPCS"},{"code":"71288060011","type":"NDC"}],"standard_charges":[{"gross_charge":37.32,"discounted_cash":37.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"MEROPENEM 500 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2185","type":"HCPCS"},{"code":"63323050725","type":"NDC"}],"standard_charges":[{"gross_charge":51.34,"discounted_cash":51.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 UN"}]},{"description":"PANTOPRAZOLE SODIUM 40 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2470","type":"HCPCS"},{"code":"67850015025","type":"NDC"}],"standard_charges":[{"gross_charge":33.15,"discounted_cash":33.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"CEFTRIAXONE SODIUM 1 G IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0696","type":"HCPCS"},{"code":"00143985725","type":"NDC"}],"standard_charges":[{"gross_charge":29.35,"discounted_cash":29.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"PANTOPRAZOLE SODIUM 40 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2470","type":"HCPCS"},{"code":"70095002403","type":"NDC"}],"standard_charges":[{"gross_charge":49.22,"discounted_cash":49.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"LEUCOVORIN CALCIUM 100 MG IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0640","type":"HCPCS"},{"code":"25021081430","type":"NDC"}],"standard_charges":[{"gross_charge":110.15,"discounted_cash":110.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 UN"}]},{"description":"PIPERACILLIN SOD-TAZOBACTAM SO 4.5 (4-0.5) G IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2543","type":"HCPCS"},{"code":"60505615904","type":"NDC"}],"standard_charges":[{"gross_charge":52.34,"discounted_cash":52.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"PANTOPRAZOLE SODIUM 40 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2470","type":"HCPCS"},{"code":"00781323295","type":"NDC"}],"standard_charges":[{"gross_charge":37.8,"discounted_cash":37.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"CEFTRIAXONE SODIUM 1 G IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0696","type":"HCPCS"},{"code":"25021010610","type":"NDC"}],"standard_charges":[{"gross_charge":39.87,"discounted_cash":39.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"CEFTRIAXONE SODIUM 1 G IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0696","type":"HCPCS"},{"code":"00781320895","type":"NDC"}],"standard_charges":[{"gross_charge":32.45,"discounted_cash":32.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"AZITHROMYCIN 500 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0456","type":"HCPCS"},{"code":"63323039810","type":"NDC"}],"standard_charges":[{"gross_charge":38.48,"discounted_cash":38.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"CEFTRIAXONE SODIUM 1 G IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0696","type":"HCPCS"},{"code":"00409733201","type":"NDC"}],"standard_charges":[{"gross_charge":34.65,"discounted_cash":34.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"PANTOPRAZOLE SODIUM 40 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2470","type":"HCPCS"},{"code":"55150020210","type":"NDC"}],"standard_charges":[{"gross_charge":44.33,"discounted_cash":44.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"AMPICILLIN-SULBACTAM SODIUM 3 (2-1) G IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0295","type":"HCPCS"},{"code":"25021014330","type":"NDC"}],"standard_charges":[{"gross_charge":45.27,"discounted_cash":45.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"CEFTRIAXONE SODIUM 1 G IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0696","type":"HCPCS"},{"code":"44567070125","type":"NDC"}],"standard_charges":[{"gross_charge":23.59,"discounted_cash":23.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 UN"}]},{"description":"AZITHROMYCIN 500 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0456","type":"HCPCS"},{"code":"70095002501","type":"NDC"}],"standard_charges":[{"gross_charge":52.29,"discounted_cash":52.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"VANCOMYCIN HCL 1 G IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3370","type":"HCPCS"},{"code":"00409653321","type":"NDC"}],"standard_charges":[{"gross_charge":24.83,"discounted_cash":24.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 UN"}]},{"description":"LEUCOVORIN CALCIUM 350 MG IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0640","type":"HCPCS"},{"code":"67457053035","type":"NDC"}],"standard_charges":[{"gross_charge":139.74,"discounted_cash":139.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.331 UN"}]},{"description":"PIPERACILLIN SOD-TAZOBACTAM SO 4.5 (4-0.5) G IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2543","type":"HCPCS"},{"code":"72485040401","type":"NDC"}],"standard_charges":[{"gross_charge":43.97,"discounted_cash":43.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"MEROPENEM 500 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2185","type":"HCPCS"},{"code":"00409139051","type":"NDC"}],"standard_charges":[{"gross_charge":35.32,"discounted_cash":35.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"AZITHROMYCIN 500 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0456","type":"HCPCS"},{"code":"70436001982","type":"NDC"}],"standard_charges":[{"gross_charge":38.88,"discounted_cash":38.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"CEFTRIAXONE SODIUM 1 G IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0696","type":"HCPCS"},{"code":"44567070195","type":"NDC"}],"standard_charges":[{"gross_charge":30.1,"discounted_cash":30.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"FLUOROURACIL 5 GM/100ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9190","type":"HCPCS"},{"code":"25021021599","type":"NDC"}],"standard_charges":[{"gross_charge":69.94,"discounted_cash":69.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 9.8 ML"}]},{"description":"PANTOPRAZOLE SODIUM 40 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2470","type":"HCPCS"},{"code":"00143928410","type":"NDC"}],"standard_charges":[{"gross_charge":32.46,"discounted_cash":32.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"VANCOMYCIN HCL 1 G IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3370","type":"HCPCS"},{"code":"00143916210","type":"NDC"}],"standard_charges":[{"gross_charge":21.76,"discounted_cash":21.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 UN"}]},{"description":"AMPICILLIN SODIUM 2 G IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0290","type":"HCPCS"},{"code":"44567010310","type":"NDC"}],"standard_charges":[{"gross_charge":47.83,"discounted_cash":47.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"CEFOXITIN SODIUM 1 G IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0694","type":"HCPCS"},{"code":"25021010910","type":"NDC"}],"standard_charges":[{"gross_charge":49.3,"discounted_cash":49.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 UN"}]},{"description":"MEROPENEM 500 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2185","type":"HCPCS"},{"code":"63323050720","type":"NDC"}],"standard_charges":[{"gross_charge":40.8,"discounted_cash":40.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"PIPERACILLIN SOD-TAZOBACTAM SO 2.25 (2-0.25) G IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2543","type":"HCPCS"},{"code":"60505615604","type":"NDC"}],"standard_charges":[{"gross_charge":38.24,"discounted_cash":38.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"MEROPENEM 500 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2185","type":"HCPCS"},{"code":"00409022210","type":"NDC"}],"standard_charges":[{"gross_charge":35.01,"discounted_cash":35.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"AMPICILLIN SODIUM 2 G IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0290","type":"HCPCS"},{"code":"00781340895","type":"NDC"}],"standard_charges":[{"gross_charge":41.67,"discounted_cash":41.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"PANTOPRAZOLE SODIUM 40 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2470","type":"HCPCS"},{"code":"25021075110","type":"NDC"}],"standard_charges":[{"gross_charge":35.15,"discounted_cash":35.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"HC GENERAL ROOM WITH TELEMETRY DAILY","code_information":[{"code":"1200000002","type":"CDM"},{"code":"0121","type":"RC"}],"standard_charges":[{"gross_charge":1343.0,"discounted_cash":1343.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC R&B SEMI-PRIVATE ROOM DAILY - MED/SURG","code_information":[{"code":"1210000001","type":"CDM"},{"code":"0121","type":"RC"}],"standard_charges":[{"gross_charge":921.0,"discounted_cash":921.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OB SEMI-PRIVATE ROOM DAILY","code_information":[{"code":"1220000001","type":"CDM"},{"code":"0122","type":"RC"}],"standard_charges":[{"gross_charge":1304.0,"discounted_cash":1304.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC R&B SEMI-PRIVATE ROOM DAILY - BH ADOLESCENT","code_information":[{"code":"1240000001","type":"CDM"},{"code":"0124","type":"RC"}],"standard_charges":[{"gross_charge":2092.0,"discounted_cash":2092.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC R&B SEMI-PRIVATE ROOM DAILY - BH ADULT","code_information":[{"code":"1240000002","type":"CDM"},{"code":"0124","type":"RC"}],"standard_charges":[{"gross_charge":1343.0,"discounted_cash":1343.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HOSPICE SEMI-PRIVATE ROOM DAILY","code_information":[{"code":"1250000001","type":"CDM"},{"code":"0125","type":"RC"}],"standard_charges":[{"gross_charge":921.0,"discounted_cash":921.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC NURSERY 1 ROOM DAILY","code_information":[{"code":"1710000001","type":"CDM"},{"code":"0171","type":"RC"}],"standard_charges":[{"gross_charge":1544.0,"discounted_cash":1544.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC NURSERY 2 ROOM DAILY","code_information":[{"code":"1720000001","type":"CDM"},{"code":"0172","type":"RC"}],"standard_charges":[{"gross_charge":1812.0,"discounted_cash":1812.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC NURSERY 3 ROOM DAILY","code_information":[{"code":"1730000001","type":"CDM"},{"code":"0173","type":"RC"}],"standard_charges":[{"gross_charge":2053.0,"discounted_cash":2053.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ICU ROOM DAILY","code_information":[{"code":"2000000001","type":"CDM"},{"code":"0200","type":"RC"}],"standard_charges":[{"gross_charge":1881.0,"discounted_cash":1881.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INTERMEDIATE ICU ROOM DAILY","code_information":[{"code":"2060000001","type":"CDM"},{"code":"0206","type":"RC"}],"standard_charges":[{"gross_charge":1411.0,"discounted_cash":1411.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IV INF HYDRATION, 30-60 MIN","code_information":[{"code":"2609636001","type":"CDM"},{"code":"0260","type":"RC"},{"code":"96360","type":"HCPCS"}],"standard_charges":[{"gross_charge":660.0,"discounted_cash":660.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IV INF HYDRATION, EA ADDL HR","code_information":[{"code":"2609636101","type":"CDM"},{"code":"0260","type":"RC"},{"code":"96361","type":"HCPCS"}],"standard_charges":[{"gross_charge":296.0,"discounted_cash":296.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IV INF NON-CHEMO, THER/PROPH/DIAG, INITIAL, TO 1 HR","code_information":[{"code":"2609636501","type":"CDM"},{"code":"0260","type":"RC"},{"code":"96365","type":"HCPCS"}],"standard_charges":[{"gross_charge":712.0,"discounted_cash":712.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IV INF NON-CHEMO, THER/PROPH/DIAG, EA ADD HOUR","code_information":[{"code":"2609636601","type":"CDM"},{"code":"0260","type":"RC"},{"code":"96366","type":"HCPCS"}],"standard_charges":[{"gross_charge":326.0,"discounted_cash":326.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IV INF NON-CHEMO, THER/PROPH/DIAG, SEQUENTIAL, NEW DRUG, TO 1 HR","code_information":[{"code":"2609636701","type":"CDM"},{"code":"0260","type":"RC"},{"code":"96367","type":"HCPCS"}],"standard_charges":[{"gross_charge":244.0,"discounted_cash":244.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IV INF NON-CHEMO, THER/PROPH/DIAG, CONCURRENT","code_information":[{"code":"2609636801","type":"CDM"},{"code":"0260","type":"RC"},{"code":"96368","type":"HCPCS"}],"standard_charges":[{"gross_charge":237.0,"discounted_cash":237.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SC INF W/ PUMP, NON-CHEMO, THER/PROPH, INITIAL, TO 1 HR","code_information":[{"code":"2609636901","type":"CDM"},{"code":"0260","type":"RC"},{"code":"96369","type":"HCPCS"}],"standard_charges":[{"gross_charge":610.0,"discounted_cash":610.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SC INF, NON-CHEMO, THER/PROPH, EA ADDL HOUR","code_information":[{"code":"2609637001","type":"CDM"},{"code":"0260","type":"RC"},{"code":"96370","type":"HCPCS"}],"standard_charges":[{"gross_charge":395.0,"discounted_cash":395.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INJ NON-CHEMO, THER/PROPH/DIAG, SUBQ/IM","code_information":[{"code":"2609637201","type":"CDM"},{"code":"0260","type":"RC"},{"code":"96372","type":"HCPCS"}],"standard_charges":[{"gross_charge":174.0,"discounted_cash":174.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INJ NON-CHEMO, THER/PROPH/DIAG, INTRA-ARTERIAL","code_information":[{"code":"2609637301","type":"CDM"},{"code":"0260","type":"RC"},{"code":"96373","type":"HCPCS"}],"standard_charges":[{"gross_charge":475.0,"discounted_cash":475.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INJ NON-CHEMO, THER/PROPH/DIAG, IV PUSH, SGL/INITIAL DRUG","code_information":[{"code":"2609637401","type":"CDM"},{"code":"0260","type":"RC"},{"code":"96374","type":"HCPCS"}],"standard_charges":[{"gross_charge":438.0,"discounted_cash":438.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INJ NON-CHEMO, THER/PROPH/DIAG, EA IV PUSH, SEQUENTIAL, NEW DRUG","code_information":[{"code":"2609637501","type":"CDM"},{"code":"0260","type":"RC"},{"code":"96375","type":"HCPCS"}],"standard_charges":[{"gross_charge":425.0,"discounted_cash":425.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INJ NON-CHEMO, THER/PROPH/DIAG, EA IV PUSH, SEQUENTIAL, SAME DRUG","code_information":[{"code":"2609637601","type":"CDM"},{"code":"0260","type":"RC"},{"code":"96376","type":"HCPCS"}],"standard_charges":[{"gross_charge":415.0,"discounted_cash":415.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC APPL ON-BODY INJECTOR FOR TIMED SUBQ INJECTION","code_information":[{"code":"2609637701","type":"CDM"},{"code":"0260","type":"RC"},{"code":"96377","type":"HCPCS"}],"standard_charges":[{"gross_charge":357.0,"discounted_cash":357.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IRRIG IMPLANTED DRUG DELIVERY DEVICE","code_information":[{"code":"2609652301","type":"CDM"},{"code":"0260","type":"RC"},{"code":"96523","type":"HCPCS"}],"standard_charges":[{"gross_charge":273.0,"discounted_cash":273.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TOCILIZUMAB 1ST DOSE INFUSION","code_information":[{"code":"260M024901","type":"CDM"},{"code":"0260","type":"RC"},{"code":"M0249","type":"HCPCS"}],"standard_charges":[{"gross_charge":1386.0,"discounted_cash":1386.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SYS CAST TOT CONTACT BOOT","code_information":[{"code":"271Q403802","type":"CDM"},{"code":"0271","type":"RC"},{"code":"Q4038","type":"HCPCS"}],"standard_charges":[{"gross_charge":598.67,"discounted_cash":598.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SUPPLY PS1753273 PICC DBL 5FR","code_information":[{"code":"272C175104","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":1607.11,"discounted_cash":1607.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SUPPLY PS1790314 PICC TRPL 5FR","code_information":[{"code":"272C175105","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":1529.74,"discounted_cash":1529.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SUPPLY PS1822337 MIDLINE SNGL 3FR","code_information":[{"code":"272C175111","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":1649.37,"discounted_cash":1649.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SUPPLY PS1838107 MST MIDLINE SNGL 3FR","code_information":[{"code":"272C175117","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":1965.2,"discounted_cash":1965.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SUPPLY PS1838111 PICC DBL 4FR","code_information":[{"code":"272C175119","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":3295.81,"discounted_cash":3295.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SUPPLY CHARGE SKIN SUB (TOT SZ 44 SC) APLIGRAF PER SQ CM","code_information":[{"code":"278Q410102","type":"CDM"},{"code":"0278","type":"RC"},{"code":"Q4101","type":"HCPCS"}],"standard_charges":[{"gross_charge":252.85,"discounted_cash":252.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SUPPLY CHARGE SKIN SUB (TOT SZ 16 SC) GRAFTJACKET PER SQ CM","code_information":[{"code":"278Q410705","type":"CDM"},{"code":"0278","type":"RC"},{"code":"Q4107","type":"HCPCS"}],"standard_charges":[{"gross_charge":934.76,"discounted_cash":934.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SUPPLY CHARGE SKIN SUB (TOT SZ 12 SC) GRAFIX CORE/GRAFIXPL CORE PER SQ CM","code_information":[{"code":"278Q413204","type":"CDM"},{"code":"0278","type":"RC"},{"code":"Q4132","type":"HCPCS"}],"standard_charges":[{"gross_charge":2794.34,"discounted_cash":2794.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SUPPLY CHARGE SKIN SUB (TOT SZ 12 SC) GRAFIX PRIME/GRAFIXPL PRIME/STRAVIX/STRAVIXPL PER SQ CM","code_information":[{"code":"278Q413309","type":"CDM"},{"code":"0278","type":"RC"},{"code":"Q4133","type":"HCPCS"}],"standard_charges":[{"gross_charge":694.61,"discounted_cash":694.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SUPPLY CHARGE SKIN SUB (TOT SZ 3 SC) AFFINITY PER SQ CM","code_information":[{"code":"278Q415902","type":"CDM"},{"code":"0278","type":"RC"},{"code":"Q4159","type":"HCPCS"}],"standard_charges":[{"gross_charge":4320.67,"discounted_cash":4320.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SUPPLY CHARGE SKIN SUB (TOT SZ 6 SC) NUSHIELD PER SQ CM","code_information":[{"code":"278Q416002","type":"CDM"},{"code":"0278","type":"RC"},{"code":"Q4160","type":"HCPCS"}],"standard_charges":[{"gross_charge":661.09,"discounted_cash":661.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SUPPLY CHARGE SKIN SUB (TOT SZ 8 SC) NUSHIELD PER SQ CM","code_information":[{"code":"278Q416003","type":"CDM"},{"code":"0278","type":"RC"},{"code":"Q4160","type":"HCPCS"}],"standard_charges":[{"gross_charge":860.22,"discounted_cash":860.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SUPPLY CHARGE SKIN SUB (TOT SZ 12 SC) NUSHIELD PER SQ CM","code_information":[{"code":"278Q416004","type":"CDM"},{"code":"0278","type":"RC"},{"code":"Q4160","type":"HCPCS"}],"standard_charges":[{"gross_charge":860.22,"discounted_cash":860.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SUPPLY CHARGE SKIN SUB (TOT SZ 3 SC) NUSHIELD PER SQ CM","code_information":[{"code":"278Q416008","type":"CDM"},{"code":"0278","type":"RC"},{"code":"Q4160","type":"HCPCS"}],"standard_charges":[{"gross_charge":1983.37,"discounted_cash":1983.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SUPPLY CHARGE SKIN SUB (TOT SZ 2 SC) PURAPLY AM PER SQ CM","code_information":[{"code":"278Q419602","type":"CDM"},{"code":"0278","type":"RC"},{"code":"Q4196","type":"HCPCS"}],"standard_charges":[{"gross_charge":1151.31,"discounted_cash":1151.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SUPPLY CHARGE SKIN SUB (TOT SZ 4 SC) PURAPLY AM PER SQ CM","code_information":[{"code":"278Q419603","type":"CDM"},{"code":"0278","type":"RC"},{"code":"Q4196","type":"HCPCS"}],"standard_charges":[{"gross_charge":1219.88,"discounted_cash":1219.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SUPPLY CHARGE SKIN SUB (TOT SZ 8 SC) PURAPLY AM PER SQ CM","code_information":[{"code":"278Q419604","type":"CDM"},{"code":"0278","type":"RC"},{"code":"Q4196","type":"HCPCS"}],"standard_charges":[{"gross_charge":902.51,"discounted_cash":902.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SUPPLY CHARGE SKIN SUB (TOT SZ 12 SC) PURAPLY AM PER SQ CM","code_information":[{"code":"278Q419605","type":"CDM"},{"code":"0278","type":"RC"},{"code":"Q4196","type":"HCPCS"}],"standard_charges":[{"gross_charge":634.51,"discounted_cash":634.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CHG COLLECTION VENOUS BLOOD,VENIPUNCTURE - DRAW CHARGE","code_information":[{"code":"3003641501","type":"CDM"},{"code":"0300","type":"RC"},{"code":"36415","type":"HCPCS"}],"standard_charges":[{"gross_charge":31.0,"discounted_cash":31.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CHG COLLECTION CAPILLARY BLOOD SPECIMEN - DRAW CHARGE","code_information":[{"code":"3003641601","type":"CDM"},{"code":"0300","type":"RC"},{"code":"36416","type":"HCPCS"}],"standard_charges":[{"gross_charge":19.0,"discounted_cash":19.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CHG COLLECTION CAPILLARY BLOOD SPECIMEN - RESPIRATORY","code_information":[{"code":"3003641603","type":"CDM"},{"code":"0300","type":"RC"},{"code":"36416","type":"HCPCS"}],"standard_charges":[{"gross_charge":29.0,"discounted_cash":29.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC COLLECT BLOOD FROM IMPLANT VENOUS ACCESS DEVICE","code_information":[{"code":"3003659101","type":"CDM"},{"code":"0300","type":"RC"},{"code":"36591","type":"HCPCS"}],"standard_charges":[{"gross_charge":212.0,"discounted_cash":212.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC COLLECT BLOOD FROM CATHETER VENOUS NOS","code_information":[{"code":"3003659201","type":"CDM"},{"code":"0300","type":"RC"},{"code":"36592","type":"HCPCS"}],"standard_charges":[{"gross_charge":172.0,"discounted_cash":172.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC WITHDRAWAL OF ARTERIAL BLOOD","code_information":[{"code":"3003660001","type":"CDM"},{"code":"0300","type":"RC"},{"code":"36600","type":"HCPCS"}],"standard_charges":[{"gross_charge":124.0,"discounted_cash":124.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GENE ANALYSIS - IDH1 VARIANTS","code_information":[{"code":"3008112001","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81120","type":"HCPCS"}],"standard_charges":[{"gross_charge":1572.0,"discounted_cash":1572.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GENE ANALYSIS - IDH2 VARIANTS","code_information":[{"code":"3008112101","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81121","type":"HCPCS"}],"standard_charges":[{"gross_charge":2216.0,"discounted_cash":2216.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GENE ANALYSIS - BRCA1 VARIANTS","code_information":[{"code":"3008116201","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81162","type":"HCPCS"}],"standard_charges":[{"gross_charge":14463.0,"discounted_cash":14463.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GENE ANALYSIS - ABL1 VARIANTS","code_information":[{"code":"3008117001","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81170","type":"HCPCS"}],"standard_charges":[{"gross_charge":2003.0,"discounted_cash":2003.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GENE ANALYSIS - BCR/ABL1 MAJOR BREAK","code_information":[{"code":"3008120601","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81206","type":"HCPCS"}],"standard_charges":[{"gross_charge":1001.0,"discounted_cash":1001.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GENE ANALYSIS - BCR/ABL1 MINOR BREAK","code_information":[{"code":"3008120701","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81207","type":"HCPCS"}],"standard_charges":[{"gross_charge":1130.0,"discounted_cash":1130.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GENE ANALYSIS - BCR/ABL1 OTHER BREAK","code_information":[{"code":"3008120801","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81208","type":"HCPCS"}],"standard_charges":[{"gross_charge":1688.0,"discounted_cash":1688.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DIAGNOSTIC QUAL BCR-ABL1 ASSAY W/RFLX P190 OR P210 QUANT ASSAYS - ARUP","code_information":[{"code":"3008120802","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81208","type":"HCPCS"}],"standard_charges":[{"gross_charge":1688.0,"discounted_cash":1688.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GENE ANALYSIS - BRAF V600E MUTATION","code_information":[{"code":"3008121001","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81210","type":"HCPCS"}],"standard_charges":[{"gross_charge":1887.0,"discounted_cash":1887.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GENE ANALYSIS - CALR EXON 9 VARIANT","code_information":[{"code":"3008121901","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81219","type":"HCPCS"}],"standard_charges":[{"gross_charge":449.0,"discounted_cash":449.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CALRETICULIN (CALR) MUTATION ANALYSIS (CSI) - ARUP","code_information":[{"code":"3008121902","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81219","type":"HCPCS"}],"standard_charges":[{"gross_charge":449.0,"discounted_cash":449.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CFTR GENE ANALYSIS COMMON VARIANTS - CYSTIC FIBROSIS DIAGNOSTIC STDY","code_information":[{"code":"3008122001","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81220","type":"HCPCS"}],"standard_charges":[{"gross_charge":4491.0,"discounted_cash":4491.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GENE ANALYSIS - CYP2C19 VARIANT","code_information":[{"code":"3008122501","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81225","type":"HCPCS"}],"standard_charges":[{"gross_charge":1819.0,"discounted_cash":1819.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CYTOCHROME P450 2C19 GENOTYPE (CYP2C19 VARIANT) - ARUP","code_information":[{"code":"3008122503","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81225","type":"HCPCS"}],"standard_charges":[{"gross_charge":1819.0,"discounted_cash":1819.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GENE ANALYSIS - CYP2D6 VARIANTS","code_information":[{"code":"3008122601","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81226","type":"HCPCS"}],"standard_charges":[{"gross_charge":1819.0,"discounted_cash":1819.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GENE ANALYSIS - CYP2D9 VARIANTS","code_information":[{"code":"3008122701","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81227","type":"HCPCS"}],"standard_charges":[{"gross_charge":1349.0,"discounted_cash":1349.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC F2 GENE ANALYSIS 20210G >A VARIANT - PROTHROMBIN GENE MUTATION","code_information":[{"code":"3008124001","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81240","type":"HCPCS"}],"standard_charges":[{"gross_charge":767.0,"discounted_cash":767.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC F5 COAGULATION FACTOR V ANAL LEIDEN VARIANT - FACTOR V LEIDEN","code_information":[{"code":"3008124101","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81241","type":"HCPCS"}],"standard_charges":[{"gross_charge":857.0,"discounted_cash":857.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GENE ANALYSIS - GJB2 MUTATION","code_information":[{"code":"3008125201","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81252","type":"HCPCS"}],"standard_charges":[{"gross_charge":836.72,"discounted_cash":836.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HFE HEMOCHROMATOSIS GENE ANAL COMMON VARIANTS - HEMOCHROMATOSIS MUT","code_information":[{"code":"3008125601","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81256","type":"HCPCS"}],"standard_charges":[{"gross_charge":482.0,"discounted_cash":482.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GENE ANALYSIS - HBA1/HBA2 VARIANTS","code_information":[{"code":"3008125901","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81259","type":"HCPCS"}],"standard_charges":[{"gross_charge":4300.0,"discounted_cash":4300.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GENE ANALYSIS - IGH VARIABLE REGION SOMATIC MUTATION","code_information":[{"code":"3008126301","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81263","type":"HCPCS"}],"standard_charges":[{"gross_charge":2273.0,"discounted_cash":2273.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MTHFR MUTATION PCR","code_information":[{"code":"3008129101","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81291","type":"HCPCS"}],"standard_charges":[{"gross_charge":763.0,"discounted_cash":763.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SNRPN/UBE3A METHYLATION ANALYSIS - PRADER-WILLI PANEL","code_information":[{"code":"3008133101","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81331","type":"HCPCS"}],"standard_charges":[{"gross_charge":488.0,"discounted_cash":488.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TPMT VARIANTS - TPMT AND NUDT15 GENETICS - ARUP","code_information":[{"code":"3008133501","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81335","type":"HCPCS"}],"standard_charges":[{"gross_charge":1834.0,"discounted_cash":1834.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GENE ANALYSIS - TRG T CELL VARIANTS","code_information":[{"code":"3008134201","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81342","type":"HCPCS"}],"standard_charges":[{"gross_charge":2354.0,"discounted_cash":2354.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HLA TYPING - B27","code_information":[{"code":"3008137401","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81374","type":"HCPCS"}],"standard_charges":[{"gross_charge":776.0,"discounted_cash":776.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HLA TYPING - CLASS II DRB1 DRB3 DQB1 DQA1 DPB1 DPA12","code_information":[{"code":"3008138201","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81382","type":"HCPCS"}],"standard_charges":[{"gross_charge":932.0,"discounted_cash":932.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GENE ANALYSIS - PAI1GN 4G 5G POLYMORPHISM","code_information":[{"code":"3008140001","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81400","type":"HCPCS"}],"standard_charges":[{"gross_charge":559.0,"discounted_cash":559.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GENE ANALYSIS - LEVEL 4","code_information":[{"code":"3008140301","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81403","type":"HCPCS"}],"standard_charges":[{"gross_charge":2859.0,"discounted_cash":2859.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GENE ANALYSIS - LEVEL 5","code_information":[{"code":"3008140401","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81404","type":"HCPCS"}],"standard_charges":[{"gross_charge":1970.0,"discounted_cash":1970.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GENE SEQUENCE PANEL","code_information":[{"code":"3008145501","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81455","type":"HCPCS"}],"standard_charges":[{"gross_charge":4093.0,"discounted_cash":4093.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GENE ANALYSIS - UNLISTED PROCEDURE","code_information":[{"code":"3008147901","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81479","type":"HCPCS"}],"standard_charges":[{"gross_charge":1782.0,"discounted_cash":1782.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALPHA-1-ANTITRYPSIN PHENOTYPE","code_information":[{"code":"3008210401","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82104","type":"HCPCS"}],"standard_charges":[{"gross_charge":269.0,"discounted_cash":269.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BLOOD GAS - ABG W 02 SAT","code_information":[{"code":"3008280501","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82805","type":"HCPCS"}],"standard_charges":[{"gross_charge":545.0,"discounted_cash":545.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BLOOD GAS - CBG W 02 SAT","code_information":[{"code":"3008280502","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82805","type":"HCPCS"}],"standard_charges":[{"gross_charge":522.0,"discounted_cash":522.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MUSK AUTOANTIBODY","code_information":[{"code":"3008351905","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83519","type":"HCPCS"}],"standard_charges":[{"gross_charge":215.0,"discounted_cash":215.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PHOSPHO-TAU(217) - MAYO","code_information":[{"code":"3008439303","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84393","type":"HCPCS"}],"standard_charges":[{"gross_charge":1400.0,"discounted_cash":1400.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RBC ANTIBODY SCREEN - ANTIBODY SCREEN","code_information":[{"code":"3008685001","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86850","type":"HCPCS"}],"standard_charges":[{"gross_charge":123.0,"discounted_cash":123.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RBC ANTIBODY ELUTION - ELUTION & ANTIBODY IDENTIFICATION, RBC","code_information":[{"code":"3008686001","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86860","type":"HCPCS"}],"standard_charges":[{"gross_charge":480.0,"discounted_cash":480.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RBC ANTIBODY IDENTIFICATION - ANTIBODY IDENTIFICATION","code_information":[{"code":"3008687001","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86870","type":"HCPCS"}],"standard_charges":[{"gross_charge":312.0,"discounted_cash":312.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DIRECT COOMBS (ANTIGLOBULIN TEST)","code_information":[{"code":"3008688002","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86880","type":"HCPCS"}],"standard_charges":[{"gross_charge":81.0,"discounted_cash":81.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ANTIHUMAN GLOBULIN INDIR QUAL EA REAGENT CELL - COOMBS TEST, IND - WEAK D","code_information":[{"code":"3008688502","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86885","type":"HCPCS"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ANTIHUMAN GLOBULIN INDIRECT EA ANTIBODY TITER - ANTIBODY TITER","code_information":[{"code":"3008688601","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86886","type":"HCPCS"}],"standard_charges":[{"gross_charge":193.0,"discounted_cash":193.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BLOOD TYPING SEROLOGIC ABO - ABO/RH TYPE","code_information":[{"code":"3008690002","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86900","type":"HCPCS"}],"standard_charges":[{"gross_charge":235.0,"discounted_cash":235.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BLOOD TYPING SEROLOGIC ABO - BLOOD GROUP","code_information":[{"code":"3008690004","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86900","type":"HCPCS"}],"standard_charges":[{"gross_charge":235.0,"discounted_cash":235.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BLOOD TYPING SEROLOGIC RH (D) - BLOOD TYPE","code_information":[{"code":"3008690102","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86901","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.0,"discounted_cash":87.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BLOOD TYPE ANTIGEN DONOR REAGENT SERUM EACH - BLOOD TYPING, ANTIGEN","code_information":[{"code":"3008690201","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86902","type":"HCPCS"}],"standard_charges":[{"gross_charge":77.0,"discounted_cash":77.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BLOOD TYPE ANTIGEN DONOR REAGENT SERUM EA - BLOOD TYPING,  ANTIGEN REFRD","code_information":[{"code":"3008690202","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86902","type":"HCPCS"}],"standard_charges":[{"gross_charge":126.0,"discounted_cash":126.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BLOOD TYPING RBC ANTIGENS OTH/THN ABO/RH D EACH - BLOOD TYPING, RBC","code_information":[{"code":"3008690501","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86905","type":"HCPCS"}],"standard_charges":[{"gross_charge":110.0,"discounted_cash":110.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PATIENT RBC PHENOTYPE REFERRED","code_information":[{"code":"3008690502","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86905","type":"HCPCS"}],"standard_charges":[{"gross_charge":93.0,"discounted_cash":93.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BLOOD TYPING - RH PHENOTYPE COMPLETE","code_information":[{"code":"3008690601","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86906","type":"HCPCS"}],"standard_charges":[{"gross_charge":94.0,"discounted_cash":94.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CROSSMATCH - IMMEDIATE SPIN","code_information":[{"code":"3008692001","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86920","type":"HCPCS"}],"standard_charges":[{"gross_charge":179.0,"discounted_cash":179.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CROSSMATCH - ANTIHUMAN GLOBULIN","code_information":[{"code":"3008692201","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86922","type":"HCPCS"}],"standard_charges":[{"gross_charge":240.0,"discounted_cash":240.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CROSSMATCH - ANTIHUMAN GLOBULIN REF LAB","code_information":[{"code":"3008692202","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86922","type":"HCPCS"}],"standard_charges":[{"gross_charge":240.0,"discounted_cash":240.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BLOOD COMPATIBILITY - CROSSMATCH -COMPUTER","code_information":[{"code":"3008692301","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86923","type":"HCPCS"}],"standard_charges":[{"gross_charge":352.0,"discounted_cash":352.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BLOOD COMPATIBILITY ANTIBODY IDENTIFICATION - PRETREATMENT","code_information":[{"code":"3008697001","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86970","type":"HCPCS"}],"standard_charges":[{"gross_charge":181.0,"discounted_cash":181.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BLOOD COMPATIBILITY ANTIBODY IDENTIFICATION - PRETREATMENT ABSORPTION","code_information":[{"code":"3008697801","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86978","type":"HCPCS"}],"standard_charges":[{"gross_charge":127.0,"discounted_cash":127.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MONOCYTE MONOLAYER ASSAY (MMA) - ONEBLOOD","code_information":[{"code":"3008699902","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86999","type":"HCPCS"}],"standard_charges":[{"gross_charge":350.35,"discounted_cash":350.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MICROBIOLOGY - O&P STAIN","code_information":[{"code":"3008720901","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87209","type":"HCPCS"}],"standard_charges":[{"gross_charge":187.0,"discounted_cash":187.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SARS-COV2 + INFLUENZA A AND B PCR MULTIPLEX","code_information":[{"code":"3008763601","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87636","type":"HCPCS"}],"standard_charges":[{"gross_charge":438.0,"discounted_cash":438.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SARS-COV2 + INFLUENZA A AND B + RSV PCR MULTIPLEX","code_information":[{"code":"3008763701","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87637","type":"HCPCS"}],"standard_charges":[{"gross_charge":438.0,"discounted_cash":438.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC COVID-19, FLU A, FLU B, RSV PCR","code_information":[{"code":"3008763702","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87637","type":"HCPCS"}],"standard_charges":[{"gross_charge":438.0,"discounted_cash":438.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CELL COUNT,MISC BODY FLUIDS - BODY FLUID CELL COUNT","code_information":[{"code":"3008905001","type":"CDM"},{"code":"0300","type":"RC"},{"code":"89050","type":"HCPCS"}],"standard_charges":[{"gross_charge":79.0,"discounted_cash":79.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BODY FLUID CELL COUNT W DIFF - BODY FLUID CELL COUNT W/DIFF","code_information":[{"code":"3008905102","type":"CDM"},{"code":"0300","type":"RC"},{"code":"89051","type":"HCPCS"}],"standard_charges":[{"gross_charge":110.0,"discounted_cash":110.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC LEUKOCYTE COUNT,FECAL - FECAL LEUKOCYTES","code_information":[{"code":"3008905501","type":"CDM"},{"code":"0300","type":"RC"},{"code":"89055","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.0,"discounted_cash":87.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CRYSTALS, BODY FLUID","code_information":[{"code":"3008906002","type":"CDM"},{"code":"0300","type":"RC"},{"code":"89060","type":"HCPCS"}],"standard_charges":[{"gross_charge":141.0,"discounted_cash":141.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PLATELET PATHOGEN TESTING PER UNIT","code_information":[{"code":"300P910001","type":"CDM"},{"code":"0300","type":"RC"},{"code":"P9100","type":"HCPCS"}],"standard_charges":[{"gross_charge":520.0,"discounted_cash":520.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CATHETERIZATION FOR SPECIMEN COLLECTION","code_information":[{"code":"300P961201","type":"CDM"},{"code":"0300","type":"RC"},{"code":"P9612","type":"HCPCS"}],"standard_charges":[{"gross_charge":353.0,"discounted_cash":353.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BASIC METABOLIC PANEL CALCIUM TOTAL","code_information":[{"code":"3018004801","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80048","type":"HCPCS"}],"standard_charges":[{"gross_charge":165.0,"discounted_cash":165.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GENERAL HEALTH PANEL - BUNDLED CHARGE","code_information":[{"code":"3018005001","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80050","type":"HCPCS"}],"standard_charges":[{"gross_charge":522.0,"discounted_cash":522.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ELECTROLYTE PANEL - BUNDLED CHARGE","code_information":[{"code":"3018005101","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80051","type":"HCPCS"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":125.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC COMPREHENSIVE METABOLIC PANEL - CMP","code_information":[{"code":"3018005301","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80053","type":"HCPCS"}],"standard_charges":[{"gross_charge":239.0,"discounted_cash":239.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OBSTETRIC PANEL - BUNDLED CHARGE","code_information":[{"code":"3018005501","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80055","type":"HCPCS"}],"standard_charges":[{"gross_charge":759.0,"discounted_cash":759.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC LIPID PANEL - BUNDLED CHARGE","code_information":[{"code":"3018006101","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80061","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.0,"discounted_cash":132.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC LIPID PROFILE BY NMR - NMR LIPOMED PROFILE - ARUP","code_information":[{"code":"3018006102","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80061","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.0,"discounted_cash":132.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RENAL FUNCTION PANEL - BUNDLED CHARGE","code_information":[{"code":"3018006901","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80069","type":"HCPCS"}],"standard_charges":[{"gross_charge":180.0,"discounted_cash":180.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HEPATITIS PANEL,ACUTE - BUNDLED CHARGE","code_information":[{"code":"3018007401","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80074","type":"HCPCS"}],"standard_charges":[{"gross_charge":242.0,"discounted_cash":242.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HEPATIC FUNCTION PANEL - BUNDLED CHARGE","code_information":[{"code":"3018007601","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80076","type":"HCPCS"}],"standard_charges":[{"gross_charge":207.0,"discounted_cash":207.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OBSTETRIC PANEL W HIV","code_information":[{"code":"3018008101","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80081","type":"HCPCS"}],"standard_charges":[{"gross_charge":759.0,"discounted_cash":759.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ACETAMINOPHEN (TYLENOL) LEVEL","code_information":[{"code":"3018014301","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80143","type":"HCPCS"}],"standard_charges":[{"gross_charge":129.0,"discounted_cash":129.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DRUG ASSAY - ADALIMUMAB","code_information":[{"code":"3018014501","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80145","type":"HCPCS"}],"standard_charges":[{"gross_charge":76.0,"discounted_cash":76.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DRUG ASSAY - ADALIMUMAB - ARUP","code_information":[{"code":"3018014502","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80145","type":"HCPCS"}],"standard_charges":[{"gross_charge":76.0,"discounted_cash":76.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC AMIKACIN LEVEL","code_information":[{"code":"3018015001","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80150","type":"HCPCS"}],"standard_charges":[{"gross_charge":122.0,"discounted_cash":122.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF CARBAMAZEPINE TOTAL - CARBAMAZEPINE TOTAL","code_information":[{"code":"3018015601","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80156","type":"HCPCS"}],"standard_charges":[{"gross_charge":137.0,"discounted_cash":137.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CARBAMAZEPINE LEVEL TOTAL - CARBAMAZEPINE FREE AND TOTAL - ARUP","code_information":[{"code":"3018015602","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80156","type":"HCPCS"}],"standard_charges":[{"gross_charge":137.0,"discounted_cash":137.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF ASSAY CARBAMAZEPINE, FREE - CARBAMAZEPINE FREE","code_information":[{"code":"3018015701","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80157","type":"HCPCS"}],"standard_charges":[{"gross_charge":101.0,"discounted_cash":101.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CARBAMAZEPINE LEVEL FREE - CARBAMAZEPINE FREE AND TOTAL -ARUP","code_information":[{"code":"3018015702","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80157","type":"HCPCS"}],"standard_charges":[{"gross_charge":101.0,"discounted_cash":101.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF CYCLOSPORINE - CYCLOSPORINE","code_information":[{"code":"3018015801","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80158","type":"HCPCS"}],"standard_charges":[{"gross_charge":74.0,"discounted_cash":74.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CLOZAPINE (CLOZARIL) LEVEL","code_information":[{"code":"3018015901","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80159","type":"HCPCS"}],"standard_charges":[{"gross_charge":45.0,"discounted_cash":45.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CLOZAPINE (CLOZARIL) LEVEL - ARUP","code_information":[{"code":"3018015902","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80159","type":"HCPCS"}],"standard_charges":[{"gross_charge":45.0,"discounted_cash":45.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DIGOXIN LEVEL TOTAL","code_information":[{"code":"3018016201","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80162","type":"HCPCS"}],"standard_charges":[{"gross_charge":160.0,"discounted_cash":160.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC VALPROIC ACID LEVEL TOTAL","code_information":[{"code":"3018016402","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80164","type":"HCPCS"}],"standard_charges":[{"gross_charge":188.0,"discounted_cash":188.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC VALPROIC ACID TOTAL - VALPROIC ACID FREE AND TOTAL - ARUP","code_information":[{"code":"3018016405","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80164","type":"HCPCS"}],"standard_charges":[{"gross_charge":188.0,"discounted_cash":188.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC VALPROIC ACID LEVEL FREE ARUP","code_information":[{"code":"3018016501","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80165","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.0,"discounted_cash":87.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC VALPROIC ACID FREE - VALPROIC ACID FREE AND TOTAL - ARUP","code_information":[{"code":"3018016502","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80165","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.0,"discounted_cash":87.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF ETHOSUXIMIDE - ETHOSUXIMIDE LEVEL","code_information":[{"code":"3018016801","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80168","type":"HCPCS"}],"standard_charges":[{"gross_charge":102.0,"discounted_cash":102.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ETHOSUXIMIDE LEVEL - ARUP","code_information":[{"code":"3018016802","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80168","type":"HCPCS"}],"standard_charges":[{"gross_charge":102.0,"discounted_cash":102.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF GENTAMICIN - GENTAMICIN RANDOM","code_information":[{"code":"3018017002","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80170","type":"HCPCS"}],"standard_charges":[{"gross_charge":160.0,"discounted_cash":160.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DRUG ASSAY - GABAPENTIN/NEURONTIN","code_information":[{"code":"3018017101","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80171","type":"HCPCS"}],"standard_charges":[{"gross_charge":71.0,"discounted_cash":71.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GABAPENTIN (NEURONTIN) LEVEL - ARUP","code_information":[{"code":"3018017102","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80171","type":"HCPCS"}],"standard_charges":[{"gross_charge":71.0,"discounted_cash":71.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF DRUG - LAMOTRIGINE/LAMICTAL LEVEL","code_information":[{"code":"3018017501","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80175","type":"HCPCS"}],"standard_charges":[{"gross_charge":71.0,"discounted_cash":71.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC LAMOTRIGINE (LAMICTAL) LEVEL - ARUP","code_information":[{"code":"3018017502","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80175","type":"HCPCS"}],"standard_charges":[{"gross_charge":71.0,"discounted_cash":71.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC LEVETIRACETAM (KEPPRA) LEVEL","code_information":[{"code":"3018017701","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80177","type":"HCPCS"}],"standard_charges":[{"gross_charge":74.0,"discounted_cash":74.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC LEVETIRACETAM (KEPPRA) LEVEL - ARUP","code_information":[{"code":"3018017703","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80177","type":"HCPCS"}],"standard_charges":[{"gross_charge":74.0,"discounted_cash":74.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC LITHIUM LEVEL","code_information":[{"code":"3018017801","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80178","type":"HCPCS"}],"standard_charges":[{"gross_charge":93.0,"discounted_cash":93.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DRUG THERAPEUTIC LEVEL - SALICYLATE LEVEL SERUM","code_information":[{"code":"3018017901","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80179","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.0,"discounted_cash":38.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FLECAINIDE (TAMBOCOR) LEVEL - ARUP","code_information":[{"code":"3018018102","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80181","type":"HCPCS"}],"standard_charges":[{"gross_charge":98.0,"discounted_cash":98.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF DRUG - OXCARBAZEPINE/TRILEPTAL LEVEL","code_information":[{"code":"3018018301","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80183","type":"HCPCS"}],"standard_charges":[{"gross_charge":71.0,"discounted_cash":71.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OXCARBAZEPINE (TRILEPTAL) LEVEL - ARUP","code_information":[{"code":"3018018302","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80183","type":"HCPCS"}],"standard_charges":[{"gross_charge":71.0,"discounted_cash":71.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PHENOBARBITAL LEVEL","code_information":[{"code":"3018018401","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80184","type":"HCPCS"}],"standard_charges":[{"gross_charge":171.0,"discounted_cash":171.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PHENOBARBITAL LEVEL - ARUP","code_information":[{"code":"3018018402","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80184","type":"HCPCS"}],"standard_charges":[{"gross_charge":171.0,"discounted_cash":171.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PHENOBARBITAL LEVEL - PRIMIDONE AND METABOLITE - ARUP","code_information":[{"code":"3018018403","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80184","type":"HCPCS"}],"standard_charges":[{"gross_charge":171.0,"discounted_cash":171.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PHENYTOIN LEVEL TOTAL","code_information":[{"code":"3018018502","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80185","type":"HCPCS"}],"standard_charges":[{"gross_charge":106.0,"discounted_cash":106.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PHENYTOIN LEVEL FREE","code_information":[{"code":"3018018601","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80186","type":"HCPCS"}],"standard_charges":[{"gross_charge":174.0,"discounted_cash":174.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC POSACONAZOLE LEVEL QUANT - ARUP","code_information":[{"code":"3018018702","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80187","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":75.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PRIMIDONE LEVEL - ARUP","code_information":[{"code":"3018018801","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80188","type":"HCPCS"}],"standard_charges":[{"gross_charge":84.0,"discounted_cash":84.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PRIMIDONE LEVEL - PRIMIDONE AND METABOLITE - ARUP","code_information":[{"code":"3018018802","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80188","type":"HCPCS"}],"standard_charges":[{"gross_charge":84.0,"discounted_cash":84.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ITRACONAZOLE LEVEL - ARUP","code_information":[{"code":"3018018902","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80189","type":"HCPCS"}],"standard_charges":[{"gross_charge":163.8,"discounted_cash":163.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC LEFLUNOMIDE","code_information":[{"code":"3018019301","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80193","type":"HCPCS"}],"standard_charges":[{"gross_charge":135.0,"discounted_cash":135.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC LEFLUNOMIDE LEVEL - ARUP","code_information":[{"code":"3018019302","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80193","type":"HCPCS"}],"standard_charges":[{"gross_charge":135.0,"discounted_cash":135.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SIROLIMUS LEVEL","code_information":[{"code":"3018019501","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80195","type":"HCPCS"}],"standard_charges":[{"gross_charge":133.0,"discounted_cash":133.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SIROLIMUS LEVEL - ARUP","code_information":[{"code":"3018019502","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80195","type":"HCPCS"}],"standard_charges":[{"gross_charge":133.0,"discounted_cash":133.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TACROLIMUS LEVEL IMMUNOASSAY","code_information":[{"code":"3018019701","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80197","type":"HCPCS"}],"standard_charges":[{"gross_charge":343.0,"discounted_cash":343.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TACROLIMUS (TMS) - ARUP","code_information":[{"code":"3018019702","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80197","type":"HCPCS"}],"standard_charges":[{"gross_charge":343.0,"discounted_cash":343.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC THEOPHYLLINE LEVEL - ARUP","code_information":[{"code":"3018019802","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80198","type":"HCPCS"}],"standard_charges":[{"gross_charge":101.0,"discounted_cash":101.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TOBRAMYCIN LEVEL","code_information":[{"code":"3018020002","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80200","type":"HCPCS"}],"standard_charges":[{"gross_charge":84.0,"discounted_cash":84.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF TOPIRAMATE - TOPIRAMATE LEVEL","code_information":[{"code":"3018020101","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80201","type":"HCPCS"}],"standard_charges":[{"gross_charge":165.0,"discounted_cash":165.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TOPIRAMATE LEVEL - ARUP","code_information":[{"code":"3018020102","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80201","type":"HCPCS"}],"standard_charges":[{"gross_charge":165.0,"discounted_cash":165.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC VANCOMYCIN LEVEL","code_information":[{"code":"3018020202","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80202","type":"HCPCS"}],"standard_charges":[{"gross_charge":122.0,"discounted_cash":122.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DRUG ASSAY - ZONISAMIDE","code_information":[{"code":"3018020301","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80203","type":"HCPCS"}],"standard_charges":[{"gross_charge":118.0,"discounted_cash":118.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ZONISAMIDE LEVEL- ARUP","code_information":[{"code":"3018020302","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80203","type":"HCPCS"}],"standard_charges":[{"gross_charge":118.0,"discounted_cash":118.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DRUG ASSAY - INFLIXIMAB","code_information":[{"code":"3018023001","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80230","type":"HCPCS"}],"standard_charges":[{"gross_charge":499.0,"discounted_cash":499.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC THERAPEUTIC DRUG ASSAY - LACOSAMIDE LEVEL","code_information":[{"code":"3018023501","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80235","type":"HCPCS"}],"standard_charges":[{"gross_charge":136.0,"discounted_cash":136.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC LACOSAMIDE LEVEL - ARUP","code_information":[{"code":"3018023502","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80235","type":"HCPCS"}],"standard_charges":[{"gross_charge":136.0,"discounted_cash":136.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DRUG ASSAY - VORICONAZOLE","code_information":[{"code":"3018028501","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80285","type":"HCPCS"}],"standard_charges":[{"gross_charge":73.0,"discounted_cash":73.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC QUANTITATION DRUG NOT ELSEWHERE SPECIFIED - METHOTREXATE LEVEL","code_information":[{"code":"3018029903","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80299","type":"HCPCS"}],"standard_charges":[{"gross_charge":172.0,"discounted_cash":172.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF DRUG - THIOPURINE METABOLITES LEVEL","code_information":[{"code":"3018029919","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80299","type":"HCPCS"}],"standard_charges":[{"gross_charge":259.0,"discounted_cash":259.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DRUG ASSAY - DEXAMETHASONE","code_information":[{"code":"3018029922","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80299","type":"HCPCS"}],"standard_charges":[{"gross_charge":320.0,"discounted_cash":320.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DRUG ASSAY - USTEKINUMAB","code_information":[{"code":"3018029933","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80299","type":"HCPCS"}],"standard_charges":[{"gross_charge":202.0,"discounted_cash":202.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DEXAMETHASONE LEVEL - ARUP","code_information":[{"code":"3018029935","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80299","type":"HCPCS"}],"standard_charges":[{"gross_charge":320.0,"discounted_cash":320.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC METHOTREXATE LEVEL SENSITIVE - ARUP","code_information":[{"code":"3018029940","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80299","type":"HCPCS"}],"standard_charges":[{"gross_charge":172.0,"discounted_cash":172.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DRUG TEST PRSMV DIR OPT OBS - TOXICOLOGY SCREEN URINE","code_information":[{"code":"3018030505","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80305","type":"HCPCS"}],"standard_charges":[{"gross_charge":97.0,"discounted_cash":97.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DRUG TEST PRSMV CHEM ANLYZR - ALCOHOL LEVEL","code_information":[{"code":"3018030724","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":327.0,"discounted_cash":327.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DRUG TEST PRSMV CHEM ANLYZR - NICOTINE SCREEN URINE","code_information":[{"code":"3018030728","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":327.0,"discounted_cash":327.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DRUG SCREEN 9 TARGETS WITH CONFIRMATION/QUANTITATION URINE - ARUP","code_information":[{"code":"3018030730","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":502.0,"discounted_cash":502.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DRUG TEST PRSMV CHEM ANLYZR - DRUG SCREEN PANEL COMPREHENSIVE 9 AND CONFIRM","code_information":[{"code":"3018030734","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":125.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DRUG TEST PRSMV CHEM ANLYZR - DRUG SCREEN PANEL COMPREHENSIVE 7 AND CONFIRM","code_information":[{"code":"3018030735","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":502.0,"discounted_cash":502.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TOXICOLOGY SCREEN URINE, 10 DRUG CLASSES","code_information":[{"code":"3018030736","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":441.0,"discounted_cash":441.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DRUG TEST PRSMV CHEM ANLYZR - DRUG SCREEN PANEL SERUM AND CONFIRM","code_information":[{"code":"3018030737","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":451.0,"discounted_cash":451.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC COTININE URINE SCREEN - ARUP","code_information":[{"code":"3018030751","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":327.0,"discounted_cash":327.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC URINE DRUG SCREEN WITH CONFIRMATION","code_information":[{"code":"3018030754","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":441.0,"discounted_cash":441.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC URINE FENTANYL SCREEN","code_information":[{"code":"3018030760","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":327.0,"discounted_cash":327.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GAMMA HYDROXYBUTYRIC (GHB) ACID SCREEN SERUM /PLASMA - ARUP","code_information":[{"code":"3018030769","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":441.0,"discounted_cash":441.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC COTININE LEVEL URINE - ARUP","code_information":[{"code":"3018030772","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":327.0,"discounted_cash":327.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DRUG SCREEN QUANTITATIVE ALCOHOLS - ISOPROPANOL","code_information":[{"code":"3018032006","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80320","type":"HCPCS"}],"standard_charges":[{"gross_charge":55.0,"discounted_cash":55.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ISOPROPYL ALCOHOL LEVEL - ARUP","code_information":[{"code":"3018032008","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80320","type":"HCPCS"}],"standard_charges":[{"gross_charge":55.0,"discounted_cash":55.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC METHANOL LEVEL - ARUP","code_information":[{"code":"3018032009","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80320","type":"HCPCS"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC VOLATILES SCREEN - ARUP","code_information":[{"code":"3018032011","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80320","type":"HCPCS"}],"standard_charges":[{"gross_charge":55.0,"discounted_cash":55.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DRUG TEST DEFIN - ALCOHOL BIOMARKERS","code_information":[{"code":"3018032101","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80321","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":75.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PHOSPHATIDYLETHANOL (PETH) - ARUP","code_information":[{"code":"3018032104","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80321","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":75.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC NICOTINE AND METABOLITES QUANT - ARUP","code_information":[{"code":"3018032306","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80323","type":"HCPCS"}],"standard_charges":[{"gross_charge":82.0,"discounted_cash":82.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC NICOTINE AND METABOLITES URINE - ARUP","code_information":[{"code":"3018032309","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80323","type":"HCPCS"}],"standard_charges":[{"gross_charge":82.0,"discounted_cash":82.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC NICOTINE AND METABOLITES PLASMA - ARUP","code_information":[{"code":"3018032310","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80323","type":"HCPCS"}],"standard_charges":[{"gross_charge":82.0,"discounted_cash":82.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALKALOIDS - DRUG DETECTION PANEL QUALITATIVE MECONIUM - ARUP","code_information":[{"code":"3018032313","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80323","type":"HCPCS"}],"standard_charges":[{"gross_charge":62.0,"discounted_cash":62.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALKALOIDS DEFINITIVE - DRUG DETECT PNL MECONIUM QUAL - ARUP","code_information":[{"code":"3018032314","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80323","type":"HCPCS"}],"standard_charges":[{"gross_charge":226.59,"discounted_cash":226.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DRUG SCREEN QUANT AMPHETAMINES 1 OR 2 - AMPHETAMINE, BLOOD, QUANT","code_information":[{"code":"3018032401","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80324","type":"HCPCS"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DRUG SCREEN QUANT AMPHETAMINES 3 OR 4 - BUNDLED CHARGE","code_information":[{"code":"3018032501","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80325","type":"HCPCS"}],"standard_charges":[{"gross_charge":37.0,"discounted_cash":37.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC AMPHETAMINE QUANT - AMPHETAMINE URINE CONFIRMATION - ARUP","code_information":[{"code":"3018032502","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80325","type":"HCPCS"}],"standard_charges":[{"gross_charge":37.0,"discounted_cash":37.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC AMPHETAMINES DEFINITIVE - DRUG DETECT PNL MECONIUM QUAL - ARUP","code_information":[{"code":"3018032503","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80325","type":"HCPCS"}],"standard_charges":[{"gross_charge":165.0,"discounted_cash":165.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC AMPHETAMINES DEFINITIVE - DRUG DETECT PNL CORDTISS QUAL-ARUP","code_information":[{"code":"3018032504","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80325","type":"HCPCS"}],"standard_charges":[{"gross_charge":165.0,"discounted_cash":165.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DRUG SCREEN QUANT AMPHETAMINES 5 OR MORE - BUNDLED CHARGE","code_information":[{"code":"3018032601","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80326","type":"HCPCS"}],"standard_charges":[{"gross_charge":165.0,"discounted_cash":165.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC AMPHETAMINES - DRUG DETECTION PANEL QUALITATIVE MECONIUM - ARUP","code_information":[{"code":"3018032604","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80326","type":"HCPCS"}],"standard_charges":[{"gross_charge":165.0,"discounted_cash":165.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC AMITRIPTYLINE AND NORTRIPTYLINE SP LEVEL - ARUP","code_information":[{"code":"3018033518","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80335","type":"HCPCS"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TRAZODONE DESYREL LEVEL - ARUP","code_information":[{"code":"3018033803","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80338","type":"HCPCS"}],"standard_charges":[{"gross_charge":45.0,"discounted_cash":45.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ANTIEPILEPTICS NOS 1-3 - BUNDLED CHARGE","code_information":[{"code":"3018033905","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80339","type":"HCPCS"}],"standard_charges":[{"gross_charge":113.0,"discounted_cash":113.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ANTIEPILEPTICS NOS 1-3 CLOBAZAM - BUNDLED CHARGE","code_information":[{"code":"3018033906","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80339","type":"HCPCS"}],"standard_charges":[{"gross_charge":114.0,"discounted_cash":114.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC COBAZAM (ONFI) LEVEL - ARUP","code_information":[{"code":"3018033910","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80339","type":"HCPCS"}],"standard_charges":[{"gross_charge":114.0,"discounted_cash":114.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PERAMPANEL QUANT SERUM OR PLASMA - ARUP","code_information":[{"code":"3018033911","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80339","type":"HCPCS"}],"standard_charges":[{"gross_charge":113.0,"discounted_cash":113.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ANTIPSYCHOTICS NOS 1-3 RISPERIDONE - BUNDLED CHARGE","code_information":[{"code":"3018034217","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80342","type":"HCPCS"}],"standard_charges":[{"gross_charge":73.0,"discounted_cash":73.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DRUG SCREENING BARBITURATES - BARBITURATE URINE QUANT","code_information":[{"code":"3018034501","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80345","type":"HCPCS"}],"standard_charges":[{"gross_charge":41.0,"discounted_cash":41.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BARBITURATE URINE CONFIRMATION - ARUP","code_information":[{"code":"3018034506","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80345","type":"HCPCS"}],"standard_charges":[{"gross_charge":41.0,"discounted_cash":41.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BARBITURATES DEFINITIVE - DRUG DETECT PNL MECONIUM QUAL - ARUP","code_information":[{"code":"3018034510","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80345","type":"HCPCS"}],"standard_charges":[{"gross_charge":90.52,"discounted_cash":90.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BARBITURATES DEFINITIVE - DRUG DETECT PNL CORDTISS QUAL-ARUP","code_information":[{"code":"3018034511","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80345","type":"HCPCS"}],"standard_charges":[{"gross_charge":90.52,"discounted_cash":90.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DRUG SCREENING BENZODIAZEPINES 1-12 BENZODIAZEPINE - BUNDLED CHARGE","code_information":[{"code":"3018034604","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80346","type":"HCPCS"}],"standard_charges":[{"gross_charge":48.0,"discounted_cash":48.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DRUG SCREENING BENZODIAZEPINES 1-12 - CLONAZEPAM / KLONOPIN QUANT","code_information":[{"code":"3018034610","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80346","type":"HCPCS"}],"standard_charges":[{"gross_charge":61.0,"discounted_cash":61.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BENZODIAZEPINE LEVEL URINE QUANT - ARUP","code_information":[{"code":"3018034615","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80346","type":"HCPCS"}],"standard_charges":[{"gross_charge":76.0,"discounted_cash":76.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BENZODIAZEPINES DEFINITIVE - DRUG DETECT PNL MECONIUM QUAL - ARUP","code_information":[{"code":"3018034621","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80346","type":"HCPCS"}],"standard_charges":[{"gross_charge":167.83,"discounted_cash":167.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BENZODIAZEPINES DEFINITIVE - DRUG DETECT PNL CORDTISS QUAL-ARUP","code_information":[{"code":"3018034622","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80346","type":"HCPCS"}],"standard_charges":[{"gross_charge":167.83,"discounted_cash":167.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DRUG SCREENING BENZODIAZEPINES 13+ BENZODIAZEPINE - BUNDLED CHARGE","code_information":[{"code":"3018034701","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80347","type":"HCPCS"}],"standard_charges":[{"gross_charge":50.0,"discounted_cash":50.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BENZODIAZEPINES - DRUG DETECTION PANEL QUALITATIVE MECONIUM - ARUP","code_information":[{"code":"3018034706","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80347","type":"HCPCS"}],"standard_charges":[{"gross_charge":50.0,"discounted_cash":50.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BUPRENORPHINE & METABOLITES QUANT URINE - ARUP","code_information":[{"code":"3018034804","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80348","type":"HCPCS"}],"standard_charges":[{"gross_charge":48.0,"discounted_cash":48.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BUPRENORPHINE DEFINITIVE - DRUG DETECT PNL MECONIUM QUAL - ARUP","code_information":[{"code":"3018034806","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80348","type":"HCPCS"}],"standard_charges":[{"gross_charge":167.83,"discounted_cash":167.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BUPRENORPHINE DEFINITIVE - DRUG DETECT PNL CORDTISS QUAL-ARUP","code_information":[{"code":"3018034807","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80348","type":"HCPCS"}],"standard_charges":[{"gross_charge":167.83,"discounted_cash":167.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DRUG SCREENING CANNABINOIDS NATURAL - CANNABINOID CONFIRMATION UR","code_information":[{"code":"3018034901","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80349","type":"HCPCS"}],"standard_charges":[{"gross_charge":78.0,"discounted_cash":78.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DRUG SCREENING CANNABINOIDS NATURAL - CANNABINOID CONFIRMATION","code_information":[{"code":"3018034902","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80349","type":"HCPCS"}],"standard_charges":[{"gross_charge":77.0,"discounted_cash":77.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC THC (CANNABINOID) METABOLITE QUANT URINE - ARUP","code_information":[{"code":"3018034906","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80349","type":"HCPCS"}],"standard_charges":[{"gross_charge":78.0,"discounted_cash":78.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC THC MARIJUANA METABOLITE DEFINITIVE, CORDTISS, QUAL - ARUP","code_information":[{"code":"3018034908","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80349","type":"HCPCS"}],"standard_charges":[{"gross_charge":77.0,"discounted_cash":77.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC THC MARIJUANA METABOLITE DEFINITIVE, MECONIUM, QUAL - ARUP","code_information":[{"code":"3018034909","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80349","type":"HCPCS"}],"standard_charges":[{"gross_charge":78.0,"discounted_cash":78.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DRUG SCREENING COCAINE - COCAINE URINE CONF","code_information":[{"code":"3018035301","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80353","type":"HCPCS"}],"standard_charges":[{"gross_charge":34.0,"discounted_cash":34.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DRUG SCREENING COCAINE - COCAINE MECONIUM CONF","code_information":[{"code":"3018035303","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80353","type":"HCPCS"}],"standard_charges":[{"gross_charge":78.0,"discounted_cash":78.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC COCAINE DEFINITIVE - DRUG DETECT PNL MECONIUM QUAL-ARUP","code_information":[{"code":"3018035305","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80353","type":"HCPCS"}],"standard_charges":[{"gross_charge":78.0,"discounted_cash":78.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC COCAINE DEFINITIVE - DRUG DETECT PNL CORDTISS QUAL-ARUP","code_information":[{"code":"3018035306","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80353","type":"HCPCS"}],"standard_charges":[{"gross_charge":78.0,"discounted_cash":78.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DRUG SCREENING FENTANYL - FENTANYL URINE","code_information":[{"code":"3018035401","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80354","type":"HCPCS"}],"standard_charges":[{"gross_charge":55.0,"discounted_cash":55.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FENTANYL AND METABOLITE URINE QUANT - ARUP","code_information":[{"code":"3018035403","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80354","type":"HCPCS"}],"standard_charges":[{"gross_charge":55.0,"discounted_cash":55.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FENTANYL DEFINITIVE - DRUG DETECT PNL MECONIUM QUAL-ARUP","code_information":[{"code":"3018035405","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80354","type":"HCPCS"}],"standard_charges":[{"gross_charge":122.76,"discounted_cash":122.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FENTANYL DEFINITIVE - DRUG DETECT PNL CORDTISS QUAL-ARUP","code_information":[{"code":"3018035406","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80354","type":"HCPCS"}],"standard_charges":[{"gross_charge":122.76,"discounted_cash":122.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DEFINITIVE DRUG ASSAY - GABAPENTIN NON-BLOOD","code_information":[{"code":"3018035501","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80355","type":"HCPCS"}],"standard_charges":[{"gross_charge":93.0,"discounted_cash":93.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GABAPENTIN - DRUG DETECTION PANEL QUALITATIVE MECONIUM - ARUP","code_information":[{"code":"3018035504","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80355","type":"HCPCS"}],"standard_charges":[{"gross_charge":93.0,"discounted_cash":93.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GABAPENTIN NON-BLOOD DEFINITIVE - DRUG DETECT PNL MECONIUM QUAL-ARUP","code_information":[{"code":"3018035505","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80355","type":"HCPCS"}],"standard_charges":[{"gross_charge":93.0,"discounted_cash":93.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GABAPENTIN NON-BLOOD DEFINITIVE - DRUG DETECT PNL CORDTISS QUAL-ARUP","code_information":[{"code":"3018035506","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80355","type":"HCPCS"}],"standard_charges":[{"gross_charge":93.0,"discounted_cash":93.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HEROIN METABOLITE DEFINITIVE - DRUG DETECT PNL MECONIUM QUAL - ARUP","code_information":[{"code":"3018035603","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80356","type":"HCPCS"}],"standard_charges":[{"gross_charge":230.64,"discounted_cash":230.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HEROIN METABOLITE DEFINITIVE - DRUG DETECT PNL CORDTISS QUAL-ARUP","code_information":[{"code":"3018035604","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80356","type":"HCPCS"}],"standard_charges":[{"gross_charge":230.64,"discounted_cash":230.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DRUG DEFINITIVE EVAL - METHADONE QUANTITATION URINE","code_information":[{"code":"3018035803","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80358","type":"HCPCS"}],"standard_charges":[{"gross_charge":40.0,"discounted_cash":40.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC METHADONE & METABOLITES LEVEL URINE CONFIRMATION - ARUP","code_information":[{"code":"3018035806","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80358","type":"HCPCS"}],"standard_charges":[{"gross_charge":40.0,"discounted_cash":40.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC METHADONE DEFINITIVE - DRUG DETECT PNL MECONIUM QUAL - ARUP","code_information":[{"code":"3018035807","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80358","type":"HCPCS"}],"standard_charges":[{"gross_charge":93.0,"discounted_cash":93.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC METHADONE DEFINITIVE - DRUG DETECT PNL CORDTISS QUAL-ARUP","code_information":[{"code":"3018035808","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80358","type":"HCPCS"}],"standard_charges":[{"gross_charge":93.0,"discounted_cash":93.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DRUG SCREENING METHYLENEDIOXYAMPHETAMINES","code_information":[{"code":"3018035902","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80359","type":"HCPCS"}],"standard_charges":[{"gross_charge":37.0,"discounted_cash":37.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC METHAMPHETAMINE QUANT - AMPHETAMINE URINE CONFIRMATION - ARUP","code_information":[{"code":"3018035903","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80359","type":"HCPCS"}],"standard_charges":[{"gross_charge":37.0,"discounted_cash":37.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MDMA/ECSTASY DEFINITIVE - DRUG DETECT PNL MECONIUM QUAL - ARUP","code_information":[{"code":"3018035904","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80359","type":"HCPCS"}],"standard_charges":[{"gross_charge":78.0,"discounted_cash":78.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MDMA/ECSTASY DEFINITIVE - DRUG DETECT PNL CORDTISS QUAL-ARUP","code_information":[{"code":"3018035905","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80359","type":"HCPCS"}],"standard_charges":[{"gross_charge":78.0,"discounted_cash":78.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC METHYLPHENIDATE DEFINITIVE - DRUG DETECT PNL MECONIUM QUAL - ARUP","code_information":[{"code":"3018036004","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80360","type":"HCPCS"}],"standard_charges":[{"gross_charge":78.0,"discounted_cash":78.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DRUG SCREENING OPIATES 1 OR MORE - OPIATE,QUANTITATIVE,UR CONF","code_information":[{"code":"3018036101","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80361","type":"HCPCS"}],"standard_charges":[{"gross_charge":43.0,"discounted_cash":43.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OPIATE LEVEL QUANT URINE CONFIRMATION - ARUP","code_information":[{"code":"3018036104","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80361","type":"HCPCS"}],"standard_charges":[{"gross_charge":43.0,"discounted_cash":43.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OPIATES DEFINITIVE - DRUG DETECT PNL MECONIUM QUAL - ARUP","code_information":[{"code":"3018036107","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80361","type":"HCPCS"}],"standard_charges":[{"gross_charge":94.82,"discounted_cash":94.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OPIATES DEFINITIVE - DRUG DETECT PNL CORDTISS QUAL-ARUP","code_information":[{"code":"3018036108","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80361","type":"HCPCS"}],"standard_charges":[{"gross_charge":94.82,"discounted_cash":94.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OPIOIDS, OPIATE ANALOGS DEFINITIVE - DRUG DETECT PNL MECONIUM QUAL -  ARUP","code_information":[{"code":"3018036203","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80362","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.73,"discounted_cash":38.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OPIOIDS, OPIATE ANALOGS DEFINITIVE - DRUG DETECT PNL CORDTISS QUAL  ARUP","code_information":[{"code":"3018036204","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80362","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.73,"discounted_cash":38.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OPIATE 5+ MECONIUM CONFIRMATION","code_information":[{"code":"3018036401","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80364","type":"HCPCS"}],"standard_charges":[{"gross_charge":23.0,"discounted_cash":23.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DRUG DETECTION PANEL UMBILICAL CORD TISSUE QUAL - ARUP","code_information":[{"code":"3018036403","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80364","type":"HCPCS"}],"standard_charges":[{"gross_charge":23.0,"discounted_cash":23.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OPIATES - DRUG DETECTION PANEL QUALITATIVE MECONIUM - ARUP","code_information":[{"code":"3018036405","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80364","type":"HCPCS"}],"standard_charges":[{"gross_charge":23.0,"discounted_cash":23.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DRUG SCREENING OXYCODONE - CONFIRMATION","code_information":[{"code":"3018036501","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80365","type":"HCPCS"}],"standard_charges":[{"gross_charge":43.0,"discounted_cash":43.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OXYCODONE DEFINITIVE - DRUG DETECT PNL MECONIUM QUAL - ARUP","code_information":[{"code":"3018036502","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80365","type":"HCPCS"}],"standard_charges":[{"gross_charge":93.0,"discounted_cash":93.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OXYCODONE DEFINITIVE - DRUG DETECT PNL CORDTISS QUAL-ARUP","code_information":[{"code":"3018036503","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80365","type":"HCPCS"}],"standard_charges":[{"gross_charge":93.0,"discounted_cash":93.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PROPOXYPHENE DEFINITIVE - DRUG DETECT PNL CORDTISS QUAL-ARUP","code_information":[{"code":"3018036705","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80367","type":"HCPCS"}],"standard_charges":[{"gross_charge":104.53,"discounted_cash":104.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DRUG DEFINITIVE EVAL - AMBIEN LEVEL","code_information":[{"code":"3018036805","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80368","type":"HCPCS"}],"standard_charges":[{"gross_charge":47.0,"discounted_cash":47.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SEDATIVE HYPNOTICS DEFINITIVE - DRUG DETECT PNL MECONIUM QUAL - ARUP","code_information":[{"code":"3018036807","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80368","type":"HCPCS"}],"standard_charges":[{"gross_charge":104.53,"discounted_cash":104.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SEDATIVE HYPNOTICS DEFINITIVE - DRUG DETECT PNL CORDTISS QUAL-ARUP","code_information":[{"code":"3018036808","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80368","type":"HCPCS"}],"standard_charges":[{"gross_charge":104.53,"discounted_cash":104.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TAPENTADOL DEFINITIVE - DRUG DETECT PNL MECONIUM QUAL - ARUP","code_information":[{"code":"3018037203","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80372","type":"HCPCS"}],"standard_charges":[{"gross_charge":78.39,"discounted_cash":78.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TAPENTADOL DEFINITIVE - DRUG DETECT PNL CORDTISS QUAL-ARUP","code_information":[{"code":"3018037204","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80372","type":"HCPCS"}],"standard_charges":[{"gross_charge":78.39,"discounted_cash":78.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TRAMADOL LEVEL URINE","code_information":[{"code":"3018037301","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80373","type":"HCPCS"}],"standard_charges":[{"gross_charge":73.0,"discounted_cash":73.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TRAMADOL DEFINITIVE - DRUG DETECT PNL MECONIUM QUAL - ARUP","code_information":[{"code":"3018037303","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80373","type":"HCPCS"}],"standard_charges":[{"gross_charge":165.0,"discounted_cash":165.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TRAMADOL DEFINITIVE - DRUG DETECT PNL CORDTISS QUAL-ARUP","code_information":[{"code":"3018037304","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80373","type":"HCPCS"}],"standard_charges":[{"gross_charge":165.0,"discounted_cash":165.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DRUG/SUBSTANCE DEFINITIVE QUAL/QUANT NOS 1-3 - BUNDLED CHARGE","code_information":[{"code":"3018037506","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80375","type":"HCPCS"}],"standard_charges":[{"gross_charge":98.0,"discounted_cash":98.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HYPOGLYCEMIA PANEL (SULFONYLUREAS), SERUM OR PLASMA - ARUP","code_information":[{"code":"3018037705","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80377","type":"HCPCS"}],"standard_charges":[{"gross_charge":118.0,"discounted_cash":118.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALPHA GLOBIN HBA2 SEQUENCING AND DELETION","code_information":[{"code":"3018126901","type":"CDM"},{"code":"0301","type":"RC"},{"code":"81269","type":"HCPCS"}],"standard_charges":[{"gross_charge":2167.0,"discounted_cash":2167.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC KETONE BODIES SERUM QUALITATIVE - ACETONE","code_information":[{"code":"3018200901","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82009","type":"HCPCS"}],"standard_charges":[{"gross_charge":37.0,"discounted_cash":37.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC KETONE BODIES SERUM QUANTITATIVE - BETA HYDROXYBUTYRATE","code_information":[{"code":"3018201002","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82010","type":"HCPCS"}],"standard_charges":[{"gross_charge":97.0,"discounted_cash":97.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF ACTH - ACTH","code_information":[{"code":"3018202401","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82024","type":"HCPCS"}],"standard_charges":[{"gross_charge":94.0,"discounted_cash":94.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ACTH LEVEL - ARUP","code_information":[{"code":"3018202403","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82024","type":"HCPCS"}],"standard_charges":[{"gross_charge":94.0,"discounted_cash":94.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALBUMIN LEVEL","code_information":[{"code":"3018204001","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82040","type":"HCPCS"}],"standard_charges":[{"gross_charge":63.0,"discounted_cash":63.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALBUMIN LEVEL SERUM -  IMMUNOGLOBULIN G (IGG) CSF INDEX - ARUP","code_information":[{"code":"3018204003","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82040","type":"HCPCS"}],"standard_charges":[{"gross_charge":63.0,"discounted_cash":63.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALBUMIN LEVEL ARUP OLIGOCLONAL BAND","code_information":[{"code":"3018204004","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82040","type":"HCPCS"}],"standard_charges":[{"gross_charge":63.0,"discounted_cash":63.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALBUMIN LEVEL SERUM - OLIGOCLONAL BAND PROFILE - ARUP","code_information":[{"code":"3018204005","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82040","type":"HCPCS"}],"standard_charges":[{"gross_charge":63.0,"discounted_cash":63.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF URINE ALBUMIN - ALBUMIN BODY FLUID","code_information":[{"code":"3018204201","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82042","type":"HCPCS"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALBUMIN CSF IGG SYNTH -ARUP","code_information":[{"code":"3018204203","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82042","type":"HCPCS"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALBUMIN CSF IGG OLIGOCLONAL BAND PROFILE - ARUP","code_information":[{"code":"3018204204","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82042","type":"HCPCS"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALBUMIN BODY FLUID - ARUP","code_information":[{"code":"3018204207","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82042","type":"HCPCS"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALBUMIN LEVEL CSF - OLIGOCLONAL BAND PROFILE - ARUP","code_information":[{"code":"3018204210","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82042","type":"HCPCS"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALBUMIN LEVEL CSF - IMMUNOGLOBULIN G (IGG) CSF INDEX - ARUP","code_information":[{"code":"3018204211","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82042","type":"HCPCS"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MICROALBUMIN, QUANTITATIVE - MICROALBUMIN 24HR URINE","code_information":[{"code":"3018204301","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82043","type":"HCPCS"}],"standard_charges":[{"gross_charge":103.0,"discounted_cash":103.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MICROALBUMIN, QUANTITATIVE - MICROALBUMIN RANDOM URINE","code_information":[{"code":"3018204302","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82043","type":"HCPCS"}],"standard_charges":[{"gross_charge":111.0,"discounted_cash":111.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MICROALBUMIN, QUANTITATIVE - MICROALBUMIN / CREATININE URINE RATIO","code_information":[{"code":"3018204303","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82043","type":"HCPCS"}],"standard_charges":[{"gross_charge":111.0,"discounted_cash":111.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALBUMIN LEVEL - ALBUMIN / CREATININE RATIO URINE - ARUP","code_information":[{"code":"3018204305","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82043","type":"HCPCS"}],"standard_charges":[{"gross_charge":111.0,"discounted_cash":111.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MICROALBUMIN LEVEL -  MICROALBUMIN/CREATININE RATIO RANDOME URINE MG/DL","code_information":[{"code":"3018204306","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82043","type":"HCPCS"}],"standard_charges":[{"gross_charge":111.0,"discounted_cash":111.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ETHANOL LEVEL","code_information":[{"code":"3018207701","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82077","type":"HCPCS"}],"standard_charges":[{"gross_charge":108.0,"discounted_cash":108.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF ALDOLASE - ALDOLASE","code_information":[{"code":"3018208501","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82085","type":"HCPCS"}],"standard_charges":[{"gross_charge":73.0,"discounted_cash":73.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALDOLASE LEVEL - ARUP","code_information":[{"code":"3018208502","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82085","type":"HCPCS"}],"standard_charges":[{"gross_charge":73.0,"discounted_cash":73.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF ALDOSTERONE - ALDOSTERONE,24HR URINE","code_information":[{"code":"3018208801","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82088","type":"HCPCS"}],"standard_charges":[{"gross_charge":198.0,"discounted_cash":198.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALDOSTERONE LEVEL - ARUP","code_information":[{"code":"3018208802","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82088","type":"HCPCS"}],"standard_charges":[{"gross_charge":198.0,"discounted_cash":198.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALDOSTERONE LEVEL - ALDOSTERONE/RENIN ACTIVITY RATIO - ARUP","code_information":[{"code":"3018208803","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82088","type":"HCPCS"}],"standard_charges":[{"gross_charge":198.0,"discounted_cash":198.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALDOSTERONE INTERNAL SAMPLING - ARUP","code_information":[{"code":"3018208805","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82088","type":"HCPCS"}],"standard_charges":[{"gross_charge":198.0,"discounted_cash":198.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALPHA-1-ANTITRYPSIN TOTAL","code_information":[{"code":"3018210301","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82103","type":"HCPCS"}],"standard_charges":[{"gross_charge":185.0,"discounted_cash":185.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALPHA 1 ANTITRYPSIN STOOL - ARUP","code_information":[{"code":"3018210302","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82103","type":"HCPCS"}],"standard_charges":[{"gross_charge":142.0,"discounted_cash":142.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALPHA-1-ANTITRYPSIN - ARUP","code_information":[{"code":"3018210305","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82103","type":"HCPCS"}],"standard_charges":[{"gross_charge":185.0,"discounted_cash":185.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALPHA 1 ANTITRYPSIN PHENOTYPE - ARUP","code_information":[{"code":"3018210306","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82103","type":"HCPCS"}],"standard_charges":[{"gross_charge":185.0,"discounted_cash":185.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALPHA-1-ANTITRYPSIN TOTAL - A1A PHENOTYPE - ARUP","code_information":[{"code":"3018210307","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82103","type":"HCPCS"}],"standard_charges":[{"gross_charge":185.0,"discounted_cash":185.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALPHA-1-ANTITRYPSIN TOTAL - AIA GENOTYPE - ARUP","code_information":[{"code":"3018210308","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82103","type":"HCPCS"}],"standard_charges":[{"gross_charge":185.0,"discounted_cash":185.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALPHA 1 ANTITRYPSIN PHENOTYPE - A1A PHENOTYPE - ARUP","code_information":[{"code":"3018210403","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82104","type":"HCPCS"}],"standard_charges":[{"gross_charge":269.0,"discounted_cash":269.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALPHA FETOPROTEIN (AFP) TUMOR MARKER","code_information":[{"code":"3018210501","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82105","type":"HCPCS"}],"standard_charges":[{"gross_charge":259.0,"discounted_cash":259.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALPHA FETOPROTEIN MATERNAL SERUM - ARUP","code_information":[{"code":"3018210502","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82105","type":"HCPCS"}],"standard_charges":[{"gross_charge":99.0,"discounted_cash":99.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALPHA FETOPROTEIN (AFP) TUMOR MARKER SERUM - ARUP","code_information":[{"code":"3018210506","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82105","type":"HCPCS"}],"standard_charges":[{"gross_charge":259.0,"discounted_cash":259.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALPHA-FETOPROTEIN L3 - ALPHA FETOPROTEIN, L3 PERCENT","code_information":[{"code":"3018210701","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82107","type":"HCPCS"}],"standard_charges":[{"gross_charge":700.0,"discounted_cash":700.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALPHA FETOPROTEIN (AFP) TOTAL AND L3 PERCENT - ARUP","code_information":[{"code":"3018210702","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82107","type":"HCPCS"}],"standard_charges":[{"gross_charge":700.0,"discounted_cash":700.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF ALUMINUM - ALUMINUM LEVEL","code_information":[{"code":"3018210801","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82108","type":"HCPCS"}],"standard_charges":[{"gross_charge":243.0,"discounted_cash":243.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC AMMONIA LEVEL","code_information":[{"code":"3018214001","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82140","type":"HCPCS"}],"standard_charges":[{"gross_charge":107.0,"discounted_cash":107.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF AMYLASE - AMYLASE BODY FLUID","code_information":[{"code":"3018215001","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82150","type":"HCPCS"}],"standard_charges":[{"gross_charge":218.0,"discounted_cash":218.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC AMYLASE LEVEL","code_information":[{"code":"3018215005","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82150","type":"HCPCS"}],"standard_charges":[{"gross_charge":218.0,"discounted_cash":218.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC AMYLASE LEVEL, BODY FLUID - UCH","code_information":[{"code":"3018215011","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82150","type":"HCPCS"}],"standard_charges":[{"gross_charge":218.0,"discounted_cash":218.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF ANDROSTENEDIONE - ANDROSTENEDIONE","code_information":[{"code":"3018215701","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82157","type":"HCPCS"}],"standard_charges":[{"gross_charge":187.0,"discounted_cash":187.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ANDROSTENEDIONE LEVEL - ARUP","code_information":[{"code":"3018215702","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82157","type":"HCPCS"}],"standard_charges":[{"gross_charge":187.0,"discounted_cash":187.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ANGIOTENSIN I ENZYME TEST - ANGIOTENSIN CONVERTING ENZYME","code_information":[{"code":"3018216401","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82164","type":"HCPCS"}],"standard_charges":[{"gross_charge":85.0,"discounted_cash":85.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ANGIOTENSIN I ENZYME TEST - ANGIOTENSIN CONVERT ENZYME CSF","code_information":[{"code":"3018216402","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82164","type":"HCPCS"}],"standard_charges":[{"gross_charge":85.0,"discounted_cash":85.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ANGIOTENSIN CONVERT ENZYME CSF - ARUP","code_information":[{"code":"3018216403","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82164","type":"HCPCS"}],"standard_charges":[{"gross_charge":85.0,"discounted_cash":85.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ANTI-MULLERIAN HORMONE (AMH) ASSAY","code_information":[{"code":"3018216601","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82166","type":"HCPCS"}],"standard_charges":[{"gross_charge":164.0,"discounted_cash":164.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF APOLIPOPROTEIN - LIPOPROTEIN A (LPA)","code_information":[{"code":"3018217201","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82172","type":"HCPCS"}],"standard_charges":[{"gross_charge":46.0,"discounted_cash":46.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC APOLIPOPROTEIN B100","code_information":[{"code":"3018217202","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82172","type":"HCPCS"}],"standard_charges":[{"gross_charge":235.0,"discounted_cash":235.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC APOLIPOPROTEIN A1 - ARUP","code_information":[{"code":"3018217205","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82172","type":"HCPCS"}],"standard_charges":[{"gross_charge":46.0,"discounted_cash":46.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC APOLIPOPROTEIN B 100 - ARUP","code_information":[{"code":"3018217206","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82172","type":"HCPCS"}],"standard_charges":[{"gross_charge":235.0,"discounted_cash":235.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF ARSENIC - ARSENIC,FRACTIONATION,UR","code_information":[{"code":"3018217502","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82175","type":"HCPCS"}],"standard_charges":[{"gross_charge":211.0,"discounted_cash":211.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF ARSENIC - ARSENIC RANDOM URINE","code_information":[{"code":"3018217503","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82175","type":"HCPCS"}],"standard_charges":[{"gross_charge":211.0,"discounted_cash":211.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ARSENIC URINE HEAVY METALS PANEL 3- ARUP","code_information":[{"code":"3018217504","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82175","type":"HCPCS"}],"standard_charges":[{"gross_charge":211.0,"discounted_cash":211.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ARSENIC LEVEL","code_information":[{"code":"3018217505","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82175","type":"HCPCS"}],"standard_charges":[{"gross_charge":94.0,"discounted_cash":94.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ARSENIC FRACTIONATIONED URINE - ARUP","code_information":[{"code":"3018217508","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82175","type":"HCPCS"}],"standard_charges":[{"gross_charge":248.0,"discounted_cash":248.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ARSENIC LEVEL BLOOD - ARUP","code_information":[{"code":"3018217509","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82175","type":"HCPCS"}],"standard_charges":[{"gross_charge":211.0,"discounted_cash":211.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ARSENIC URINE - HEAVY METALS PANEL 3 - ARUP","code_information":[{"code":"3018217510","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82175","type":"HCPCS"}],"standard_charges":[{"gross_charge":211.0,"discounted_cash":211.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ARSENIC FRACTIONATION URINE REFLEX - ARUP","code_information":[{"code":"3018217511","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82175","type":"HCPCS"}],"standard_charges":[{"gross_charge":248.0,"discounted_cash":248.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF ASCORBIC ACID - VITAMIN C","code_information":[{"code":"3018218001","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82180","type":"HCPCS"}],"standard_charges":[{"gross_charge":70.0,"discounted_cash":70.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC VITAMIN C (ASCORBIC ACID) LEVEL - ARUP","code_information":[{"code":"3018218002","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82180","type":"HCPCS"}],"standard_charges":[{"gross_charge":70.0,"discounted_cash":70.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BETA-2 PROTEIN - BETA 2 MICROGLOBULIN","code_information":[{"code":"3018223202","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82232","type":"HCPCS"}],"standard_charges":[{"gross_charge":189.0,"discounted_cash":189.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BETA 2 MICROGLOBULIN SERUM - ARUP","code_information":[{"code":"3018223205","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82232","type":"HCPCS"}],"standard_charges":[{"gross_charge":189.0,"discounted_cash":189.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BILE ACIDS, TOTAL - BILE ACIDS, TOTAL","code_information":[{"code":"3018223901","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82239","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.0,"discounted_cash":80.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BILIRUBIN TOTAL - BILIRUBIN BODY FLUID","code_information":[{"code":"3018224702","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82247","type":"HCPCS"}],"standard_charges":[{"gross_charge":77.0,"discounted_cash":77.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BILIRUBIN TOTAL","code_information":[{"code":"3018224703","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82247","type":"HCPCS"}],"standard_charges":[{"gross_charge":41.0,"discounted_cash":41.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BILIRUBIN TOTAL BODY FLUID - ARUP","code_information":[{"code":"3018224708","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82247","type":"HCPCS"}],"standard_charges":[{"gross_charge":77.0,"discounted_cash":77.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BILIRUBIN DIRECT","code_information":[{"code":"3018224801","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82248","type":"HCPCS"}],"standard_charges":[{"gross_charge":39.0,"discounted_cash":39.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY BIOTINIDASE - BIOTINIDASE LEVEL","code_information":[{"code":"3018226101","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82261","type":"HCPCS"}],"standard_charges":[{"gross_charge":95.0,"discounted_cash":95.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BLOOD OCCULT,BY PEROXID,FECES,SINGLE, COLORECTAL SCREEN - OCCULT BLD","code_information":[{"code":"3018227001","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82270","type":"HCPCS"}],"standard_charges":[{"gross_charge":73.0,"discounted_cash":73.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OCCULT BLOOD GASTRIC / DUODENUM","code_information":[{"code":"3018227101","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82271","type":"HCPCS"}],"standard_charges":[{"gross_charge":73.0,"discounted_cash":73.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OCCULT BLOOD - OCCULT BLOOD STOOL","code_information":[{"code":"3018227201","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82272","type":"HCPCS"}],"standard_charges":[{"gross_charge":73.0,"discounted_cash":73.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OCCULT BLOOD - 1 TO 3 SIMULTANEOUS TESTS POC","code_information":[{"code":"3018227401","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82274","type":"HCPCS"}],"standard_charges":[{"gross_charge":119.0,"discounted_cash":119.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OCCULT BLOOD FECES SCREENING SPECIMEN #1","code_information":[{"code":"3018227402","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82274","type":"HCPCS"}],"standard_charges":[{"gross_charge":246.0,"discounted_cash":246.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OCCULT BLOOD FECES DIAGNOSTIC SPECIMEN #1","code_information":[{"code":"3018227403","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82274","type":"HCPCS"}],"standard_charges":[{"gross_charge":186.0,"discounted_cash":186.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OCCULT BLOOD BY IMMUNOASSAY, FECES","code_information":[{"code":"3018227404","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82274","type":"HCPCS"}],"standard_charges":[{"gross_charge":119.0,"discounted_cash":119.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF CADMIUM - CADMIUM 24 HR URINE","code_information":[{"code":"3018230001","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82300","type":"HCPCS"}],"standard_charges":[{"gross_charge":289.0,"discounted_cash":289.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CADMIUM LEVEL BLOOD - ARUP","code_information":[{"code":"3018230002","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82300","type":"HCPCS"}],"standard_charges":[{"gross_charge":61.0,"discounted_cash":61.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CADMIUM LEVEL -  PANEL 4 BLOOD ARUP","code_information":[{"code":"3018230003","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82300","type":"HCPCS"}],"standard_charges":[{"gross_charge":61.0,"discounted_cash":61.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CADMIUM LEVEL, RANDOM URINE - ARUP","code_information":[{"code":"3018230004","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82300","type":"HCPCS"}],"standard_charges":[{"gross_charge":289.0,"discounted_cash":289.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC VITAMIN D 25-HYDROXY LEVEL DEFICIENCY","code_information":[{"code":"3018230601","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82306","type":"HCPCS"}],"standard_charges":[{"gross_charge":208.0,"discounted_cash":208.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC VITAMIN D2 AND D3 25 HYDROXY LEVEL - ARUP","code_information":[{"code":"3018230602","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82306","type":"HCPCS"}],"standard_charges":[{"gross_charge":208.0,"discounted_cash":208.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF CALCITONIN - CALCITONIN","code_information":[{"code":"3018230801","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82308","type":"HCPCS"}],"standard_charges":[{"gross_charge":146.0,"discounted_cash":146.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CALCITONIN - ARUP","code_information":[{"code":"3018230802","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82308","type":"HCPCS"}],"standard_charges":[{"gross_charge":146.0,"discounted_cash":146.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CALCIUM TOTAL LEVEL","code_information":[{"code":"3018231001","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82310","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.0,"discounted_cash":80.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF CALCIUM, TOTAL - ADDITIONAL CHARGE","code_information":[{"code":"3018231004","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82310","type":"HCPCS"}],"standard_charges":[{"gross_charge":48.0,"discounted_cash":48.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CALCIUM LEVEL TOTAL -  PTH INTACT WITH CALCIUM - ARUP","code_information":[{"code":"3018231006","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82310","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.0,"discounted_cash":80.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF CALCIUM, IONIZED - CALCIUM IONIZED","code_information":[{"code":"3018233001","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82330","type":"HCPCS"}],"standard_charges":[{"gross_charge":114.0,"discounted_cash":114.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CALCIUM, IONIZED - ARUP","code_information":[{"code":"3018233003","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82330","type":"HCPCS"}],"standard_charges":[{"gross_charge":114.0,"discounted_cash":114.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CALCIUM RANDOM URINE","code_information":[{"code":"3018234001","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82340","type":"HCPCS"}],"standard_charges":[{"gross_charge":93.0,"discounted_cash":93.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CALCIUM TIMED URINE","code_information":[{"code":"3018234002","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82340","type":"HCPCS"}],"standard_charges":[{"gross_charge":93.0,"discounted_cash":93.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CALCIUM SUPERSATURATION PROFILE, URINE - ARUP","code_information":[{"code":"3018234005","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82340","type":"HCPCS"}],"standard_charges":[{"gross_charge":93.0,"discounted_cash":93.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CALCIUM TOTAL URINE - ARUP","code_information":[{"code":"3018234007","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82340","type":"HCPCS"}],"standard_charges":[{"gross_charge":93.0,"discounted_cash":93.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CALCULUS ASSAY,INFRARED SPECTR - KIDNEY STONE ANALYSIS","code_information":[{"code":"3018236501","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82365","type":"HCPCS"}],"standard_charges":[{"gross_charge":64.0,"discounted_cash":64.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CARBOHYDRATE DEFICIENT TRANSFERRIN FOR ALCOHOL USE - ARUP","code_information":[{"code":"3018237302","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82373","type":"HCPCS"}],"standard_charges":[{"gross_charge":433.0,"discounted_cash":433.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CO2 TOTAL BLOOD","code_information":[{"code":"3018237401","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82374","type":"HCPCS"}],"standard_charges":[{"gross_charge":51.0,"discounted_cash":51.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY URINE CARBON DIOXIDE - CO2 TOTAL","code_information":[{"code":"3018237402","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82374","type":"HCPCS"}],"standard_charges":[{"gross_charge":116.0,"discounted_cash":116.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CARBON DIOXIDE (CO2) TOTAL URINE - ARUP","code_information":[{"code":"3018237403","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82374","type":"HCPCS"}],"standard_charges":[{"gross_charge":116.0,"discounted_cash":116.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY BLOOD CARBON MONOXIDE - CARBOXYHEMOGLOBIN","code_information":[{"code":"3018237501","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82375","type":"HCPCS"}],"standard_charges":[{"gross_charge":240.0,"discounted_cash":240.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CARBOXYHEMOGLOBIN QUANT, CO-OX, WHOLE BLOOD - ARUP","code_information":[{"code":"3018237502","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82375","type":"HCPCS"}],"standard_charges":[{"gross_charge":240.0,"discounted_cash":240.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CARCINOEMBRYONIC ANTIGEN (CEA)","code_information":[{"code":"3018237801","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82378","type":"HCPCS"}],"standard_charges":[{"gross_charge":212.0,"discounted_cash":212.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CARCINOEMBRYONIC ANTIGEN (CEA) FLUID - ARUP","code_information":[{"code":"3018237805","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82378","type":"HCPCS"}],"standard_charges":[{"gross_charge":218.0,"discounted_cash":218.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF CARNITINE - CARNITINE","code_information":[{"code":"3018237901","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82379","type":"HCPCS"}],"standard_charges":[{"gross_charge":146.0,"discounted_cash":146.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CARNITINE TOTAL AND FREE - ARUP","code_information":[{"code":"3018237903","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82379","type":"HCPCS"}],"standard_charges":[{"gross_charge":146.0,"discounted_cash":146.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY, THREE CATECHOLAMINES - CATECHOLAMINES FRACTIONATED PL","code_information":[{"code":"3018238402","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82384","type":"HCPCS"}],"standard_charges":[{"gross_charge":210.0,"discounted_cash":210.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CATECHOLAMINES, FRACTIONATED, BY LC-MS/MS - ARUP","code_information":[{"code":"3018238403","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82384","type":"HCPCS"}],"standard_charges":[{"gross_charge":210.0,"discounted_cash":210.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CATECHOLAMINES, FRACTIONATED, PLASMA - ARUP","code_information":[{"code":"3018238405","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82384","type":"HCPCS"}],"standard_charges":[{"gross_charge":210.0,"discounted_cash":210.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF CERULOPLASMIN - CERULOPLASMIN","code_information":[{"code":"3018239001","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82390","type":"HCPCS"}],"standard_charges":[{"gross_charge":94.0,"discounted_cash":94.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CERULOPLASMIN LEVEL - ARUP","code_information":[{"code":"3018239003","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82390","type":"HCPCS"}],"standard_charges":[{"gross_charge":94.0,"discounted_cash":94.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CHEMILUMINESCENT ASSAY - IGF BINDING PROTEIN 3","code_information":[{"code":"3018239702","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82397","type":"HCPCS"}],"standard_charges":[{"gross_charge":141.0,"discounted_cash":141.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CHEMILUMINESCENT ASSAY - MISCELLANEOUS","code_information":[{"code":"3018239704","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82397","type":"HCPCS"}],"standard_charges":[{"gross_charge":249.0,"discounted_cash":249.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CHEMILUMINESCENT ASSAY - ANTIBODIES TO ADALIMUMAB QUANT - ARUP","code_information":[{"code":"3018239709","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82397","type":"HCPCS"}],"standard_charges":[{"gross_charge":217.35,"discounted_cash":217.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CHLORIDE BLOOD","code_information":[{"code":"3018243501","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82435","type":"HCPCS"}],"standard_charges":[{"gross_charge":36.0,"discounted_cash":36.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CHLORIDE URINE TIMED","code_information":[{"code":"3018243601","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82436","type":"HCPCS"}],"standard_charges":[{"gross_charge":36.0,"discounted_cash":36.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CHLORIDE SUPERSATURATION PROFILE, URINE - ARUP","code_information":[{"code":"3018243604","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82436","type":"HCPCS"}],"standard_charges":[{"gross_charge":36.0,"discounted_cash":36.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CHLORIDE URINE RANDOM","code_information":[{"code":"3018243606","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82436","type":"HCPCS"}],"standard_charges":[{"gross_charge":36.0,"discounted_cash":36.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CHLORIDE URINE 24 HOUR TIMED","code_information":[{"code":"3018243607","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82436","type":"HCPCS"}],"standard_charges":[{"gross_charge":36.0,"discounted_cash":36.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY, BLD/SERUM CHOLESTEROL - CHOLESTEROL TOTAL","code_information":[{"code":"3018246502","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82465","type":"HCPCS"}],"standard_charges":[{"gross_charge":34.0,"discounted_cash":34.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY, SERUM CHOLINESTERASE - PSEUDOCHOLINESTERASE PHENOTYPE","code_information":[{"code":"3018248002","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82480","type":"HCPCS"}],"standard_charges":[{"gross_charge":101.0,"discounted_cash":101.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF CHROMIUM - CHROMIUM LEVEL","code_information":[{"code":"3018249501","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82495","type":"HCPCS"}],"standard_charges":[{"gross_charge":97.0,"discounted_cash":97.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CHROMIUM LEVEL - ARUP","code_information":[{"code":"3018249502","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82495","type":"HCPCS"}],"standard_charges":[{"gross_charge":97.0,"discounted_cash":97.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CITRIC ACID - SUPERSATURATION PROFILE - ARUP","code_information":[{"code":"3018250707","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82507","type":"HCPCS"}],"standard_charges":[{"gross_charge":158.0,"discounted_cash":158.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY FOR COLLAGEN CROSS LINKS - COLLAGEN TYPE I CROSSLINK","code_information":[{"code":"3018252301","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82523","type":"HCPCS"}],"standard_charges":[{"gross_charge":208.0,"discounted_cash":208.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY FOR COLLAGEN CROSS LINKS - N-TELOPEPTIDE, URINE","code_information":[{"code":"3018252302","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82523","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.0,"discounted_cash":83.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC C-TELOPEPTIDE, BETA-CROSS -LINKED, SERUM - ARUP","code_information":[{"code":"3018252305","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82523","type":"HCPCS"}],"standard_charges":[{"gross_charge":208.0,"discounted_cash":208.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC N-TELOPEPTIDE, CROSS-LINKED, SERUM - ARUP","code_information":[{"code":"3018252306","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82523","type":"HCPCS"}],"standard_charges":[{"gross_charge":208.0,"discounted_cash":208.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC N TELOPEPTIDE URINE - ARUP","code_information":[{"code":"3018252307","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82523","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.0,"discounted_cash":83.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF COPPER - COPPER RANDOM URINE","code_information":[{"code":"3018252503","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82525","type":"HCPCS"}],"standard_charges":[{"gross_charge":109.0,"discounted_cash":109.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF COPPER - COPPER, SERUM","code_information":[{"code":"3018252504","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82525","type":"HCPCS"}],"standard_charges":[{"gross_charge":109.0,"discounted_cash":109.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CORTISOL, FREE - CORTISOL, FREE","code_information":[{"code":"3018253002","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82530","type":"HCPCS"}],"standard_charges":[{"gross_charge":146.0,"discounted_cash":146.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CORTISOL, FREE - CORTISOL, URINE, FREE","code_information":[{"code":"3018253003","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82530","type":"HCPCS"}],"standard_charges":[{"gross_charge":114.0,"discounted_cash":114.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CORTISOL FREE URINE - ARUP","code_information":[{"code":"3018253005","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82530","type":"HCPCS"}],"standard_charges":[{"gross_charge":114.0,"discounted_cash":114.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CORTISOL TOTAL","code_information":[{"code":"3018253301","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82533","type":"HCPCS"}],"standard_charges":[{"gross_charge":236.0,"discounted_cash":236.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TOTAL CORTISOL - ACTH STIMULATION BASELINE","code_information":[{"code":"3018253302","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82533","type":"HCPCS"}],"standard_charges":[{"gross_charge":236.0,"discounted_cash":236.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TOTAL CORTISOL - ACTH STIMULATION 30 MINUTES","code_information":[{"code":"3018253303","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82533","type":"HCPCS"}],"standard_charges":[{"gross_charge":257.0,"discounted_cash":257.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TOTAL CORTISOL - ACTH STIMULATION 1 HOUR","code_information":[{"code":"3018253304","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82533","type":"HCPCS"}],"standard_charges":[{"gross_charge":257.0,"discounted_cash":257.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TOTAL CORTISOL AM - QWDL","code_information":[{"code":"3018253305","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82533","type":"HCPCS"}],"standard_charges":[{"gross_charge":257.0,"discounted_cash":257.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TOTAL CORTISOL - CORTISOL PM","code_information":[{"code":"3018253306","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82533","type":"HCPCS"}],"standard_charges":[{"gross_charge":257.0,"discounted_cash":257.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CORTISOL SALIVARY - ARUP","code_information":[{"code":"3018253309","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82533","type":"HCPCS"}],"standard_charges":[{"gross_charge":236.0,"discounted_cash":236.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CORTISOL INTERNAL SAMPLING - ARUP","code_information":[{"code":"3018253312","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82533","type":"HCPCS"}],"standard_charges":[{"gross_charge":236.0,"discounted_cash":236.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF CREATINE - CREATINE","code_information":[{"code":"3018254001","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82540","type":"HCPCS"}],"standard_charges":[{"gross_charge":78.0,"discounted_cash":78.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CREATINE LEVEL URINE","code_information":[{"code":"3018254002","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82540","type":"HCPCS"}],"standard_charges":[{"gross_charge":264.0,"discounted_cash":264.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CREATINE LEVEL URINE - ARUP","code_information":[{"code":"3018254004","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82540","type":"HCPCS"}],"standard_charges":[{"gross_charge":264.0,"discounted_cash":264.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC COL-CHR/MS NONDRUG ANALYTE NES QUAL/QUAN EA SPEC COENZYME Q10","code_information":[{"code":"3018254204","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82542","type":"HCPCS"}],"standard_charges":[{"gross_charge":255.0,"discounted_cash":255.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC COL-CHR/MS NONDRUG ANALYTE NES QUAL/QUAN EA SPEC","code_information":[{"code":"3018254206","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82542","type":"HCPCS"}],"standard_charges":[{"gross_charge":530.0,"discounted_cash":530.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC COL-CHR/MS NONDRUG ANALYTE NES QUAL/QUAN EA SPEC PARATHYROID HORMONE RELATED PEPTIDE","code_information":[{"code":"3018254207","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82542","type":"HCPCS"}],"standard_charges":[{"gross_charge":255.0,"discounted_cash":255.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PTH-RELATED PEPTIDE - ARUP","code_information":[{"code":"3018254215","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82542","type":"HCPCS"}],"standard_charges":[{"gross_charge":255.0,"discounted_cash":255.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FATTY ACIDS PROFILE, ESSENTIAL - ARUP","code_information":[{"code":"3018254216","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82542","type":"HCPCS"}],"standard_charges":[{"gross_charge":530.0,"discounted_cash":530.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CK (CPK) TOTAL","code_information":[{"code":"3018255001","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82550","type":"HCPCS"}],"standard_charges":[{"gross_charge":112.0,"discounted_cash":112.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CK (CPK) TOTAL - ARUP","code_information":[{"code":"3018255002","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82550","type":"HCPCS"}],"standard_charges":[{"gross_charge":112.0,"discounted_cash":112.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CREATINE KINASE (CK) TOTAL","code_information":[{"code":"3018255006","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82550","type":"HCPCS"}],"standard_charges":[{"gross_charge":112.0,"discounted_cash":112.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CREATINE KINASE (CPK) TOTAL - CK ISOENZYMES - ARUP","code_information":[{"code":"3018255008","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82550","type":"HCPCS"}],"standard_charges":[{"gross_charge":112.0,"discounted_cash":112.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CPK ISOENZYMES","code_information":[{"code":"3018255201","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82552","type":"HCPCS"}],"standard_charges":[{"gross_charge":106.0,"discounted_cash":106.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CREATINE KINASE ISOENZYMES - CK ISOENZYMES - ARUP","code_information":[{"code":"3018255202","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82552","type":"HCPCS"}],"standard_charges":[{"gross_charge":106.0,"discounted_cash":106.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CREATINE, MB FRACTION - CKMB","code_information":[{"code":"3018255302","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82553","type":"HCPCS"}],"standard_charges":[{"gross_charge":97.0,"discounted_cash":97.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CREATINE, MB FRACTION - CKMB - ARUP","code_information":[{"code":"3018255303","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82553","type":"HCPCS"}],"standard_charges":[{"gross_charge":97.0,"discounted_cash":97.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CREATININE LEVEL","code_information":[{"code":"3018256501","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82565","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":65.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CREATININE, EGFR - CYSTATIN, CREATININE, EGFR - ARUP","code_information":[{"code":"3018256504","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82565","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":65.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CREATININE LEVEL RANDOM URINE","code_information":[{"code":"3018257001","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82570","type":"HCPCS"}],"standard_charges":[{"gross_charge":205.0,"discounted_cash":205.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF URINE CREATININE - CREATININE, URINE, 24 HOUR","code_information":[{"code":"3018257004","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82570","type":"HCPCS"}],"standard_charges":[{"gross_charge":205.0,"discounted_cash":205.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CREATININE LEVEL BODY FLUID","code_information":[{"code":"3018257005","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82570","type":"HCPCS"}],"standard_charges":[{"gross_charge":104.0,"discounted_cash":104.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CREATININE LEVEL BODY FLUID - ARUP","code_information":[{"code":"3018257010","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82570","type":"HCPCS"}],"standard_charges":[{"gross_charge":104.0,"discounted_cash":104.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CREATININE LEVEL - ALBUMIN / CREATININE RATIO URINE - ARUP","code_information":[{"code":"3018257011","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82570","type":"HCPCS"}],"standard_charges":[{"gross_charge":205.0,"discounted_cash":205.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CREATININE LEVEL - MICROALBUMIN/CREATININE RATIO RANDOME URINE MG/DL","code_information":[{"code":"3018257012","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82570","type":"HCPCS"}],"standard_charges":[{"gross_charge":111.0,"discounted_cash":111.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CREATININE LEVEL URINE 24 HOUR","code_information":[{"code":"3018257017","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82570","type":"HCPCS"}],"standard_charges":[{"gross_charge":205.0,"discounted_cash":205.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CREATININE LEVEL - PROTEIN/CREATININE RATIO URINE","code_information":[{"code":"3018257018","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82570","type":"HCPCS"}],"standard_charges":[{"gross_charge":205.0,"discounted_cash":205.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CREATININE CLEARANCE URINE 24 HOUR","code_information":[{"code":"3018257501","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82575","type":"HCPCS"}],"standard_charges":[{"gross_charge":123.0,"discounted_cash":123.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF CRYOGLOBULIN - CRYOGLOBULIN","code_information":[{"code":"3018259501","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82595","type":"HCPCS"}],"standard_charges":[{"gross_charge":123.0,"discounted_cash":123.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC VITAMIN B12 LEVEL","code_information":[{"code":"3018260701","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82607","type":"HCPCS"}],"standard_charges":[{"gross_charge":123.0,"discounted_cash":123.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CYSTATIN C","code_information":[{"code":"3018261001","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82610","type":"HCPCS"}],"standard_charges":[{"gross_charge":131.0,"discounted_cash":131.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CYSTATIN C, WITH REFLEX - ARUP","code_information":[{"code":"3018261002","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82610","type":"HCPCS"}],"standard_charges":[{"gross_charge":131.0,"discounted_cash":131.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CYSTATIN - CYSTATIN, CREATININE, EGFR - ARUP","code_information":[{"code":"3018261003","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82610","type":"HCPCS"}],"standard_charges":[{"gross_charge":131.0,"discounted_cash":131.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DEHYDROEPIANDROSTERONE - DHEA","code_information":[{"code":"3018262601","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82626","type":"HCPCS"}],"standard_charges":[{"gross_charge":121.0,"discounted_cash":121.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DEHYDROEPIANDROSTERONE (DHEA) - ARUP","code_information":[{"code":"3018262602","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82626","type":"HCPCS"}],"standard_charges":[{"gross_charge":121.0,"discounted_cash":121.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DEHYDROEPIANDROSTERONE-SULFATE - DHEA-SULFATE","code_information":[{"code":"3018262701","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82627","type":"HCPCS"}],"standard_charges":[{"gross_charge":153.0,"discounted_cash":153.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DEHYDROEPIANDROSTERONE SULFATE (DHEA) SULFATE - ARUP","code_information":[{"code":"3018262703","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82627","type":"HCPCS"}],"standard_charges":[{"gross_charge":153.0,"discounted_cash":153.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CHOLINESTERASE AND DIBUCAINE NUMBER","code_information":[{"code":"3018263802","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82638","type":"HCPCS"}],"standard_charges":[{"gross_charge":104.0,"discounted_cash":104.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DIHYDROTESTOSTERONE","code_information":[{"code":"3018264201","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82642","type":"HCPCS"}],"standard_charges":[{"gross_charge":266.0,"discounted_cash":266.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC 5 A DIHYDROTESTOSTERONE - ARUP","code_information":[{"code":"3018264202","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82642","type":"HCPCS"}],"standard_charges":[{"gross_charge":266.0,"discounted_cash":266.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY, DIHYDROXYVITAMIN D W/FRACTIONS, IF PERFORMED - VITAMIN D 1","code_information":[{"code":"3018265201","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82652","type":"HCPCS"}],"standard_charges":[{"gross_charge":223.0,"discounted_cash":223.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC VITAMIN D 1,25 DIHYDROXY - ARUP","code_information":[{"code":"3018265202","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82652","type":"HCPCS"}],"standard_charges":[{"gross_charge":223.0,"discounted_cash":223.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PANCREATIC ELASTASE, FECAL, QUANT","code_information":[{"code":"3018265301","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82653","type":"HCPCS"}],"standard_charges":[{"gross_charge":202.0,"discounted_cash":202.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PANCREATIC ELASTASE STOOL QUANT - ARUP","code_information":[{"code":"3018265302","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82653","type":"HCPCS"}],"standard_charges":[{"gross_charge":202.0,"discounted_cash":202.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ENZYME ACTIVITY NOS ALPHA GALACTOSIDASE","code_information":[{"code":"3018265702","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82657","type":"HCPCS"}],"standard_charges":[{"gross_charge":357.0,"discounted_cash":357.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PORPHOBILINOGEN DEAMINASE RBC - ARUP","code_information":[{"code":"3018265709","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82657","type":"HCPCS"}],"standard_charges":[{"gross_charge":305.0,"discounted_cash":305.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CHYLOMICRONS FLUID","code_information":[{"code":"3018266404","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82664","type":"HCPCS"}],"standard_charges":[{"gross_charge":166.92,"discounted_cash":166.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF ERYTHROPOIETIN - ERYTHROPOIETIN","code_information":[{"code":"3018266801","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82668","type":"HCPCS"}],"standard_charges":[{"gross_charge":97.0,"discounted_cash":97.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ERYTHROPOIETIN LEVEL - ARUP","code_information":[{"code":"3018266802","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82668","type":"HCPCS"}],"standard_charges":[{"gross_charge":97.0,"discounted_cash":97.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF ESTRADIOL - ESTRADIOL","code_information":[{"code":"3018267001","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82670","type":"HCPCS"}],"standard_charges":[{"gross_charge":405.0,"discounted_cash":405.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ESTRADIOL LEVEL PEDIATRICS","code_information":[{"code":"3018267002","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82670","type":"HCPCS"}],"standard_charges":[{"gross_charge":128.0,"discounted_cash":128.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ESTRADIOL LEVEL - FEMALE ADULT PREMENOPAUSE - ARUP","code_information":[{"code":"3018267003","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82670","type":"HCPCS"}],"standard_charges":[{"gross_charge":405.0,"discounted_cash":405.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ESTRADIOL MALE, CHILD, POST-MENOPAUSE FEMALE BY MASS SPEC - ARUP","code_information":[{"code":"3018267004","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82670","type":"HCPCS"}],"standard_charges":[{"gross_charge":405.0,"discounted_cash":405.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF ESTROGENS - ESTROGENS, FRACTIONATED","code_information":[{"code":"3018267101","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82671","type":"HCPCS"}],"standard_charges":[{"gross_charge":89.0,"discounted_cash":89.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ESTROGENS FRACTIONATED - ARUP","code_information":[{"code":"3018267102","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82671","type":"HCPCS"}],"standard_charges":[{"gross_charge":89.0,"discounted_cash":89.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF ESTRIOL - ADDITIONAL CHARGE","code_information":[{"code":"3018267701","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82677","type":"HCPCS"}],"standard_charges":[{"gross_charge":195.0,"discounted_cash":195.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ESTRIOL LEVEL - ARUP","code_information":[{"code":"3018267703","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82677","type":"HCPCS"}],"standard_charges":[{"gross_charge":195.0,"discounted_cash":195.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF ESTRONE - ESTRONE","code_information":[{"code":"3018267902","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82679","type":"HCPCS"}],"standard_charges":[{"gross_charge":121.0,"discounted_cash":121.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ESTRONE LEVEL - ARUP","code_information":[{"code":"3018267903","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82679","type":"HCPCS"}],"standard_charges":[{"gross_charge":121.0,"discounted_cash":121.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY DIRECT MEASURE FREE - ESTRADIOL","code_information":[{"code":"3018268101","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82681","type":"HCPCS"}],"standard_charges":[{"gross_charge":82.0,"discounted_cash":82.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ESTRADIOL FREE - ARUP","code_information":[{"code":"3018268102","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82681","type":"HCPCS"}],"standard_charges":[{"gross_charge":82.0,"discounted_cash":82.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF ETHYLENE GLYCOL - ETHYLENE GLYCOL","code_information":[{"code":"3018269301","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82693","type":"HCPCS"}],"standard_charges":[{"gross_charge":95.0,"discounted_cash":95.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FECAL FAT QUAL","code_information":[{"code":"3018270501","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82705","type":"HCPCS"}],"standard_charges":[{"gross_charge":162.0,"discounted_cash":162.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FECAL FAT QUAL - ARUP","code_information":[{"code":"3018270502","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82705","type":"HCPCS"}],"standard_charges":[{"gross_charge":162.0,"discounted_cash":162.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FERRITIN LEVEL","code_information":[{"code":"3018272801","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82728","type":"HCPCS"}],"standard_charges":[{"gross_charge":66.0,"discounted_cash":66.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC NON-ALCOHOLIC FATTY LIVER DISEASE PANEL - FERRITIN","code_information":[{"code":"3018272802","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82728","type":"HCPCS"}],"standard_charges":[{"gross_charge":66.0,"discounted_cash":66.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FETAL FIBRONECTIN","code_information":[{"code":"3018273101","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82731","type":"HCPCS"}],"standard_charges":[{"gross_charge":678.0,"discounted_cash":678.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FOLATE LEVEL SERUM","code_information":[{"code":"3018274601","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82746","type":"HCPCS"}],"standard_charges":[{"gross_charge":107.0,"discounted_cash":107.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FOLATE RBC LEVEL","code_information":[{"code":"3018274701","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82747","type":"HCPCS"}],"standard_charges":[{"gross_charge":133.0,"discounted_cash":133.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FOLATE RBC LEVEL - ARUP","code_information":[{"code":"3018274702","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82747","type":"HCPCS"}],"standard_charges":[{"gross_charge":133.0,"discounted_cash":133.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF GAMMAGLOBULIN IGA, IGD, IGG, IGM, EACH - IMMUNOGLOBULINS","code_information":[{"code":"3018278401","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":102.0,"discounted_cash":102.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF GAMMAGLOBULIN IGA, IGD, IGG, IGM, EACH - IGG","code_information":[{"code":"3018278402","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":102.0,"discounted_cash":102.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF GAMMAGLOBULIN IGA, IGD, IGG, IGM, EACH - IGM","code_information":[{"code":"3018278403","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":102.0,"discounted_cash":102.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF GAMMAGLOBULIN IGA, IGD, IGG, IGM, EACH - IGA","code_information":[{"code":"3018278404","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":102.0,"discounted_cash":102.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF GAMMAGLOBULIN IGA, IGD, IGG, IGM, EACH - CELIAC REFLEX PNL","code_information":[{"code":"3018278407","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":109.0,"discounted_cash":109.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IGG LEVEL SERUM/CSF IGG SYNTH - ARUP","code_information":[{"code":"3018278408","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":102.0,"discounted_cash":102.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IMMUNOGLOBULIN G CSF","code_information":[{"code":"3018278410","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":102.0,"discounted_cash":102.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IGG LEVEL SERUM/CSF OLIGOCLONAL BAND PROFILE - ARUP","code_information":[{"code":"3018278416","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":102.0,"discounted_cash":102.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IMMUNOGLOBULIN G (IGG) CSF - ARUP","code_information":[{"code":"3018278421","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":102.0,"discounted_cash":102.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IMMUNOGLOBULIN M (IGM) - IMMUNOGLOBULINS IGG IGA IGM QUANTITATIVE - ARUP","code_information":[{"code":"3018278422","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":102.0,"discounted_cash":102.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IMMUNOGLOBULIN G (IGG) - IMMUNOGLOBULINS IGG IGA IGM QUANTITATIVE - ARUP","code_information":[{"code":"3018278423","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":102.0,"discounted_cash":102.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IMMUNOGLOBULIN A (IGA) - IMMUNOGLOBULINS IGG, IGA, IGM - ARUP","code_information":[{"code":"3018278424","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":102.0,"discounted_cash":102.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IMMUNOGLOBULIN A (IGA) - CELIAC DISEASE REFLEX CASCADE - ARUP","code_information":[{"code":"3018278430","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":109.0,"discounted_cash":109.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IMMUNOGLOBULIN D SERUM - ARUP","code_information":[{"code":"3018278431","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":102.0,"discounted_cash":102.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IMMUNOGLOBULIN G(IGG)-IMMUNOGLOBULINS CRYOPRECIPITINS REFLEX SERUM- ARUP","code_information":[{"code":"3018278432","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":102.0,"discounted_cash":102.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IMMUNOGLOBULIN M(IGM)-IMMUNOGLOBULINS CRYOPRECIPITINS REFLEX SERUM- ARUP","code_information":[{"code":"3018278433","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":102.0,"discounted_cash":102.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IMMUNOGLOBULIN A(IGA)-IMMUNOGLOBULINS CRYOPRECIPITINS REFLEX SERUM- ARUP","code_information":[{"code":"3018278434","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":102.0,"discounted_cash":102.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IMMUNOGLOBULIN G (IGG) - ARUP","code_information":[{"code":"3018278436","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":102.0,"discounted_cash":102.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IMMUNOGLOBULIN M (IGM) - ARUP","code_information":[{"code":"3018278439","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":102.0,"discounted_cash":102.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IMMUNOGLOBULIN A (IGA) - ARUP","code_information":[{"code":"3018278443","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":102.0,"discounted_cash":102.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IMMUNOGLOBULIN G (IGG) CSF - OLIGOCLONAL BAND PROFILE - ARUP","code_information":[{"code":"3018278444","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":102.0,"discounted_cash":102.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IMMUNOGLOBULIN G (IGG) - OLIGOCLONAL BAND PROFILE CSF - ARUP","code_information":[{"code":"3018278445","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":102.0,"discounted_cash":102.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IMMUNOGLOBULIN G (IGG) - OLIGOCLONAL BAND PROFILE SERUM - ARUP","code_information":[{"code":"3018278446","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":102.0,"discounted_cash":102.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IGG - IMMUNOGLOBULIN G (IGG) CSF INDEX - ARUP","code_information":[{"code":"3018278448","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":102.0,"discounted_cash":102.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IMMUNOGLOBULIN E - IGE","code_information":[{"code":"3018278501","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82785","type":"HCPCS"}],"standard_charges":[{"gross_charge":102.0,"discounted_cash":102.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IMMUNOGLOBULIN E (IGE) - ARUP","code_information":[{"code":"3018278503","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82785","type":"HCPCS"}],"standard_charges":[{"gross_charge":102.0,"discounted_cash":102.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IGG1, 2, 3 OR 4, EACH - IGG 1","code_information":[{"code":"3018278701","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82787","type":"HCPCS"}],"standard_charges":[{"gross_charge":56.0,"discounted_cash":56.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IGG1, 2, 3 OR 4, EACH - IGG 2","code_information":[{"code":"3018278702","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82787","type":"HCPCS"}],"standard_charges":[{"gross_charge":56.0,"discounted_cash":56.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IGG1, 2, 3 OR 4, EACH - IGG 3","code_information":[{"code":"3018278703","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82787","type":"HCPCS"}],"standard_charges":[{"gross_charge":56.0,"discounted_cash":56.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IGG1, 2, 3 OR 4, EACH - IGG 4","code_information":[{"code":"3018278704","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82787","type":"HCPCS"}],"standard_charges":[{"gross_charge":56.0,"discounted_cash":56.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IMMUNOGLOBULIN A SUBCLASSES","code_information":[{"code":"3018278706","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82787","type":"HCPCS"}],"standard_charges":[{"gross_charge":94.0,"discounted_cash":94.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IMMUNOGLOBULIN G SUBCLASSES 1 - 4 (ARUP)","code_information":[{"code":"3018278710","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82787","type":"HCPCS"}],"standard_charges":[{"gross_charge":56.0,"discounted_cash":56.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IMMUNOGLOBULIN G SUBCLASS 4 (IGG4) (ARUP)","code_information":[{"code":"3018278715","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82787","type":"HCPCS"}],"standard_charges":[{"gross_charge":56.0,"discounted_cash":56.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BLOOD PH - PH VENOUS","code_information":[{"code":"3018280001","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82800","type":"HCPCS"}],"standard_charges":[{"gross_charge":170.0,"discounted_cash":170.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BLOOD PH - PH CORD","code_information":[{"code":"3018280002","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82800","type":"HCPCS"}],"standard_charges":[{"gross_charge":194.0,"discounted_cash":194.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PH VENOUS","code_information":[{"code":"3018280006","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82800","type":"HCPCS"}],"standard_charges":[{"gross_charge":170.0,"discounted_cash":170.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BLOOD GASES: PH, PO2 & PCO2 - BLOOD GAS CORD VENOUS","code_information":[{"code":"3018280302","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82803","type":"HCPCS"}],"standard_charges":[{"gross_charge":503.0,"discounted_cash":503.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BLOOD GASES: PH, PO2 & PCO2 - BLOOD GAS VENOUS","code_information":[{"code":"3018280304","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82803","type":"HCPCS"}],"standard_charges":[{"gross_charge":503.0,"discounted_cash":503.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BLOOD GASES: PH, PO2 & PCO2 - BLOOD GAS CORD ARTERIAL","code_information":[{"code":"3018280305","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82803","type":"HCPCS"}],"standard_charges":[{"gross_charge":503.0,"discounted_cash":503.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BLOOD GAS CORD BLOOD","code_information":[{"code":"3018280310","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82803","type":"HCPCS"}],"standard_charges":[{"gross_charge":503.0,"discounted_cash":503.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BLOOD GAS CORD VENOUS","code_information":[{"code":"3018280324","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82803","type":"HCPCS"}],"standard_charges":[{"gross_charge":503.0,"discounted_cash":503.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BLOOD GAS VENOUS","code_information":[{"code":"3018280325","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82803","type":"HCPCS"}],"standard_charges":[{"gross_charge":503.0,"discounted_cash":503.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BLOOD GASES, O2 SAT ONLY - OXYGEN SATURATION, ARTERIAL","code_information":[{"code":"3018281001","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82810","type":"HCPCS"}],"standard_charges":[{"gross_charge":194.0,"discounted_cash":194.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF GASTRIN - GASTRIN","code_information":[{"code":"3018294101","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82941","type":"HCPCS"}],"standard_charges":[{"gross_charge":119.0,"discounted_cash":119.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GASTRIN LEVEL - ARUP","code_information":[{"code":"3018294102","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82941","type":"HCPCS"}],"standard_charges":[{"gross_charge":119.0,"discounted_cash":119.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GLUCAGON LEVEL - ARUP","code_information":[{"code":"3018294302","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82943","type":"HCPCS"}],"standard_charges":[{"gross_charge":56.0,"discounted_cash":56.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY GLUCOSE, BODY FLUID - GLUCOSE CSF","code_information":[{"code":"3018294501","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82945","type":"HCPCS"}],"standard_charges":[{"gross_charge":111.0,"discounted_cash":111.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GLUCOSE BODY FLUID","code_information":[{"code":"3018294502","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82945","type":"HCPCS"}],"standard_charges":[{"gross_charge":111.0,"discounted_cash":111.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY QUANTITATIVE,BLOOD GLUCOSE - POCT GLUCOMETER","code_information":[{"code":"3018294701","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82947","type":"HCPCS"}],"standard_charges":[{"gross_charge":26.0,"discounted_cash":26.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GLUCOSE LEVEL FASTING","code_information":[{"code":"3018294703","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82947","type":"HCPCS"}],"standard_charges":[{"gross_charge":82.0,"discounted_cash":82.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GLUCOSE LEVEL","code_information":[{"code":"3018294704","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82947","type":"HCPCS"}],"standard_charges":[{"gross_charge":94.0,"discounted_cash":94.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY QUANTITATIVE,BLOOD GLUCOSE - GLUCOSE","code_information":[{"code":"3018294706","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82947","type":"HCPCS"}],"standard_charges":[{"gross_charge":82.0,"discounted_cash":82.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC NON ALCOHOLIC FATTY LIVER DISEASE PANEL - GLUCOSE","code_information":[{"code":"3018294708","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82947","type":"HCPCS"}],"standard_charges":[{"gross_charge":82.0,"discounted_cash":82.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GLUCOSE TOLERANCE TEST (GTT) 1 HOUR SPECIMEN","code_information":[{"code":"3018295001","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82950","type":"HCPCS"}],"standard_charges":[{"gross_charge":77.0,"discounted_cash":77.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GLUCOSE TEST - POST GLUCOSE DOSE","code_information":[{"code":"3018295007","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82950","type":"HCPCS"}],"standard_charges":[{"gross_charge":73.0,"discounted_cash":73.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GLUCOSE TOLERANCE TEST (GTT) FIRST 3 SPECIMENS, 2 HOUR GTT","code_information":[{"code":"3018295101","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82951","type":"HCPCS"}],"standard_charges":[{"gross_charge":209.0,"discounted_cash":209.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GLUCOSE TOLERANCE TEST (GTT) FIRST 3 SPECIMENS","code_information":[{"code":"3018295102","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82951","type":"HCPCS"}],"standard_charges":[{"gross_charge":207.0,"discounted_cash":207.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GLUCOSE TOLERANCE TEST (GTT) 3 HOUR SPECIMEN","code_information":[{"code":"3018295201","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82952","type":"HCPCS"}],"standard_charges":[{"gross_charge":61.0,"discounted_cash":61.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GLUCOSE TOLERANCE TEST (GTT) EACH ADDITIONAL SPECIMEN","code_information":[{"code":"3018295204","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82952","type":"HCPCS"}],"standard_charges":[{"gross_charge":56.0,"discounted_cash":56.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF G6PD ENZYME - GLUCOSE 6 PHOSPHATE DEHYDROGENASE","code_information":[{"code":"3018295501","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82955","type":"HCPCS"}],"standard_charges":[{"gross_charge":66.0,"discounted_cash":66.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GLUCOSE 6 PHOSPHATE DEHYDROGENASE - ARUP","code_information":[{"code":"3018295502","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82955","type":"HCPCS"}],"standard_charges":[{"gross_charge":66.0,"discounted_cash":66.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GLUCOSE BLOOD TEST WITH DEVICE - POCT GLUCOSE","code_information":[{"code":"3018296201","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82962","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":24.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GAMMA GT LEVEL","code_information":[{"code":"3018297701","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82977","type":"HCPCS"}],"standard_charges":[{"gross_charge":123.0,"discounted_cash":123.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC LIVER FIBROSIS PANEL - GGT","code_information":[{"code":"3018297703","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82977","type":"HCPCS"}],"standard_charges":[{"gross_charge":68.0,"discounted_cash":68.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GAMMA GT - ARUP","code_information":[{"code":"3018297704","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82977","type":"HCPCS"}],"standard_charges":[{"gross_charge":123.0,"discounted_cash":123.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GGT - LIVER FIBROSIS CHRONIC VIRAL HEPATITIS FIBROMETER PANEL - ARUP","code_information":[{"code":"3018297705","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82977","type":"HCPCS"}],"standard_charges":[{"gross_charge":68.0,"discounted_cash":68.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GLUTATHIONE","code_information":[{"code":"3018297801","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82978","type":"HCPCS"}],"standard_charges":[{"gross_charge":199.0,"discounted_cash":199.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GLYCATED PROTEIN - FRUCTOSAMINE","code_information":[{"code":"3018298504","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82985","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.0,"discounted_cash":80.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FRUCTOSAMINE LEVEL - ARUP","code_information":[{"code":"3018298505","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82985","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.0,"discounted_cash":80.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GONADOTROPIN (FSH) - FSH","code_information":[{"code":"3018300101","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83001","type":"HCPCS"}],"standard_charges":[{"gross_charge":208.0,"discounted_cash":208.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FOLLICLE STIMULATING HORMONE (FSH) - ARUP","code_information":[{"code":"3018300104","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83001","type":"HCPCS"}],"standard_charges":[{"gross_charge":208.0,"discounted_cash":208.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC LUTEINIZING HORMONE LEVEL","code_information":[{"code":"3018300201","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83002","type":"HCPCS"}],"standard_charges":[{"gross_charge":207.0,"discounted_cash":207.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC LUTEINIZING HORMONE LEVEL - ARUP","code_information":[{"code":"3018300206","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83002","type":"HCPCS"}],"standard_charges":[{"gross_charge":207.0,"discounted_cash":207.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY GROWTH HORMONE (HGH) - GROWTH HORMONE","code_information":[{"code":"3018300301","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83003","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.0,"discounted_cash":87.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HAPTOGLOBIN LEVEL","code_information":[{"code":"3018301001","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83010","type":"HCPCS"}],"standard_charges":[{"gross_charge":147.0,"discounted_cash":147.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HAPTOGLOBIN LEVEL - ARUP","code_information":[{"code":"3018301003","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83010","type":"HCPCS"}],"standard_charges":[{"gross_charge":147.0,"discounted_cash":147.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC H. PYLORI;BREATH TEST, NON-ISOTOPE - H PYLORI BREATH TEST","code_information":[{"code":"3018301301","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83013","type":"HCPCS"}],"standard_charges":[{"gross_charge":489.0,"discounted_cash":489.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC H PYLORI BREATH TEST - ARUP","code_information":[{"code":"3018301304","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83013","type":"HCPCS"}],"standard_charges":[{"gross_charge":489.0,"discounted_cash":489.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC QUANTITATIVE SCREEN, METALS - COBALT","code_information":[{"code":"3018301801","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83018","type":"HCPCS"}],"standard_charges":[{"gross_charge":180.0,"discounted_cash":180.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC QUANTITATIVE SCREEN, METALS - OTHER","code_information":[{"code":"3018301810","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83018","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":300.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC QUANTITATIVE SCREEN, METALS - IODINE","code_information":[{"code":"3018301811","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83018","type":"HCPCS"}],"standard_charges":[{"gross_charge":244.0,"discounted_cash":244.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC COBALT LEVEL SERUM/PLASMA - ARUP","code_information":[{"code":"3018301815","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83018","type":"HCPCS"}],"standard_charges":[{"gross_charge":180.0,"discounted_cash":180.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IODINE LEVEL QUANT RANDOM OR 24HR URINE - ARUP","code_information":[{"code":"3018301821","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83018","type":"HCPCS"}],"standard_charges":[{"gross_charge":244.0,"discounted_cash":244.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IODINE LEVEL, QUANTITATIVE, SERUM - ARUP","code_information":[{"code":"3018301824","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83018","type":"HCPCS"}],"standard_charges":[{"gross_charge":244.0,"discounted_cash":244.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HEMOGLOBIN ELECTROPHORESIS","code_information":[{"code":"3018302001","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83020","type":"HCPCS"}],"standard_charges":[{"gross_charge":95.0,"discounted_cash":95.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CAPILLARY HEMOGLOBIN ELECTROPHORESIS - ARUP","code_information":[{"code":"3018302005","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83020","type":"HCPCS"}],"standard_charges":[{"gross_charge":95.0,"discounted_cash":95.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HEMOGLOBIN F EVALUATION BY HPLC W/REFLEX - ARUP","code_information":[{"code":"3018302101","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83021","type":"HCPCS"}],"standard_charges":[{"gross_charge":155.0,"discounted_cash":155.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HEMOGLOBIN A2 AND F BY COLUMN CHROMATOGRAPHY W/REFLEX - ARUP","code_information":[{"code":"3018302103","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83021","type":"HCPCS"}],"standard_charges":[{"gross_charge":155.0,"discounted_cash":155.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HEMOGLOBIN S EVALUATION BY HPLC W/REFLEX - ARUP","code_information":[{"code":"3018302104","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83021","type":"HCPCS"}],"standard_charges":[{"gross_charge":155.0,"discounted_cash":155.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HEMOGLOBIN FRACTIONATION & QUANTITATION BY HPLC WITH REFLEX - ARUP","code_information":[{"code":"3018302105","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83021","type":"HCPCS"}],"standard_charges":[{"gross_charge":155.0,"discounted_cash":155.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GLYCOSYLATED HEMOGLOBIN TEST - HEMOGLOBIN A1C","code_information":[{"code":"3018303601","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83036","type":"HCPCS"}],"standard_charges":[{"gross_charge":184.0,"discounted_cash":184.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GLYCOSYLATED HEMOGLOBIN TEST - GLYCATED HEMOGLOBIN REFERRED","code_information":[{"code":"3018303603","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83036","type":"HCPCS"}],"standard_charges":[{"gross_charge":104.0,"discounted_cash":104.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BLOOD METHEMOGLOBIN, QUANT - METHEMOGLOBIN","code_information":[{"code":"3018305001","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83050","type":"HCPCS"}],"standard_charges":[{"gross_charge":140.0,"discounted_cash":140.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HEMOSIDERIN LEVEL QUALITATIVE URINE","code_information":[{"code":"3018307001","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83070","type":"HCPCS"}],"standard_charges":[{"gross_charge":44.0,"discounted_cash":44.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF HISTAMINE - HISTAMINE","code_information":[{"code":"3018308801","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83088","type":"HCPCS"}],"standard_charges":[{"gross_charge":141.0,"discounted_cash":141.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HOMOCYSTEINE LEVEL","code_information":[{"code":"3018309002","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83090","type":"HCPCS"}],"standard_charges":[{"gross_charge":271.0,"discounted_cash":271.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HOMOCYSTEINE LEVEL - ARUP","code_information":[{"code":"3018309004","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83090","type":"HCPCS"}],"standard_charges":[{"gross_charge":271.0,"discounted_cash":271.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC 17 OH CORTICOSTEROIDS URINE - ARUP","code_information":[{"code":"3018349103","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83491","type":"HCPCS"}],"standard_charges":[{"gross_charge":166.0,"discounted_cash":166.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC 5 HIAA QUANT URINE RANDOM - ARUP","code_information":[{"code":"3018349702","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83497","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.0,"discounted_cash":132.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF PROGESTERONE 17-D - 17-HYDROXYPROGESTERONE","code_information":[{"code":"3018349801","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83498","type":"HCPCS"}],"standard_charges":[{"gross_charge":131.0,"discounted_cash":131.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC 17 HYDROXYPROGESTERONE - ARUP","code_information":[{"code":"3018349803","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83498","type":"HCPCS"}],"standard_charges":[{"gross_charge":131.0,"discounted_cash":131.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IMMUNOASSAY NONANTIBODY - ANTIMULLERIAN HORMONE (AMH)","code_information":[{"code":"3018351607","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":164.0,"discounted_cash":164.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IMMUNOASSAY NONANTIBODY - CELIAC DISEASE - DEAMINATED GLIADIN PEPTIDE, EACH","code_information":[{"code":"3018351610","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":135.0,"discounted_cash":135.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IMMUNOASSAY NONINFECTIOUS ANALYTE","code_information":[{"code":"3018351611","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":119.0,"discounted_cash":119.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SERINE PROTEASE 3 ANTIBODY IGG","code_information":[{"code":"3018351612","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.0,"discounted_cash":38.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IMMUNOASSAY NONINFECTIOUS ANALYTE - HISTONE ANTIBODY","code_information":[{"code":"3018351613","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":128.0,"discounted_cash":128.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IMMUNOASSAY NONINFECTIOUS ANALYTE - CENTROMERE ANTIBODY IGG","code_information":[{"code":"3018351618","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":117.0,"discounted_cash":117.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IMMUNOASSAY NONINFECTIOUS ANALYTE - CHROMATIN ANTIBODY IGG","code_information":[{"code":"3018351619","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":166.0,"discounted_cash":166.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IMMUNOASSAY NONINFECTIOUS ANALYTE - GLOMERULAR BASEMENT MEMBRANE ANTIBODY IGG","code_information":[{"code":"3018351620","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":129.0,"discounted_cash":129.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MYELOPEROXIDASE ANTIBODY IGG","code_information":[{"code":"3018351621","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":135.0,"discounted_cash":135.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IMMUNOASSAY NONINFECTIOUS ANALYTE - GM1 GANGLIOSIDE ANTIBODY","code_information":[{"code":"3018351622","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":669.0,"discounted_cash":669.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ACETYLCHOLINE MODULATING ANTIBODY","code_information":[{"code":"3018351631","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":142.0,"discounted_cash":142.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IMMUNOASSAY ANALYTE - 21 HYDROXYLASE","code_information":[{"code":"3018351632","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":55.0,"discounted_cash":55.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ACETYLCHOLINE RECEPTOR BLOCKING ANTIBODY - ARUP","code_information":[{"code":"3018351642","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":105.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MYELOPEROXIDASE ANTIBODY IGG - ARUP","code_information":[{"code":"3018351648","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":135.0,"discounted_cash":135.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ANCA SERINE PROTEASE 3 ANTIBODY (PRE) - (ARUP)","code_information":[{"code":"3018351649","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.0,"discounted_cash":38.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ANCA MYELOPEROXIDASE ANTIBODY (MPO) - (ARUP)","code_information":[{"code":"3018351650","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":135.0,"discounted_cash":135.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MYELOPEROXIDASE (MPO) IGG - ARUP","code_information":[{"code":"3018351654","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":135.0,"discounted_cash":135.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SERINE PROTEASE 3 (PR3) IGG - ARUP","code_information":[{"code":"3018351655","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.0,"discounted_cash":38.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SERINE PROTEASE 3 (PR3) IGG - ANCA ASSOCIATED VASCULITIS PROFILE - ARUP","code_information":[{"code":"3018351658","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.0,"discounted_cash":38.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MYELOPEROXIDASE (MPO) IGG - ANCA ASSOCIATED VASCULITIS PROFILE - ARUP","code_information":[{"code":"3018351659","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":135.0,"discounted_cash":135.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ACHR BLOCKING ANTIBODY - ACETYLCHOLINE RECEPTOR AB RFLX PANEL - ARUP","code_information":[{"code":"3018351667","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":105.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CENTROMERE IGG - ARUP","code_information":[{"code":"3018351670","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":117.0,"discounted_cash":117.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CHROMATIN IGG","code_information":[{"code":"3018351671","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":166.0,"discounted_cash":166.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC 3-HYDROXY-3-METHYLGLUTARYL COENZYME A REDUCTASE (HMGCR) IGG- ARUP","code_information":[{"code":"3018351672","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":119.0,"discounted_cash":119.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GM1 IGG - GANGLIOSIDE GM1 ANTIBODIES IGG/IGM - ARUP","code_information":[{"code":"3018351675","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":119.0,"discounted_cash":119.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GM1 IGM - GANGLIOSIDE GM1 ANTIBODIES IGG/IGM - ARUP","code_information":[{"code":"3018351676","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":669.0,"discounted_cash":669.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GM1 IGG - GANGLIOSIDE GM1/GD1B/GQ1B IGG/IGM ANTIBODIES - ARUP","code_information":[{"code":"3018351677","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":669.0,"discounted_cash":669.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GM1 IGM - GANGLIOSIDE GM1/GD1B/GQ1B IGG/IGM ANTIBODIES - ARUP","code_information":[{"code":"3018351678","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":669.0,"discounted_cash":669.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GD1B IGG - GANGLIOSIDE GM1/GD1B/GQ1B IGG/IGM ANTIBODIES - ARUP","code_information":[{"code":"3018351679","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":669.0,"discounted_cash":669.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GD1B IGM- GANGLIOSIDE GM1/GD1B/GQ1B IGG/IGM ANTIBODIES - ARUP","code_information":[{"code":"3018351680","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":669.0,"discounted_cash":669.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GQ1 IGG - GANGLIOSIDE GM1/GD1B/GQ1B IGG/IGM ANTIBODIES - ARUP","code_information":[{"code":"3018351681","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":669.0,"discounted_cash":669.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GQ1 IGM - GANGLIOSIDE GM1/GD1B/GQ1B IGG/IGM ANTIBODIES - ARUP","code_information":[{"code":"3018351682","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":669.0,"discounted_cash":669.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HISTONE IGG - ARUP","code_information":[{"code":"3018351690","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":128.0,"discounted_cash":128.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MYELIN ASSOCIATED GLYCOPROTEIN IGM - ARUP","code_information":[{"code":"3018351693","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":119.0,"discounted_cash":119.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ACETYLCHOLINE BINDING ANTIBODY - MYASTHENIA GRAVIS PANEL - ARUP","code_information":[{"code":"3018351694","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":119.0,"discounted_cash":119.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ACETYLCHOLINE RECEPTOR BLOCKING ANTIBODY- MYASTHENIA GRAVIS PANEL - ARUP","code_information":[{"code":"3018351695","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":105.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SERINE PROTEASE 3 (PR3) IGG - MYELOPEROXIDASE / PROTEASE 3 AB - ARUP","code_information":[{"code":"3018351696","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.0,"discounted_cash":38.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MYELOPEROXIDASE (MPO) IGG - MYELOPEROXIDASE / PROTEASE 3 AB - ARUP","code_information":[{"code":"3018351697","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":135.0,"discounted_cash":135.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC EJ (GLYCYL TRNA SYNTHETASE) - EXTENDED MYOSITIS PANEL - ARUP","code_information":[{"code":"3018351698","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":119.0,"discounted_cash":119.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC KU ANTIBODY - EXTENDED MYOSITIS PANEL - ARUP","code_information":[{"code":"3018351699","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":119.0,"discounted_cash":119.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MI2 (NUCLEAR HELICASE PROTEIN) - EXTENDED MYOSITIS PANEL - ARUP","code_information":[{"code":"30183516A1","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":119.0,"discounted_cash":119.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OJ (ISOLEUCYL TRNA SYNTHETASE) - EXTENDED MYOSITIS PANEL - ARUP","code_information":[{"code":"30183516A2","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":119.0,"discounted_cash":119.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC P155/140 ANTIBODY - EXTENDED MYOSITIS PANEL - ARUP","code_information":[{"code":"30183516A3","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":119.0,"discounted_cash":119.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PL12 (ALANYL TRNA SYNTHETASE) - EXTENDED MYOSITIS PANEL - ARUP","code_information":[{"code":"30183516A4","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":119.0,"discounted_cash":119.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PL7 (THREONYL TRNA SYNTHETASE) - EXTENDED MYOSITIS PANEL - ARUP","code_information":[{"code":"30183516A5","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":119.0,"discounted_cash":119.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SRP (SIGNAL RECOGNITION PARTICLE) - EXTENDED MYOSITIS PANEL - ARUP","code_information":[{"code":"30183516A6","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":119.0,"discounted_cash":119.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SERINE PROTEASE 3 (PR3) IGG - MPO AND PR3 ANTIBODIES W/ RFLX ANCA- ARUP","code_information":[{"code":"30183516A7","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.0,"discounted_cash":38.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MYELOPEROXIDASE (MPO) IGG - MPO AND PR3 ANTIBODIES W/ RFLX ANCA - ARUP","code_information":[{"code":"30183516A8","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":135.0,"discounted_cash":135.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GASTRIC PARIETAL IGG - ARUP","code_information":[{"code":"30183516A9","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":119.0,"discounted_cash":119.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RF IGG - RHEUMATOID FACTOR (RF) IGA IGG IGM - ARUP","code_information":[{"code":"30183516B3","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":119.0,"discounted_cash":119.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RNA POLYMERASE III IGG - ARUP","code_information":[{"code":"30183516B4","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":119.0,"discounted_cash":119.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CARBAMYLATED PROTEIN IGG - RHEUMATOID ARTHRITIS PANEL - ARUP","code_information":[{"code":"30183516B8","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":119.0,"discounted_cash":119.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CENTROMERE IGG -CONNECTIVE TISSUE DISEASES PROFILE - ARUP","code_information":[{"code":"30183516C1","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":117.0,"discounted_cash":117.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RIBOSOMAL P ANTIBODY - CONNECTIVE TISSUE DISEASES PROFILE - ARUP","code_information":[{"code":"30183516C2","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":143.0,"discounted_cash":143.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GLOMERULAR BASEMENT MEMBRANE (GBM) IGG BY MULTIPLEX BEAD ASSAY - ARUP","code_information":[{"code":"30183516C6","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":129.0,"discounted_cash":129.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RF IGA - RHEUMATOID FACTOR (RF) IGA IGG IGM - ARUP","code_information":[{"code":"30183516C9","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":119.0,"discounted_cash":119.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RF IGM - RHEUMATOID FACTOR (RF) IGA IGG IGM - ARUP","code_information":[{"code":"30183516D1","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":119.0,"discounted_cash":119.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RIA IMMUNOASSAY NONINFECTIOUS ANALYTE","code_information":[{"code":"3018351904","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83519","type":"HCPCS"}],"standard_charges":[{"gross_charge":193.0,"discounted_cash":193.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INSULIN LIKE GROWTH FACTOR BINDING PROTEIN 1","code_information":[{"code":"3018351907","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83519","type":"HCPCS"}],"standard_charges":[{"gross_charge":215.0,"discounted_cash":215.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ACETYLCHOLINE RECEPTOR BINDING AB - ARUP","code_information":[{"code":"3018351908","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83519","type":"HCPCS"}],"standard_charges":[{"gross_charge":114.0,"discounted_cash":114.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC VOLTAGE GATED POTASSIUM CHANNEL ANTIBODY","code_information":[{"code":"3018351910","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83519","type":"HCPCS"}],"standard_charges":[{"gross_charge":215.0,"discounted_cash":215.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ACHR BINDING ANTIBODY - ACETYLCHOLINE RECEPTOR AB RFLX PANEL - ARUP","code_information":[{"code":"3018351931","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83519","type":"HCPCS"}],"standard_charges":[{"gross_charge":193.0,"discounted_cash":193.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IGF BINDING PROTEIN 1 - ARUP","code_information":[{"code":"3018351935","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83519","type":"HCPCS"}],"standard_charges":[{"gross_charge":215.0,"discounted_cash":215.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC STRIATED MUSCLE IGG - MYASTHENIA GRAVIS PANEL - ARUP","code_information":[{"code":"3018351938","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83519","type":"HCPCS"}],"standard_charges":[{"gross_charge":114.0,"discounted_cash":114.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PANCREATIC POLYPEPTIDE - ARUP","code_information":[{"code":"3018351939","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83519","type":"HCPCS"}],"standard_charges":[{"gross_charge":193.0,"discounted_cash":193.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PROCOLLAGEN TYPE 1 PROPEPTIDE - ARUP","code_information":[{"code":"3018351940","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83519","type":"HCPCS"}],"standard_charges":[{"gross_charge":193.0,"discounted_cash":193.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC VOLTAGE GATED POTASSIUM CHANNEL ANTIBODY - ARUP","code_information":[{"code":"3018351943","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83519","type":"HCPCS"}],"standard_charges":[{"gross_charge":193.0,"discounted_cash":193.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IMMUNOASSAY NONINFECTIOUS ANALYTE QUANT","code_information":[{"code":"3018352005","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":340.0,"discounted_cash":340.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IMMUNOASSAY QUANT NOS NONAB - TSH RECPT","code_information":[{"code":"3018352012","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":215.0,"discounted_cash":215.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ADIPONECTIN - ARUP","code_information":[{"code":"3018352022","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":289.0,"discounted_cash":289.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INSULIN-LIKE GROWTH FACTOR 2 - ARUP","code_information":[{"code":"3018352050","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":340.0,"discounted_cash":340.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC LEPTIN LEVEL QUANT - ARUP","code_information":[{"code":"3018352055","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":340.0,"discounted_cash":340.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TSH RECEPTOR ANTIBODY - ARUP","code_information":[{"code":"3018352081","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":215.0,"discounted_cash":215.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TRYPTASE LEVEL - ARUP","code_information":[{"code":"3018352082","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":340.0,"discounted_cash":340.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MUTATED CITRULLINATED VIMENTIN ANTIBODY - ARUP","code_information":[{"code":"3018352083","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":340.0,"discounted_cash":340.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC 14-3-3 ETA PROTEIN BY ELISA - ARUP","code_information":[{"code":"3018352091","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":340.0,"discounted_cash":340.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MUTATED CITRULLINATED VIMENTIN (MCV) ANTIBODY - QST","code_information":[{"code":"3018352092","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":340.0,"discounted_cash":340.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SULFATIDE AUTOANTIBODY TEST - QWDL","code_information":[{"code":"3018352095","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":340.0,"discounted_cash":340.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IMMUNOGLOBULIN LIGHT CHAINS FREE EACH","code_information":[{"code":"3018352101","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83521","type":"HCPCS"}],"standard_charges":[{"gross_charge":262.0,"discounted_cash":262.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC KAPPA LIGHT CHAINS - MONOCLONAL PROTEIN STUDY EXTENDED SERUM -  ARUP  [3018352101]","code_information":[{"code":"3018352102","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83521","type":"HCPCS"}],"standard_charges":[{"gross_charge":262.0,"discounted_cash":262.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC LAMBDA LIGHT CHAINS - MONOCLONAL PROTEIN STUDY EXTENDED SERUM -  ARUP","code_information":[{"code":"3018352103","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83521","type":"HCPCS"}],"standard_charges":[{"gross_charge":262.0,"discounted_cash":262.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC KAPPA/LAMBDA IMMUNOGLOBULIN LIGHT CHAINS - IMMUNOFIXATION WITH FLC, URINE - ARUP","code_information":[{"code":"3018352104","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83521","type":"HCPCS"}],"standard_charges":[{"gross_charge":262.0,"discounted_cash":262.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC KAPPA LIGHT CHAINS - IMMUNOFIXATION WITH FREE LIGHT CHAINS URINE - ARUP","code_information":[{"code":"3018352107","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83521","type":"HCPCS"}],"standard_charges":[{"gross_charge":262.0,"discounted_cash":262.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INSULIN LEVEL TOTAL","code_information":[{"code":"3018352502","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83525","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":75.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INSULIN LEVEL TOTAL RANDOM - ARUP","code_information":[{"code":"3018352504","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83525","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":75.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INSULIN LEVEL TOTAL - INSULIN LEVEL FREE AND TOTAL - ARUP","code_information":[{"code":"3018352505","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83525","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":75.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INSULIN LEVEL TOTAL (FASTING) - ARUP","code_information":[{"code":"3018352507","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83525","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":75.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF INSULIN,FREE - INSULIN, FREE","code_information":[{"code":"3018352701","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83527","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":75.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INSULIN LEVEL FREE - INSULIN LEVEL FREE AND TOTAL - ARUP","code_information":[{"code":"3018352702","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83527","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":75.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INTERLEUKIN 6 - ARUP","code_information":[{"code":"3018352902","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83529","type":"HCPCS"}],"standard_charges":[{"gross_charge":114.0,"discounted_cash":114.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF IRON - IRON,LIVER TISSUE","code_information":[{"code":"3018354001","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83540","type":"HCPCS"}],"standard_charges":[{"gross_charge":110.0,"discounted_cash":110.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IRON LEVEL","code_information":[{"code":"3018354002","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83540","type":"HCPCS"}],"standard_charges":[{"gross_charge":58.0,"discounted_cash":58.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IRON LEVEL TOTAL - IRON AND TIBC - ARUP","code_information":[{"code":"3018354004","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83540","type":"HCPCS"}],"standard_charges":[{"gross_charge":58.0,"discounted_cash":58.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IRON LEVEL","code_information":[{"code":"3018354007","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83540","type":"HCPCS"}],"standard_charges":[{"gross_charge":58.0,"discounted_cash":58.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TOTAL IRON BINDING CAPACITY","code_information":[{"code":"3018355001","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83550","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":75.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC 17 KETOSTEROIDS URINE","code_information":[{"code":"3018358601","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83586","type":"HCPCS"}],"standard_charges":[{"gross_charge":123.0,"discounted_cash":123.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC LACTIC ACID LEVEL","code_information":[{"code":"3018360502","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83605","type":"HCPCS"}],"standard_charges":[{"gross_charge":120.0,"discounted_cash":120.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC LACTIC ACID LEVEL REFLEX","code_information":[{"code":"3018360510","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83605","type":"HCPCS"}],"standard_charges":[{"gross_charge":120.0,"discounted_cash":120.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC LD (LDH) TOTAL","code_information":[{"code":"3018361502","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83615","type":"HCPCS"}],"standard_charges":[{"gross_charge":157.0,"discounted_cash":157.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC LD (LDH) TOTAL  - ARUP","code_information":[{"code":"3018361504","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83615","type":"HCPCS"}],"standard_charges":[{"gross_charge":157.0,"discounted_cash":157.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC LD (LDH) TOTAL BODY FLUID - ARUP","code_information":[{"code":"3018361505","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83615","type":"HCPCS"}],"standard_charges":[{"gross_charge":157.0,"discounted_cash":157.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC LACTATE DEHYDROGENASE TOTAL","code_information":[{"code":"3018361508","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83615","type":"HCPCS"}],"standard_charges":[{"gross_charge":157.0,"discounted_cash":157.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC LACTATE DEHYDROGENASE TOTAL - LACTATE DEHYDROGENASE ISOENZYMES - ARUP","code_information":[{"code":"3018361509","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83615","type":"HCPCS"}],"standard_charges":[{"gross_charge":157.0,"discounted_cash":157.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC LD 1 - LACTATE DEHYDROGENASE ISOENZYMES - ARUP","code_information":[{"code":"3018361510","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83615","type":"HCPCS"}],"standard_charges":[{"gross_charge":157.0,"discounted_cash":157.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF LDH ISOENZYMES - LACTATE DEHYDROGENASE ISOENZMS","code_information":[{"code":"3018362501","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83625","type":"HCPCS"}],"standard_charges":[{"gross_charge":92.0,"discounted_cash":92.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC LD (LDH) ISOENZYMES, LDH ISOENZYMES - ARUP","code_information":[{"code":"3018362502","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83625","type":"HCPCS"}],"standard_charges":[{"gross_charge":92.0,"discounted_cash":92.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC LD 2 - LACTATE DEHYDROGENASE ISOENZYMES - ARUP","code_information":[{"code":"3018362503","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83625","type":"HCPCS"}],"standard_charges":[{"gross_charge":92.0,"discounted_cash":92.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC LACTOFERRIN FECAL","code_information":[{"code":"3018363001","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83630","type":"HCPCS"}],"standard_charges":[{"gross_charge":192.0,"discounted_cash":192.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC LACTOFERRIN FECAL - ARUP","code_information":[{"code":"3018363002","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83630","type":"HCPCS"}],"standard_charges":[{"gross_charge":192.0,"discounted_cash":192.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC LEAD URINE HEAVY METALS PANEL 3- ARUP","code_information":[{"code":"3018365501","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83655","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.0,"discounted_cash":83.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC LEAD BLOOD  HEAVY METALS PANEL 3- ARUP","code_information":[{"code":"3018365503","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83655","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.0,"discounted_cash":83.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC LEAD BLOOD HEAVY METALS PANEL 4 - ARUP","code_information":[{"code":"3018365505","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83655","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.0,"discounted_cash":83.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC LEAD VENOUS - ARUP","code_information":[{"code":"3018365506","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83655","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.0,"discounted_cash":83.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC LEAD URINE - ARUP","code_information":[{"code":"3018365509","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83655","type":"HCPCS"}],"standard_charges":[{"gross_charge":76.0,"discounted_cash":76.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC LEAD URINE - HEAVY METALS PANEL 3 - ARUP","code_information":[{"code":"3018365510","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83655","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.0,"discounted_cash":83.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC LIPASE LEVEL","code_information":[{"code":"3018369001","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83690","type":"HCPCS"}],"standard_charges":[{"gross_charge":107.0,"discounted_cash":107.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF LIPASE - LIPASE BODY FLUID","code_information":[{"code":"3018369002","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83690","type":"HCPCS"}],"standard_charges":[{"gross_charge":107.0,"discounted_cash":107.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC LIPOPROTEIN SMALL A","code_information":[{"code":"3018369501","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83695","type":"HCPCS"}],"standard_charges":[{"gross_charge":120.0,"discounted_cash":120.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY LIPOPROTEIN PLA2 - LIPOPROTEIN-ASSOCIATED PHOSPHOLIPASE A2","code_information":[{"code":"3018369801","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83698","type":"HCPCS"}],"standard_charges":[{"gross_charge":205.0,"discounted_cash":205.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC LIPOPROTEIN-PLA2 (PLAC) ACTIVITY - ARUP","code_information":[{"code":"3018369802","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83698","type":"HCPCS"}],"standard_charges":[{"gross_charge":205.0,"discounted_cash":205.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC LIPOPROTEIN, BLOOD, BY NMR SPECT - LIPOPROTEIN NMR","code_information":[{"code":"3018370401","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83704","type":"HCPCS"}],"standard_charges":[{"gross_charge":320.0,"discounted_cash":320.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC LIPOPROTEIN - NMR LIPOMED PROFILE - ARUP","code_information":[{"code":"3018370403","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83704","type":"HCPCS"}],"standard_charges":[{"gross_charge":320.0,"discounted_cash":320.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF BLOOD LIPOPROTEIN,HDL CHOLEST - HDL CHOLESTEROL","code_information":[{"code":"3018371801","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83718","type":"HCPCS"}],"standard_charges":[{"gross_charge":55.0,"discounted_cash":55.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF BLOOD LIPOPROTEIN,LDL CHOLEST - LDL CHOLESTEROL DIRECT","code_information":[{"code":"3018372101","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83721","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.0,"discounted_cash":87.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MAGNESIUM LEVEL","code_information":[{"code":"3018373501","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83735","type":"HCPCS"}],"standard_charges":[{"gross_charge":58.0,"discounted_cash":58.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MAGNESIUM URINE RANDOM","code_information":[{"code":"3018373502","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83735","type":"HCPCS"}],"standard_charges":[{"gross_charge":58.0,"discounted_cash":58.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF MAGNESIUM - MAGNESIUM RBC","code_information":[{"code":"3018373504","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83735","type":"HCPCS"}],"standard_charges":[{"gross_charge":58.0,"discounted_cash":58.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MAGNESIUM, URINE - ARUP","code_information":[{"code":"3018373508","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83735","type":"HCPCS"}],"standard_charges":[{"gross_charge":58.0,"discounted_cash":58.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MAGNESIUM - SUPERSATURATION PROFILE, URINE - ARUP","code_information":[{"code":"3018373511","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83735","type":"HCPCS"}],"standard_charges":[{"gross_charge":58.0,"discounted_cash":58.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MAGNESIUM RBC - ARUP","code_information":[{"code":"3018373512","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83735","type":"HCPCS"}],"standard_charges":[{"gross_charge":58.0,"discounted_cash":58.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MASS SPECTROMETRY NONDRUG ANALYTE","code_information":[{"code":"3018378901","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83789","type":"HCPCS"}],"standard_charges":[{"gross_charge":672.95,"discounted_cash":672.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BILE ACIDS FRACTIONATED AND TOTAL - ARUP","code_information":[{"code":"3018378904","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83789","type":"HCPCS"}],"standard_charges":[{"gross_charge":673.0,"discounted_cash":673.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BACTERIAL ID BY MALDI-TOF MS - ARUP","code_information":[{"code":"3018378905","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83789","type":"HCPCS"}],"standard_charges":[{"gross_charge":672.95,"discounted_cash":672.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FUNGAL ID BY MALDI-TOF MS - ARUP","code_information":[{"code":"3018378906","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83789","type":"HCPCS"}],"standard_charges":[{"gross_charge":672.95,"discounted_cash":672.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC AFB ID BY MALDI-TOF MS - ARUP","code_information":[{"code":"3018378907","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83789","type":"HCPCS"}],"standard_charges":[{"gross_charge":672.95,"discounted_cash":672.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MERCURY URINE HEAVY METALS PANEL 3- ARUP","code_information":[{"code":"3018382501","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83825","type":"HCPCS"}],"standard_charges":[{"gross_charge":150.0,"discounted_cash":150.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MERCURY BLOOD HEAVY METALS PANEL 3 - ARUP","code_information":[{"code":"3018382503","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83825","type":"HCPCS"}],"standard_charges":[{"gross_charge":150.0,"discounted_cash":150.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MERCURY BLOOD - ARUP","code_information":[{"code":"3018382504","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83825","type":"HCPCS"}],"standard_charges":[{"gross_charge":137.0,"discounted_cash":137.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MERCURY BLOOD HEAVY METALS PANEL 4 BLOOD - ARUP","code_information":[{"code":"3018382505","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83825","type":"HCPCS"}],"standard_charges":[{"gross_charge":150.0,"discounted_cash":150.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MERCURY URINE - HEAVY METALS PANEL 3 - ARUP","code_information":[{"code":"3018382506","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83825","type":"HCPCS"}],"standard_charges":[{"gross_charge":150.0,"discounted_cash":150.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF METANEPHRINES - METANEPHRINES 24HR URINE","code_information":[{"code":"3018383501","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83835","type":"HCPCS"}],"standard_charges":[{"gross_charge":133.0,"discounted_cash":133.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF METANEPHRINES - METANEPHRINE PLASMA","code_information":[{"code":"3018383502","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83835","type":"HCPCS"}],"standard_charges":[{"gross_charge":133.0,"discounted_cash":133.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC METANEPHRINES URINE 24 HOUR - ARUP","code_information":[{"code":"3018383505","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83835","type":"HCPCS"}],"standard_charges":[{"gross_charge":133.0,"discounted_cash":133.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MYELIN BASIC PROTEIN,CSF - MYELIN BASIC PROTEIN CSF","code_information":[{"code":"3018387301","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83873","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.0,"discounted_cash":83.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MYELIN BASIC PROTEIN CSF - ARUP","code_information":[{"code":"3018387302","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83873","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.0,"discounted_cash":83.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF MYOGLOBIN - MYOGLOBIN SERUM","code_information":[{"code":"3018387401","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83874","type":"HCPCS"}],"standard_charges":[{"gross_charge":146.0,"discounted_cash":146.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF MYOGLOBIN - MYOGLOBIN URINE QUANTITATIVE","code_information":[{"code":"3018387402","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83874","type":"HCPCS"}],"standard_charges":[{"gross_charge":70.0,"discounted_cash":70.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MYOGLOBIN URINE QUANT - ARUP","code_information":[{"code":"3018387404","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83874","type":"HCPCS"}],"standard_charges":[{"gross_charge":70.0,"discounted_cash":70.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC N-TERMINAL PRO-BNP","code_information":[{"code":"3018388001","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83880","type":"HCPCS"}],"standard_charges":[{"gross_charge":191.0,"discounted_cash":191.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC B-TYPE NATRIUETIC PEPTIDE (PROBNP) - POCT","code_information":[{"code":"3018388003","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83880","type":"HCPCS"}],"standard_charges":[{"gross_charge":191.0,"discounted_cash":191.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC B-TYPE NATRIUETIC PEPTIDE (BNP)","code_information":[{"code":"3018388004","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83880","type":"HCPCS"}],"standard_charges":[{"gross_charge":191.0,"discounted_cash":191.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC B-TYPE NATRIUETIC PEPTIDE (BNP) - ARUP","code_information":[{"code":"3018388006","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83880","type":"HCPCS"}],"standard_charges":[{"gross_charge":191.0,"discounted_cash":191.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC NEPHELOMETRY ALPHA 2 MACROGLOBULIN","code_information":[{"code":"3018388303","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83883","type":"HCPCS"}],"standard_charges":[{"gross_charge":128.0,"discounted_cash":128.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC A2 MACROGLOBULIN-LIVER FIBROSIS CHRONIC VIRAL HEP FIBROMETER PNL-ARUP","code_information":[{"code":"3018388309","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83883","type":"HCPCS"}],"standard_charges":[{"gross_charge":128.0,"discounted_cash":128.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC NUCLEOTIDASE 5","code_information":[{"code":"3018391501","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83915","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":65.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC NUCLEOTIDASE 5 - ARUP","code_information":[{"code":"3018391502","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83915","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":65.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OLIGOCLONAL BANDS IN CSF AND SERUM - ARUP","code_information":[{"code":"3018391601","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83916","type":"HCPCS"}],"standard_charges":[{"gross_charge":202.0,"discounted_cash":202.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OLIGOCLONAL BANDS CSF & SERUM - ARUP","code_information":[{"code":"3018391602","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83916","type":"HCPCS"}],"standard_charges":[{"gross_charge":202.0,"discounted_cash":202.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OLIGOCLONAL BANDS NUMBER CSF - OLIGOCLONAL BAND PROFILE - ARUP","code_information":[{"code":"3018391604","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83916","type":"HCPCS"}],"standard_charges":[{"gross_charge":202.0,"discounted_cash":202.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY SNGL ORGANIC ACID, QUANTITATIVE - METHYLMALONIC ACID, SERUM","code_information":[{"code":"3018392101","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83921","type":"HCPCS"}],"standard_charges":[{"gross_charge":94.0,"discounted_cash":94.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY SNGL ORGANIC ACID QUANTITATIVE - METHYLMALONIC ACID URINE","code_information":[{"code":"3018392102","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83921","type":"HCPCS"}],"standard_charges":[{"gross_charge":99.0,"discounted_cash":99.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC METHYLMALONIC ACID LEVEL SERUM - ARUP","code_information":[{"code":"3018392104","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83921","type":"HCPCS"}],"standard_charges":[{"gross_charge":94.0,"discounted_cash":94.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OSMOLALITY SERUM/PLASMA","code_information":[{"code":"3018393001","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83930","type":"HCPCS"}],"standard_charges":[{"gross_charge":94.0,"discounted_cash":94.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OSMOLALITY URINE","code_information":[{"code":"3018393501","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83935","type":"HCPCS"}],"standard_charges":[{"gross_charge":102.0,"discounted_cash":102.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OXALATE - SUPERSATURATION PROFILE, URINE - ARUP","code_information":[{"code":"3018394507","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83945","type":"HCPCS"}],"standard_charges":[{"gross_charge":114.14,"discounted_cash":114.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PTH INTACT","code_information":[{"code":"3018397001","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83970","type":"HCPCS"}],"standard_charges":[{"gross_charge":462.0,"discounted_cash":462.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PTH INTRAOPERATIVE","code_information":[{"code":"3018397002","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83970","type":"HCPCS"}],"standard_charges":[{"gross_charge":637.0,"discounted_cash":637.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PTH INTACT FNA - ARUP","code_information":[{"code":"3018397003","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83970","type":"HCPCS"}],"standard_charges":[{"gross_charge":462.0,"discounted_cash":462.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PTH INTACT - PTH INTACT WITH CALCIUM - ARUP","code_information":[{"code":"3018397005","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83970","type":"HCPCS"}],"standard_charges":[{"gross_charge":462.0,"discounted_cash":462.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PH BODY FLUID","code_information":[{"code":"3018398601","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83986","type":"HCPCS"}],"standard_charges":[{"gross_charge":215.0,"discounted_cash":215.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PH - SUPERSATURATION PROFILE - ARUP","code_information":[{"code":"3018398609","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83986","type":"HCPCS"}],"standard_charges":[{"gross_charge":215.0,"discounted_cash":215.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY FOR PHENCYCLIDINE - PHENCYCLIDINE LEVEL","code_information":[{"code":"3018399202","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83992","type":"HCPCS"}],"standard_charges":[{"gross_charge":178.0,"discounted_cash":178.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PHENCYCLIDINE (PCP) LEVEL URINE CONF - ARUP","code_information":[{"code":"3018399206","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83992","type":"HCPCS"}],"standard_charges":[{"gross_charge":178.0,"discounted_cash":178.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PHENCYCLIDINE PCP DEFINITIVE - DRUG DETECT PNL MECONIUM QUAL - ARUP","code_information":[{"code":"3018399208","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83992","type":"HCPCS"}],"standard_charges":[{"gross_charge":177.54,"discounted_cash":177.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PHENCYCLIDINE PCP DEFINITIVE - DRUG DETECT PNL CORDTISS QUAL-ARUP","code_information":[{"code":"3018399209","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83992","type":"HCPCS"}],"standard_charges":[{"gross_charge":177.54,"discounted_cash":177.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CALPROTECTIN FECAL - ARUP","code_information":[{"code":"3018399301","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83993","type":"HCPCS"}],"standard_charges":[{"gross_charge":457.0,"discounted_cash":457.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CALPROTECTIN STOOL - ARUP","code_information":[{"code":"3018399304","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83993","type":"HCPCS"}],"standard_charges":[{"gross_charge":457.0,"discounted_cash":457.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF BLOOD PKU - PHENYLALANINE","code_information":[{"code":"3018403001","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84030","type":"HCPCS"}],"standard_charges":[{"gross_charge":252.0,"discounted_cash":252.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY PHOSPHATASE ACID PROSTATIC - PROSTATIC ACID PHOSPHATASE","code_information":[{"code":"3018406601","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84066","type":"HCPCS"}],"standard_charges":[{"gross_charge":73.0,"discounted_cash":73.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALKALINE PHOSPHATASE LEVEL","code_information":[{"code":"3018407501","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84075","type":"HCPCS"}],"standard_charges":[{"gross_charge":46.0,"discounted_cash":46.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALKALINE PHOSPHATASE - ARUP","code_information":[{"code":"3018407503","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84075","type":"HCPCS"}],"standard_charges":[{"gross_charge":46.0,"discounted_cash":46.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALKALINE PHOSPHATASE ISOENZYMES ARUP","code_information":[{"code":"3018408001","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84080","type":"HCPCS"}],"standard_charges":[{"gross_charge":73.0,"discounted_cash":73.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY ALKAL PHOSPHATASE,ISOENZYMES - ALKALINE PHOSPHATASE,ISOENZYMES BONE","code_information":[{"code":"3018408002","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84080","type":"HCPCS"}],"standard_charges":[{"gross_charge":127.0,"discounted_cash":127.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALKALINE PHOSPHOTASE BONE SPECIFIC - ARUP","code_information":[{"code":"3018408003","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84080","type":"HCPCS"}],"standard_charges":[{"gross_charge":127.0,"discounted_cash":127.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PHOSPHORUS","code_information":[{"code":"3018410004","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84100","type":"HCPCS"}],"standard_charges":[{"gross_charge":73.0,"discounted_cash":73.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PHOSPHORUS URINE 24 HOUR","code_information":[{"code":"3018410505","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84105","type":"HCPCS"}],"standard_charges":[{"gross_charge":89.0,"discounted_cash":89.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PHOSPHORUS - SUPERSATURATION PROFILE, URINE - ARUP","code_information":[{"code":"3018410506","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84105","type":"HCPCS"}],"standard_charges":[{"gross_charge":73.0,"discounted_cash":73.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CERVICOVAGINAL FLUID EXAM - AFP QUAL","code_information":[{"code":"3018411201","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84112","type":"HCPCS"}],"standard_charges":[{"gross_charge":124.0,"discounted_cash":124.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FRACTIONATED PORPHYRINS URINE - ARUP","code_information":[{"code":"3018412003","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84120","type":"HCPCS"}],"standard_charges":[{"gross_charge":192.0,"discounted_cash":192.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC POTASSIUM LEVEL","code_information":[{"code":"3018413201","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84132","type":"HCPCS"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC POTASSIUM RANDOM URINE","code_information":[{"code":"3018413303","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84133","type":"HCPCS"}],"standard_charges":[{"gross_charge":73.0,"discounted_cash":73.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC POTASSIUM URINE 24 HOUR","code_information":[{"code":"3018413307","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84133","type":"HCPCS"}],"standard_charges":[{"gross_charge":73.0,"discounted_cash":73.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC POTASSIUM - SUPERSATURATION PROFILE, URINE - ARUP","code_information":[{"code":"3018413310","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84133","type":"HCPCS"}],"standard_charges":[{"gross_charge":73.0,"discounted_cash":73.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PREALBUMIN","code_information":[{"code":"3018413401","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84134","type":"HCPCS"}],"standard_charges":[{"gross_charge":70.0,"discounted_cash":70.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF PREGNENOLONE - PREGNENOLONE","code_information":[{"code":"3018414001","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84140","type":"HCPCS"}],"standard_charges":[{"gross_charge":121.0,"discounted_cash":121.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PREGNENOLONE LEVEL - ARUP","code_information":[{"code":"3018414003","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84140","type":"HCPCS"}],"standard_charges":[{"gross_charge":121.0,"discounted_cash":121.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF PROGESTERONE - PROGESTERONE","code_information":[{"code":"3018414401","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84144","type":"HCPCS"}],"standard_charges":[{"gross_charge":233.0,"discounted_cash":233.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PROGESTERONE LEVEL","code_information":[{"code":"3018414402","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84144","type":"HCPCS"}],"standard_charges":[{"gross_charge":233.0,"discounted_cash":233.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PROCALCITONIN LEVEL","code_information":[{"code":"3018414501","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84145","type":"HCPCS"}],"standard_charges":[{"gross_charge":385.0,"discounted_cash":385.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PROCALCITONIN LEVEL - ARUP","code_information":[{"code":"3018414502","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84145","type":"HCPCS"}],"standard_charges":[{"gross_charge":385.0,"discounted_cash":385.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PROLACTIN","code_information":[{"code":"3018414601","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84146","type":"HCPCS"}],"standard_charges":[{"gross_charge":217.0,"discounted_cash":217.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PROLACTIN - ARUP","code_information":[{"code":"3018414602","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84146","type":"HCPCS"}],"standard_charges":[{"gross_charge":217.0,"discounted_cash":217.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MACROPROLACTIN - ARUP","code_information":[{"code":"3018414604","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84146","type":"HCPCS"}],"standard_charges":[{"gross_charge":217.0,"discounted_cash":217.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PROSTATE SPECIFIC ANTIGEN (PSA) TOTAL","code_information":[{"code":"3018415301","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84153","type":"HCPCS"}],"standard_charges":[{"gross_charge":284.0,"discounted_cash":284.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PROSTATE SPECIFIC ANTIGEN,TOTAL - PSA TOTAL AND FREE","code_information":[{"code":"3018415302","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84153","type":"HCPCS"}],"standard_charges":[{"gross_charge":99.0,"discounted_cash":99.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PROSTATE SPECIFIC ANTIGEN,TOTAL - PSA, ULTRASENSITIVE","code_information":[{"code":"3018415303","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84153","type":"HCPCS"}],"standard_charges":[{"gross_charge":284.0,"discounted_cash":284.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PSA SCREEN","code_information":[{"code":"3018415304","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84153","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.0,"discounted_cash":87.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PSA TOTAL SCREENING - ARUP","code_information":[{"code":"3018415307","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84153","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.0,"discounted_cash":87.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PSA TOTAL DIAGNOSTIC","code_information":[{"code":"3018415308","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84153","type":"HCPCS"}],"standard_charges":[{"gross_charge":284.0,"discounted_cash":284.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PSA TOTAL SCREENING","code_information":[{"code":"3018415310","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84153","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.0,"discounted_cash":87.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PSA ULTRASENSITIVE - ARUP","code_information":[{"code":"3018415311","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84153","type":"HCPCS"}],"standard_charges":[{"gross_charge":284.0,"discounted_cash":284.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PSA FREE","code_information":[{"code":"3018415401","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84154","type":"HCPCS"}],"standard_charges":[{"gross_charge":206.0,"discounted_cash":206.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PROSTATE SPECIFIC ANTIGEN, FREE - PSA TOTAL AND FREE","code_information":[{"code":"3018415403","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84154","type":"HCPCS"}],"standard_charges":[{"gross_charge":206.0,"discounted_cash":206.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PROTEIN TOTAL","code_information":[{"code":"3018415501","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84155","type":"HCPCS"}],"standard_charges":[{"gross_charge":63.0,"discounted_cash":63.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PROTEIN TOTAL - PROTEIN ELECTROPHORESIS REFLEX IFE/IG - ARUP","code_information":[{"code":"3018415505","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84155","type":"HCPCS"}],"standard_charges":[{"gross_charge":63.0,"discounted_cash":63.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PROTEIN TOTAL - PROTEIN ELECTROPHORESIS, SERUM - ARUP","code_information":[{"code":"3018415506","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84155","type":"HCPCS"}],"standard_charges":[{"gross_charge":63.0,"discounted_cash":63.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PROTEIN TOTAL - PROTEIN ELECTROPHORESIS REFLEX IFE - ARUP","code_information":[{"code":"3018415507","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84155","type":"HCPCS"}],"standard_charges":[{"gross_charge":63.0,"discounted_cash":63.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PROTEIN RANDOM URINE","code_information":[{"code":"3018415601","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84156","type":"HCPCS"}],"standard_charges":[{"gross_charge":63.0,"discounted_cash":63.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PROTEIN TOT XCPT REFRACTOMETRY URINE - PROTEIN TIMED URINE","code_information":[{"code":"3018415602","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84156","type":"HCPCS"}],"standard_charges":[{"gross_charge":61.0,"discounted_cash":61.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PROTEIN TOT XCPT REFRACTOMETRY URINE - BENCE JONES PROTOCOL","code_information":[{"code":"3018415605","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84156","type":"HCPCS"}],"standard_charges":[{"gross_charge":96.0,"discounted_cash":96.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PROTEIN TOTAL URINE IMMUNOFIXATION WITH FLC - ARUP","code_information":[{"code":"3018415606","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84156","type":"HCPCS"}],"standard_charges":[{"gross_charge":63.0,"discounted_cash":63.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PROTEIN URINE 24 HOUR","code_information":[{"code":"3018415609","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84156","type":"HCPCS"}],"standard_charges":[{"gross_charge":63.0,"discounted_cash":63.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PROTEIN LEVEL - PROTEIN/CREATININE RATIO URINE","code_information":[{"code":"3018415610","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84156","type":"HCPCS"}],"standard_charges":[{"gross_charge":63.0,"discounted_cash":63.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PROTEIN TOTAL - IMMUNOFIXATION WITH FREE LIGHT CHAINS URINE - ARUP","code_information":[{"code":"3018415611","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84156","type":"HCPCS"}],"standard_charges":[{"gross_charge":63.0,"discounted_cash":63.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PROTEIN TOTAL - IMMUNOFIXATION URINE - ARUP","code_information":[{"code":"3018415613","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84156","type":"HCPCS"}],"standard_charges":[{"gross_charge":96.0,"discounted_cash":96.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TOTAL PROTEIN - MONOCLONAL PROTEIN STUDY, URINE - ARUP","code_information":[{"code":"3018415614","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84156","type":"HCPCS"}],"standard_charges":[{"gross_charge":63.0,"discounted_cash":63.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PROTEIN TOT XCPT REFRACTOMETRY OTH SRC - PROTEIN CSF","code_information":[{"code":"3018415701","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84157","type":"HCPCS"}],"standard_charges":[{"gross_charge":91.0,"discounted_cash":91.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PROTEIN TOTAL BODY FLUID","code_information":[{"code":"3018415702","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84157","type":"HCPCS"}],"standard_charges":[{"gross_charge":82.0,"discounted_cash":82.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TOTAL PROTEIN CSF","code_information":[{"code":"3018415704","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84157","type":"HCPCS"}],"standard_charges":[{"gross_charge":91.0,"discounted_cash":91.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PROTEIN ELECTROPHORESIS SERUM","code_information":[{"code":"3018416501","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84165","type":"HCPCS"}],"standard_charges":[{"gross_charge":72.0,"discounted_cash":72.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PROTEIN ELECTROPHORESIS REFLEX IFE/IG - ARUP","code_information":[{"code":"3018416505","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84165","type":"HCPCS"}],"standard_charges":[{"gross_charge":72.0,"discounted_cash":72.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PROTEIN ELECTROPHORESIS, SERUM - ARUP","code_information":[{"code":"3018416506","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84165","type":"HCPCS"}],"standard_charges":[{"gross_charge":72.0,"discounted_cash":72.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PROTEIN ELECTROPHORESIS, URINE, 24 HOUR","code_information":[{"code":"3018416603","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84166","type":"HCPCS"}],"standard_charges":[{"gross_charge":275.0,"discounted_cash":275.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PROTEIN, WESTERN BLOT TEST, W BAND ID","code_information":[{"code":"3018418203","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84182","type":"HCPCS"}],"standard_charges":[{"gross_charge":209.0,"discounted_cash":209.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PROTEIN WESTERN BLOT AMPHIPHYSIN AB IGG","code_information":[{"code":"3018418210","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84182","type":"HCPCS"}],"standard_charges":[{"gross_charge":225.0,"discounted_cash":225.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MDA5 (CADM 140) - EXTENDED MYOSITIS PANEL - ARUP","code_information":[{"code":"3018418223","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84182","type":"HCPCS"}],"standard_charges":[{"gross_charge":209.0,"discounted_cash":209.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC NXP2 (NUCLEAR MATRIX PROTEIN) - EXTENDED MYOSITIS PANEL - ARUP","code_information":[{"code":"3018418224","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84182","type":"HCPCS"}],"standard_charges":[{"gross_charge":209.0,"discounted_cash":209.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SAE1 (SUMO ACTIVATING ENZYME) - EXTENDED MYOSITIS PANEL - ARUP","code_information":[{"code":"3018418225","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84182","type":"HCPCS"}],"standard_charges":[{"gross_charge":209.0,"discounted_cash":209.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TIF1 GAMMA (155 KDA) - EXTENDED MYOSITIS PANEL - ARUP","code_information":[{"code":"3018418226","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84182","type":"HCPCS"}],"standard_charges":[{"gross_charge":209.0,"discounted_cash":209.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC NEURONAL ANTIBODY (AMPHIPHYSIN) -PARANEOPLASTIC REFLEX PANEL - ARUP","code_information":[{"code":"3018418231","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84182","type":"HCPCS"}],"standard_charges":[{"gross_charge":209.0,"discounted_cash":209.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SOX1 IGG IMMUNOBLOT - PARANEOPLASTIC REFLEX PANEL - ARUP","code_information":[{"code":"3018418232","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84182","type":"HCPCS"}],"standard_charges":[{"gross_charge":209.0,"discounted_cash":209.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC AMPHIPHYSIN ANTIBODY-AUTOIMMUNE ENCEPHALOPATHY/DEMENTIA PANEL CSF - ARUP","code_information":[{"code":"3018418239","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84182","type":"HCPCS"}],"standard_charges":[{"gross_charge":111.0,"discounted_cash":111.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ERYTHROCYTE PORPHYRIN FREE - ARUP","code_information":[{"code":"3018420205","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84202","type":"HCPCS"}],"standard_charges":[{"gross_charge":173.0,"discounted_cash":173.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF PROINSULIN - PROINSULIN","code_information":[{"code":"3018420601","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84206","type":"HCPCS"}],"standard_charges":[{"gross_charge":201.0,"discounted_cash":201.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PROINSULIN - ARUP","code_information":[{"code":"3018420602","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84206","type":"HCPCS"}],"standard_charges":[{"gross_charge":201.0,"discounted_cash":201.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF VITAMIN B-6 - VITAMIN B6","code_information":[{"code":"3018420701","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84207","type":"HCPCS"}],"standard_charges":[{"gross_charge":319.0,"discounted_cash":319.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC VITAMIN B6 - ARUP","code_information":[{"code":"3018420702","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84207","type":"HCPCS"}],"standard_charges":[{"gross_charge":319.0,"discounted_cash":319.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY NON-ENDOCRINE RECEPTOR - SOLUBLE TRANSFERRIN","code_information":[{"code":"3018423804","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84238","type":"HCPCS"}],"standard_charges":[{"gross_charge":362.0,"discounted_cash":362.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SOLUBLE TRANSFERRIN RECEPTOR - ARUP","code_information":[{"code":"3018423806","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84238","type":"HCPCS"}],"standard_charges":[{"gross_charge":362.0,"discounted_cash":362.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RENIN DIRECT LEVEL  - ARUP","code_information":[{"code":"3018424401","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84244","type":"HCPCS"}],"standard_charges":[{"gross_charge":129.0,"discounted_cash":129.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RENIN ACTIVITY  - ARUP","code_information":[{"code":"3018424404","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84244","type":"HCPCS"}],"standard_charges":[{"gross_charge":129.0,"discounted_cash":129.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RENIN ACTIVITY - ALDOSTERONE/RENIN ACTIVITY RATIO - ARUP","code_information":[{"code":"3018424405","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84244","type":"HCPCS"}],"standard_charges":[{"gross_charge":129.0,"discounted_cash":129.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF VITAMIN B-2 - VITAMIN B2","code_information":[{"code":"3018425201","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84252","type":"HCPCS"}],"standard_charges":[{"gross_charge":247.0,"discounted_cash":247.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC VITAMIN B2 - ARUP","code_information":[{"code":"3018425202","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84252","type":"HCPCS"}],"standard_charges":[{"gross_charge":247.0,"discounted_cash":247.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF SELENIUM - SELENIUM SERUM","code_information":[{"code":"3018425501","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84255","type":"HCPCS"}],"standard_charges":[{"gross_charge":186.0,"discounted_cash":186.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SELENIUM SERUM - ARUP","code_information":[{"code":"3018425503","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84255","type":"HCPCS"}],"standard_charges":[{"gross_charge":186.0,"discounted_cash":186.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF SEROTONIN - SEROTONIN SERUM","code_information":[{"code":"3018426001","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84260","type":"HCPCS"}],"standard_charges":[{"gross_charge":182.0,"discounted_cash":182.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF SEX HORMONE BINDING GLOBULIN - SEX HORMONE BINDING GLOBULIN","code_information":[{"code":"3018427001","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84270","type":"HCPCS"}],"standard_charges":[{"gross_charge":104.0,"discounted_cash":104.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SEX HORMONE BINDING GLOBULIN - TESTOSTERONE FREE & TOTAL MALE ADULT-ARUP","code_information":[{"code":"3018427004","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84270","type":"HCPCS"}],"standard_charges":[{"gross_charge":104.0,"discounted_cash":104.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SEX HORMONE BINDING GLOBULIN-TESTOSTERONE BIOAVAIL/SHBG ADULT MALE-ARUP","code_information":[{"code":"3018427006","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84270","type":"HCPCS"}],"standard_charges":[{"gross_charge":104.0,"discounted_cash":104.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SEX HORMONE BINDING GLOBULIN - ARUP","code_information":[{"code":"3018427009","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84270","type":"HCPCS"}],"standard_charges":[{"gross_charge":104.0,"discounted_cash":104.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SEX HORMONE BINDING GLOBULIN-TESTOSTERONE BIOAVAILABLE FEMALE/CHILD-ARUP","code_information":[{"code":"3018427010","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84270","type":"HCPCS"}],"standard_charges":[{"gross_charge":104.0,"discounted_cash":104.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SEX HORMONE BINDING GLOBULIN-TESTOSTERONE FREE & TOTAL FEMALE/CHILD-ARUP","code_information":[{"code":"3018427011","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84270","type":"HCPCS"}],"standard_charges":[{"gross_charge":104.0,"discounted_cash":104.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SODIUM LEVEL","code_information":[{"code":"3018429501","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84295","type":"HCPCS"}],"standard_charges":[{"gross_charge":46.0,"discounted_cash":46.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SODIUM LEVEL URINE RANDOM","code_information":[{"code":"3018430001","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84300","type":"HCPCS"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SODIUM TIMED URINE","code_information":[{"code":"3018430002","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84300","type":"HCPCS"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF URINE SODIUM - SODIUM 24 HOUR URINE","code_information":[{"code":"3018430003","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84300","type":"HCPCS"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SODIUM URINE - ARUP","code_information":[{"code":"3018430006","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84300","type":"HCPCS"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SODIUM - SUPERSATURATION PROFILE, URINE - ARUP","code_information":[{"code":"3018430008","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84300","type":"HCPCS"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF SOMATOMEDIN - INSULIN-LIKE GROWTH FACTOR","code_information":[{"code":"3018430501","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84305","type":"HCPCS"}],"standard_charges":[{"gross_charge":99.0,"discounted_cash":99.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INSULIN LIKE GROWTH FACTOR (IGF) 1 - ARUP","code_information":[{"code":"3018430502","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84305","type":"HCPCS"}],"standard_charges":[{"gross_charge":99.0,"discounted_cash":99.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SPECTROPHOTOMETRY - PORPHYRIN TOTAL","code_information":[{"code":"3018431101","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84311","type":"HCPCS"}],"standard_charges":[{"gross_charge":446.0,"discounted_cash":446.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SPECTROPHOTOMETRY - CHOLESTEROL TOTAL BODY FLUID","code_information":[{"code":"3018431103","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84311","type":"HCPCS"}],"standard_charges":[{"gross_charge":28.0,"discounted_cash":28.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ADENOSINE DEAMINASE PLEURAL FLUID","code_information":[{"code":"3018431105","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84311","type":"HCPCS"}],"standard_charges":[{"gross_charge":95.0,"discounted_cash":95.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PORPHYRIN TOTAL - ARUP","code_information":[{"code":"3018431107","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84311","type":"HCPCS"}],"standard_charges":[{"gross_charge":446.0,"discounted_cash":446.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CHOLESTEROL LEVEL BODY FLUID - ARUP","code_information":[{"code":"3018431108","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84311","type":"HCPCS"}],"standard_charges":[{"gross_charge":28.0,"discounted_cash":28.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ADENOSINE DEAMINASE, PERICARDIAL FLUID - ARUP","code_information":[{"code":"3018431112","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84311","type":"HCPCS"}],"standard_charges":[{"gross_charge":446.0,"discounted_cash":446.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC 15 ANHYDROGLUCITOL LEVEL","code_information":[{"code":"3018437803","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84378","type":"HCPCS"}],"standard_charges":[{"gross_charge":115.0,"discounted_cash":115.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SULFATE - SUPERSATURATION PROFILE - ARUP","code_information":[{"code":"3018439202","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84392","type":"HCPCS"}],"standard_charges":[{"gross_charge":89.0,"discounted_cash":89.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF TESTOSTERONE - TESTOSTERONE TOTAL FREE","code_information":[{"code":"3018440201","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84402","type":"HCPCS"}],"standard_charges":[{"gross_charge":199.0,"discounted_cash":199.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF TOTAL TESTOSTERONE - TESTOSTERONE","code_information":[{"code":"3018440301","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84403","type":"HCPCS"}],"standard_charges":[{"gross_charge":120.0,"discounted_cash":120.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TESTOSTERONE LEVEL TOTAL- TESTOSTERONE FREE & TOTAL MALE ADULT - ARUP","code_information":[{"code":"3018440304","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84403","type":"HCPCS"}],"standard_charges":[{"gross_charge":120.0,"discounted_cash":120.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TESTOSTERONE TOTAL LEVEL","code_information":[{"code":"3018440306","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84403","type":"HCPCS"}],"standard_charges":[{"gross_charge":120.0,"discounted_cash":120.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TESTOSTERONE LEVEL TOTAL- TESTOSTERONE BIOAVAILABLE FEMALE/CHILD - ARUP","code_information":[{"code":"3018440310","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84403","type":"HCPCS"}],"standard_charges":[{"gross_charge":120.0,"discounted_cash":120.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TESTOSTERONE LEVEL TOTAL - TESTOSTERONE FREE & TOTAL FEMALE/CHILD - ARUP","code_information":[{"code":"3018440311","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84403","type":"HCPCS"}],"standard_charges":[{"gross_charge":120.0,"discounted_cash":120.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TESTOSTERONE LEVEL TOTAL FEMALE/CHILD - ARUP","code_information":[{"code":"3018440312","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84403","type":"HCPCS"}],"standard_charges":[{"gross_charge":120.0,"discounted_cash":120.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TESTOSTERONE TOTAL - BIOAVAIL & SEX HORMONE BIND GLOB MALE - ARUP","code_information":[{"code":"3018440314","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84403","type":"HCPCS"}],"standard_charges":[{"gross_charge":120.0,"discounted_cash":120.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF VITAMIN B-1 - VITAMIN B1","code_information":[{"code":"3018442501","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84425","type":"HCPCS"}],"standard_charges":[{"gross_charge":162.0,"discounted_cash":162.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF VITAMIN B-1 - VITAMIN B1, WHOLE BLOOD","code_information":[{"code":"3018442502","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84425","type":"HCPCS"}],"standard_charges":[{"gross_charge":163.0,"discounted_cash":163.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC VITAMIN B1 - ARUP","code_information":[{"code":"3018442504","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84425","type":"HCPCS"}],"standard_charges":[{"gross_charge":162.0,"discounted_cash":162.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC VITAMIN B1 WHOLE BLOOD - ARUP","code_information":[{"code":"3018442505","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84425","type":"HCPCS"}],"standard_charges":[{"gross_charge":163.0,"discounted_cash":163.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF THYROGLOBULIN - THYROGLOBULIN","code_information":[{"code":"3018443201","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84432","type":"HCPCS"}],"standard_charges":[{"gross_charge":114.0,"discounted_cash":114.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC THYROGLOBULIN BY LC/MS","code_information":[{"code":"3018443202","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84432","type":"HCPCS"}],"standard_charges":[{"gross_charge":145.0,"discounted_cash":145.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC THYROGLOBULIN BY CIA","code_information":[{"code":"3018443203","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84432","type":"HCPCS"}],"standard_charges":[{"gross_charge":167.0,"discounted_cash":167.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC THYROGLOBULIN CIA - ARUP","code_information":[{"code":"3018443204","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84432","type":"HCPCS"}],"standard_charges":[{"gross_charge":167.0,"discounted_cash":167.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC THYROGLOBULIN LC - ARUP","code_information":[{"code":"3018443205","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84432","type":"HCPCS"}],"standard_charges":[{"gross_charge":145.0,"discounted_cash":145.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY THIOPURIN S-MTHYLTRNSFRS (TPMT)","code_information":[{"code":"3018443301","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84433","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":65.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC THYROXINE T4 TOTAL","code_information":[{"code":"3018443601","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84436","type":"HCPCS"}],"standard_charges":[{"gross_charge":72.0,"discounted_cash":72.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC T4 THYROID PANEL WITH FTI - ARUP","code_information":[{"code":"3018443603","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84436","type":"HCPCS"}],"standard_charges":[{"gross_charge":72.0,"discounted_cash":72.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC THYROID T4 - ARUP","code_information":[{"code":"3018443604","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84436","type":"HCPCS"}],"standard_charges":[{"gross_charge":72.0,"discounted_cash":72.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC THYROXINE T4 TOTAL - ARUP","code_information":[{"code":"3018443605","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84436","type":"HCPCS"}],"standard_charges":[{"gross_charge":72.0,"discounted_cash":72.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC T4 FREE - THYROXINE FREE","code_information":[{"code":"3018443901","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84439","type":"HCPCS"}],"standard_charges":[{"gross_charge":240.0,"discounted_cash":240.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF THYROXINE BNDNG GLOBULIN - THYROXINE BINDING GLOBULIN","code_information":[{"code":"3018444201","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84442","type":"HCPCS"}],"standard_charges":[{"gross_charge":73.0,"discounted_cash":73.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC THYROID STIMULATING HORMONE","code_information":[{"code":"3018444301","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84443","type":"HCPCS"}],"standard_charges":[{"gross_charge":131.0,"discounted_cash":131.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TSH LEVEL","code_information":[{"code":"3018444303","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84443","type":"HCPCS"}],"standard_charges":[{"gross_charge":131.0,"discounted_cash":131.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TSH LEVEL - TSH CASCADE","code_information":[{"code":"3018444305","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84443","type":"HCPCS"}],"standard_charges":[{"gross_charge":131.0,"discounted_cash":131.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TSH LEVEL - ARUP","code_information":[{"code":"3018444310","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84443","type":"HCPCS"}],"standard_charges":[{"gross_charge":131.0,"discounted_cash":131.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF THYROID STIM IMMUNOGLOBULINS (TSI) - THYROID STIMULATING IM","code_information":[{"code":"3018444501","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84445","type":"HCPCS"}],"standard_charges":[{"gross_charge":247.0,"discounted_cash":247.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC THYROID STIMULATING IMMUNOGLOBULINS (TSI) - ARUP","code_information":[{"code":"3018444502","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84445","type":"HCPCS"}],"standard_charges":[{"gross_charge":247.0,"discounted_cash":247.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF VITAMIN E - VITAMIN E (TOCOPHEROL)","code_information":[{"code":"3018444601","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84446","type":"HCPCS"}],"standard_charges":[{"gross_charge":89.0,"discounted_cash":89.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC VITAMIN E (TOCOPHEROL) - ARUP","code_information":[{"code":"3018444602","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84446","type":"HCPCS"}],"standard_charges":[{"gross_charge":89.0,"discounted_cash":89.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC AST (SGOT) SERUM/PLASMA","code_information":[{"code":"3018445001","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84450","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.0,"discounted_cash":80.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC LIVER FIBROSIS PANEL - AST","code_information":[{"code":"3018445004","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84450","type":"HCPCS"}],"standard_charges":[{"gross_charge":96.0,"discounted_cash":96.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC NON ALCOHOLIC FATTY LIVER DISEASE PANEL - AST","code_information":[{"code":"3018445005","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84450","type":"HCPCS"}],"standard_charges":[{"gross_charge":37.0,"discounted_cash":37.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC AST - LIVER FIBROSIS CHRONIC VIRAL HEPATITIS FIBROMETER PANEL - ARUP","code_information":[{"code":"3018445007","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84450","type":"HCPCS"}],"standard_charges":[{"gross_charge":96.0,"discounted_cash":96.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALT (SPGT) SERUM/PLASMA","code_information":[{"code":"3018446001","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84460","type":"HCPCS"}],"standard_charges":[{"gross_charge":82.0,"discounted_cash":82.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC LIVER FIBROSIS PANEL - ALT","code_information":[{"code":"3018446004","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84460","type":"HCPCS"}],"standard_charges":[{"gross_charge":91.0,"discounted_cash":91.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC NON ALCOHOLIC FATTY LIVER DISEASE PANEL - ALT","code_information":[{"code":"3018446005","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84460","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.0,"discounted_cash":38.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALT - LIVER FIBROSIS CHRONIC VIRAL HEPATITIS FIBROMETER PANEL - ARUP","code_information":[{"code":"3018446007","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84460","type":"HCPCS"}],"standard_charges":[{"gross_charge":91.0,"discounted_cash":91.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TRANSFERRIN LEVEL","code_information":[{"code":"3018446601","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84466","type":"HCPCS"}],"standard_charges":[{"gross_charge":72.0,"discounted_cash":72.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TRIGLYCERIDES","code_information":[{"code":"3018447801","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84478","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":65.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TRIGLYCERIDES, BODY FLUID - ARUP","code_information":[{"code":"3018447804","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84478","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":65.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC THYROID HORM UPTAKE/THYR HORM BINDING RATIO - T3 UPTAKE","code_information":[{"code":"3018447901","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84479","type":"HCPCS"}],"standard_charges":[{"gross_charge":68.0,"discounted_cash":68.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC T3 UPTAKE - ARUP","code_information":[{"code":"3018447904","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84479","type":"HCPCS"}],"standard_charges":[{"gross_charge":68.0,"discounted_cash":68.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC T3 UPTAKE - THYROID PANEL WITH FTI- ARUP","code_information":[{"code":"3018447905","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84479","type":"HCPCS"}],"standard_charges":[{"gross_charge":68.0,"discounted_cash":68.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TRIIODOTHYRONINE TOTAL ASSAY, TT-3 - T3 (THYROID HORMONE)","code_information":[{"code":"3018448001","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84480","type":"HCPCS"}],"standard_charges":[{"gross_charge":159.0,"discounted_cash":159.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC T3 FREE","code_information":[{"code":"3018448101","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84481","type":"HCPCS"}],"standard_charges":[{"gross_charge":159.0,"discounted_cash":159.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC T3, FREE - ARUP","code_information":[{"code":"3018448102","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84481","type":"HCPCS"}],"standard_charges":[{"gross_charge":159.0,"discounted_cash":159.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TRIIODOTHYRONINE T3 REVERSE - T3 REVERSE","code_information":[{"code":"3018448201","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84482","type":"HCPCS"}],"standard_charges":[{"gross_charge":129.0,"discounted_cash":129.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TRIIODOTHYRONINE (T3) REVERSE - ARUP","code_information":[{"code":"3018448202","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84482","type":"HCPCS"}],"standard_charges":[{"gross_charge":129.0,"discounted_cash":129.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TROPONIN T HIGH SENSITIVITY","code_information":[{"code":"3018448401","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84484","type":"HCPCS"}],"standard_charges":[{"gross_charge":140.0,"discounted_cash":140.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TROPONIN T QUANT HIGH SENSITIVITY","code_information":[{"code":"3018448404","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84484","type":"HCPCS"}],"standard_charges":[{"gross_charge":140.0,"discounted_cash":140.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY TYROSINE - TYROSINE","code_information":[{"code":"3018451001","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84510","type":"HCPCS"}],"standard_charges":[{"gross_charge":144.0,"discounted_cash":144.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BLOOD UREA NITROGEN - BUN","code_information":[{"code":"3018452001","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84520","type":"HCPCS"}],"standard_charges":[{"gross_charge":96.0,"discounted_cash":96.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC UREA NITROGEN BODY FLUID","code_information":[{"code":"3018452005","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84520","type":"HCPCS"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":32.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BUN - LIVER FIBROSIS CHRONIC VIRAL HEPATITIS FIBROMETER PANEL - ARUP","code_information":[{"code":"3018452007","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84520","type":"HCPCS"}],"standard_charges":[{"gross_charge":96.0,"discounted_cash":96.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC UREA NITROGEN URINE RANDOM","code_information":[{"code":"3018454002","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84540","type":"HCPCS"}],"standard_charges":[{"gross_charge":85.0,"discounted_cash":85.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC UREA NITROGEN, URINE - ARUP","code_information":[{"code":"3018454003","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84540","type":"HCPCS"}],"standard_charges":[{"gross_charge":85.0,"discounted_cash":85.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC URIC ACID LEVEL","code_information":[{"code":"3018455001","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84550","type":"HCPCS"}],"standard_charges":[{"gross_charge":58.0,"discounted_cash":58.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC URIC ACID SUPERSATURATION PROFILE, URINE - ARUP","code_information":[{"code":"3018456005","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84560","type":"HCPCS"}],"standard_charges":[{"gross_charge":100.0,"discounted_cash":100.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC URIC ACID LEVEL URINE 24 HOUR - ARUP","code_information":[{"code":"3018456012","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84560","type":"HCPCS"}],"standard_charges":[{"gross_charge":100.0,"discounted_cash":100.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF URINE VMA - VMA, URINE","code_information":[{"code":"3018458502","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84585","type":"HCPCS"}],"standard_charges":[{"gross_charge":166.0,"discounted_cash":166.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC VANILLYLMANDELIC ACID (VMA) URINE - ARUP","code_information":[{"code":"3018458503","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84585","type":"HCPCS"}],"standard_charges":[{"gross_charge":166.0,"discounted_cash":166.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF VIP - VASOACTIVE INTESTINAL PEPTIDE (VIP)","code_information":[{"code":"3018458601","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84586","type":"HCPCS"}],"standard_charges":[{"gross_charge":121.0,"discounted_cash":121.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF VASOPRESSIN - ARGININE VASOPRESSIN HORMONE","code_information":[{"code":"3018458801","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84588","type":"HCPCS"}],"standard_charges":[{"gross_charge":164.0,"discounted_cash":164.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ARGININE VASOPRESSIN HORMONE - ARUP","code_information":[{"code":"3018458802","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84588","type":"HCPCS"}],"standard_charges":[{"gross_charge":164.0,"discounted_cash":164.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF VITAMIN A - VITAMIN A","code_information":[{"code":"3018459001","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84590","type":"HCPCS"}],"standard_charges":[{"gross_charge":114.0,"discounted_cash":114.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC VITAMIN A - ARUP","code_information":[{"code":"3018459002","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84590","type":"HCPCS"}],"standard_charges":[{"gross_charge":114.0,"discounted_cash":114.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF NOS VITAMIN - NIACIN (VITAMIN B3)","code_information":[{"code":"3018459101","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84591","type":"HCPCS"}],"standard_charges":[{"gross_charge":195.0,"discounted_cash":195.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC NIACIN (VITAMIN B3) - ARUP","code_information":[{"code":"3018459105","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84591","type":"HCPCS"}],"standard_charges":[{"gross_charge":195.0,"discounted_cash":195.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC VITAMIN B5 (PANTOTHENIC ACID) LEVEL - ARUP","code_information":[{"code":"3018459106","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84591","type":"HCPCS"}],"standard_charges":[{"gross_charge":308.0,"discounted_cash":308.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC VITAMIN B7 (BIOTIN) LEVEL - ARUP","code_information":[{"code":"3018459107","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84591","type":"HCPCS"}],"standard_charges":[{"gross_charge":250.0,"discounted_cash":250.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF VITAMIN K - VITAMIN K","code_information":[{"code":"3018459701","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84597","type":"HCPCS"}],"standard_charges":[{"gross_charge":182.0,"discounted_cash":182.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC VITAMIN K - ARUP","code_information":[{"code":"3018459702","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84597","type":"HCPCS"}],"standard_charges":[{"gross_charge":182.0,"discounted_cash":182.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF ZINC - ZINC","code_information":[{"code":"3018463001","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84630","type":"HCPCS"}],"standard_charges":[{"gross_charge":109.0,"discounted_cash":109.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF ZINC - ZINC, WHOLE BLOOD","code_information":[{"code":"3018463002","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84630","type":"HCPCS"}],"standard_charges":[{"gross_charge":95.0,"discounted_cash":95.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF ZINC - ZINC RBC","code_information":[{"code":"3018463003","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84630","type":"HCPCS"}],"standard_charges":[{"gross_charge":135.0,"discounted_cash":135.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ZINC LEVEL RBC - ARUP","code_information":[{"code":"3018463005","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84630","type":"HCPCS"}],"standard_charges":[{"gross_charge":135.0,"discounted_cash":135.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ZINC WHOLE BLOOD - ARUP","code_information":[{"code":"3018463006","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84630","type":"HCPCS"}],"standard_charges":[{"gross_charge":95.0,"discounted_cash":95.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF C-PEPTIDE - C-PEPTIDE","code_information":[{"code":"3018468101","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84681","type":"HCPCS"}],"standard_charges":[{"gross_charge":116.0,"discounted_cash":116.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC C PEPTIDE LEVEL - ARUP","code_information":[{"code":"3018468104","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84681","type":"HCPCS"}],"standard_charges":[{"gross_charge":116.0,"discounted_cash":116.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CHORIONIC GONADOTROPIN, QUANT - HCG QUANTITATIVE BLOOD","code_information":[{"code":"3018470201","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84702","type":"HCPCS"}],"standard_charges":[{"gross_charge":112.0,"discounted_cash":112.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CHORIONIC GONADOTROPIN, QUANT - HCG TUMOR MARKER","code_information":[{"code":"3018470204","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84702","type":"HCPCS"}],"standard_charges":[{"gross_charge":112.0,"discounted_cash":112.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HCG QUANTITATIVE TUMOR MARKER BLOOD - ARUP","code_information":[{"code":"3018470210","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84702","type":"HCPCS"}],"standard_charges":[{"gross_charge":112.0,"discounted_cash":112.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HCG PREGNANCY URINE QUAL","code_information":[{"code":"3018470301","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84703","type":"HCPCS"}],"standard_charges":[{"gross_charge":92.0,"discounted_cash":92.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CHORIONIC GONADOTROPIN, QUAL - HCG QUALITATIVE SERUM PLASMA","code_information":[{"code":"3018470302","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84703","type":"HCPCS"}],"standard_charges":[{"gross_charge":169.0,"discounted_cash":169.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IMMUNFIX E-PHORSIS URINE - IMMUNOFIXATION WITH FLC, URINE - ARUP","code_information":[{"code":"3018633502","type":"CDM"},{"code":"0301","type":"RC"},{"code":"86335","type":"HCPCS"}],"standard_charges":[{"gross_charge":146.0,"discounted_cash":146.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IMMUNFIX EPHORESIS  BETA 2 TRANSFERRIN","code_information":[{"code":"3018633504","type":"CDM"},{"code":"0301","type":"RC"},{"code":"86335","type":"HCPCS"}],"standard_charges":[{"gross_charge":146.0,"discounted_cash":146.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TISSUE TRANSGLUTAMINASE ANTIBODY, IGG","code_information":[{"code":"3018636401","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86364","type":"HCPCS"}],"standard_charges":[{"gross_charge":143.0,"discounted_cash":143.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TISSUE TRANSGLUTAMINASE ANTIBODY, IGA","code_information":[{"code":"3018636402","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86364","type":"HCPCS"}],"standard_charges":[{"gross_charge":61.0,"discounted_cash":61.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TISSUE TRANSGLUTAMINASE IGA - CELIAC CASCADE SCREEN","code_information":[{"code":"3018636403","type":"CDM"},{"code":"0301","type":"RC"},{"code":"86364","type":"HCPCS"}],"standard_charges":[{"gross_charge":61.0,"discounted_cash":61.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TISSUE TRANSGLUTAMINASE IGA WITH REFLEX TITER - ARUP","code_information":[{"code":"3018636406","type":"CDM"},{"code":"0301","type":"RC"},{"code":"86364","type":"HCPCS"}],"standard_charges":[{"gross_charge":61.0,"discounted_cash":61.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TISSUE TRANSGLUTAMINASE IGG - ARUP","code_information":[{"code":"3018636408","type":"CDM"},{"code":"0301","type":"RC"},{"code":"86364","type":"HCPCS"}],"standard_charges":[{"gross_charge":143.0,"discounted_cash":143.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TISSUE TRANSGLUTAMINASE IGA - ARUP","code_information":[{"code":"3018636410","type":"CDM"},{"code":"0301","type":"RC"},{"code":"86364","type":"HCPCS"}],"standard_charges":[{"gross_charge":61.0,"discounted_cash":61.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RHEUMATOID FACTOR - RHEUMATOID ARTHRITIS PANEL - ARUP","code_information":[{"code":"3018643102","type":"CDM"},{"code":"0301","type":"RC"},{"code":"86431","type":"HCPCS"}],"standard_charges":[{"gross_charge":157.0,"discounted_cash":157.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BILIRUBIN TOTAL TRANSCUTANEOUS","code_information":[{"code":"3018872001","type":"CDM"},{"code":"0301","type":"RC"},{"code":"88720","type":"HCPCS"}],"standard_charges":[{"gross_charge":41.0,"discounted_cash":41.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DRUG ID PANEL 1 - 7 CLASSES PER DAY","code_information":[{"code":"301G048001","type":"CDM"},{"code":"0301","type":"RC"},{"code":"G0480","type":"HCPCS"}],"standard_charges":[{"gross_charge":199.0,"discounted_cash":199.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TITIN AB - ACHR, TITIN, STM AB REFLEX PANEL - ARUP","code_information":[{"code":"3028351605","type":"CDM"},{"code":"0302","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":110.0,"discounted_cash":110.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGEN SPEC IGG QUANT,EACH - ALLERGEN, FOOD, BAKER'S YEAST IGG","code_information":[{"code":"3028600104","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86001","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.0,"discounted_cash":87.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGEN SPEC IGG QUANT,EACH - ALLERGEN, FOOD, BARLEY IGG","code_information":[{"code":"3028600105","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86001","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.0,"discounted_cash":87.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGEN SPEC IGG QUANT,EACH - ALLERGEN, FOOD, BEEF IGG","code_information":[{"code":"3028600106","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86001","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.0,"discounted_cash":87.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGEN SPEC IGG QUANT,EACH - ALLERGEN, FOOD, CHICKEN IGG","code_information":[{"code":"3028600107","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86001","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.0,"discounted_cash":87.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGEN SPEC IGG QUANT,EACH - ALLERGEN, FOOD, CHOCOLATE IGG","code_information":[{"code":"3028600108","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86001","type":"HCPCS"}],"standard_charges":[{"gross_charge":77.0,"discounted_cash":77.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGEN SPEC IGG QUANT,EACH - ALLERGEN, FOOD, CORN IGG","code_information":[{"code":"3028600110","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86001","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.0,"discounted_cash":87.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGEN SPEC IGG QUANT,EACH - ALLERGEN, FOOD, EGG WHITE IGG","code_information":[{"code":"3028600111","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86001","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.0,"discounted_cash":87.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGEN SPEC IGG QUANT,EACH - ALLERGEN, FOOD, LETTUCE IGG","code_information":[{"code":"3028600114","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86001","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.0,"discounted_cash":87.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGEN SPEC IGG QUANT,EACH - ALLERGEN, FOOD, MALT IGG","code_information":[{"code":"3028600115","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86001","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.0,"discounted_cash":87.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGEN SPEC IGG QUANT,EACH - ALLERGEN, FOOD, MILK (COW'S) IGG","code_information":[{"code":"3028600116","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86001","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.0,"discounted_cash":87.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGEN SPEC IGG QUANT,EACH - ALLERGEN, FOOD, OAT IGG","code_information":[{"code":"3028600118","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86001","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.0,"discounted_cash":87.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGEN SPEC IGG QUANT,EACH - ALLERGEN, FOOD, ORANGE IGG","code_information":[{"code":"3028600121","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86001","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.0,"discounted_cash":87.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGEN SPEC IGG QUANT,EACH - ALLERGEN, FOOD, PEANUT IGG","code_information":[{"code":"3028600122","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86001","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.0,"discounted_cash":87.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGEN SPEC IGG QUANT,EACH - ALLERGEN, FOOD, PORK IGG","code_information":[{"code":"3028600123","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86001","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.0,"discounted_cash":87.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGEN SPEC IGG QUANT,EACH - ALLERGEN, FOOD, RYE IGG","code_information":[{"code":"3028600126","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86001","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.0,"discounted_cash":87.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGEN SPEC IGG QUANT,EACH - ALLERGEN, FOOD, SOYBEAN IGG","code_information":[{"code":"3028600127","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86001","type":"HCPCS"}],"standard_charges":[{"gross_charge":77.0,"discounted_cash":77.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGEN SPEC IGG QUANT,EACH - TOMATO","code_information":[{"code":"3028600139","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86001","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.0,"discounted_cash":87.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGEN SPEC IGG QUANT,EACH - WHEAT","code_information":[{"code":"3028600140","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86001","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.0,"discounted_cash":87.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGEN SPEC IGG QUANT,EACH - WHITE POTATO","code_information":[{"code":"3028600141","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86001","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.0,"discounted_cash":87.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGEN SPEC IGG QUANT,EACH - PENICILLIUM NOTATUM","code_information":[{"code":"3028600146","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86001","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.0,"discounted_cash":87.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST CASEIN (COW'S MILK) IGG - ARUP","code_information":[{"code":"3028600149","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86001","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.0,"discounted_cash":87.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST PENICILLIUM NOTATUM IGG - ARUP","code_information":[{"code":"3028600150","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86001","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.0,"discounted_cash":87.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST ALMONDS IGE","code_information":[{"code":"3028600303","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":75.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGEN SPEC IGE - ALLERGEN ASH, WHITE IGE","code_information":[{"code":"3028600308","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":61.0,"discounted_cash":61.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST DOG DANDER IGE - ARUP","code_information":[{"code":"302860030H","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":75.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST CAT HAIR DANDER IGE - ARUP","code_information":[{"code":"302860030L","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":75.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST DERMATOPHAGOIDES FARINAE (HOUSE DUST MITE) IGE - ARUP","code_information":[{"code":"302860030S","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":75.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST DERMATOPHAGOIDES PTERONYSSINUS (HOUSE DUST MITE) IGE - ARUP","code_information":[{"code":"302860030U","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":75.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST ASPERGILLUS NIGER IGE - ARUP","code_information":[{"code":"302860030W","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":61.0,"discounted_cash":61.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST ASPERGILLUS FUMAGATUS IGE","code_information":[{"code":"3028600310","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":75.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGEN SPEC IGE - ALLERGEN ASPERGILLUS NIGER IGE","code_information":[{"code":"3028600311","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":61.0,"discounted_cash":61.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGEN SPEC IGE - ALLERGEN BARLEY IGE","code_information":[{"code":"3028600314","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":75.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST GERMAN COCKROACH IGE","code_information":[{"code":"302860031B","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":75.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGEN SPEC IGE - ALLERGEN VENOM: EUROPEAN PAPER WASP","code_information":[{"code":"302860031G","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":75.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST MACADAMIA NUT IGE - ARUP","code_information":[{"code":"302860031M","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":61.0,"discounted_cash":61.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST COCONUT IGE - ARUP","code_information":[{"code":"302860031S","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":75.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST CASHEW IGE - ARUP","code_information":[{"code":"302860031X","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":32.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST PEANUT IGE - ARUP","code_information":[{"code":"302860031Y","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":75.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST BEECH AMERICAN IGE","code_information":[{"code":"3028600320","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":61.0,"discounted_cash":61.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST BEEF IGE","code_information":[{"code":"3028600321","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":75.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST BEEF IGE - ARUP","code_information":[{"code":"3028600322","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":75.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST BERMUDA GRASS IGE","code_information":[{"code":"3028600323","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":75.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST BIRCH TREE IGE","code_information":[{"code":"3028600324","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":75.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST BIRCH TREE IGE - ARUP","code_information":[{"code":"3028600326","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":75.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGEN SPEC IGE - ALLERGEN BRAZIL NUT IGE","code_information":[{"code":"3028600329","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":61.0,"discounted_cash":61.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST BERMUDA GRASS IGE - ARUP","code_information":[{"code":"302860032B","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":75.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST OYSTER IGE - ARUP","code_information":[{"code":"302860032C","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":75.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST ASH, WHITE IGE - ARUP","code_information":[{"code":"302860032D","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":61.0,"discounted_cash":61.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST CEDAR, MOUNTAIN IGE","code_information":[{"code":"302860032F","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":75.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST OAK, WHITE IGE - ARUP","code_information":[{"code":"302860032G","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":75.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST SYCAMORE, AMERICAN IGE - ARUP","code_information":[{"code":"302860032H","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":75.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST WILLOW, BLACK IGE - ARUP","code_information":[{"code":"302860032I","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":61.0,"discounted_cash":61.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGEN SPEC IGE - ALLERGEN FOOD: RJUG R 1 WALNUT","code_information":[{"code":"302860032L","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":74.0,"discounted_cash":74.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST WALNUT JUGLANS REGIA IGE - ARUP","code_information":[{"code":"302860032M","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":75.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST ELM TREE IGE - ARUP","code_information":[{"code":"302860032R","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":75.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST MUGWORT IGE - ARUP","code_information":[{"code":"302860032U","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":75.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST RAGWEED, FALSE IGE - ARUP","code_information":[{"code":"302860032V","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":75.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST EUROPEAN PAPER WASP IGE - ARUP","code_information":[{"code":"302860032W","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":75.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST THISTLE, RUSSIAN IGE - ARUP","code_information":[{"code":"302860032X","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":75.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGEN SPEC IGE - ALLERGEN CABBAGE IGE","code_information":[{"code":"3028600335","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":61.0,"discounted_cash":61.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST CANDIDA ALBICANS IGE","code_information":[{"code":"3028600337","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":72.0,"discounted_cash":72.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST COCKROACH, AMERICAN IGE - ARUP","code_information":[{"code":"302860033B","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":70.0,"discounted_cash":70.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST FIRE ANT (INVICTA) IGE - ARUP","code_information":[{"code":"302860033C","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":61.0,"discounted_cash":61.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST HONEYBEE IGE - ARUP","code_information":[{"code":"302860033D","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":75.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST HORNET, YELLOW IGE - ARUP","code_information":[{"code":"302860033F","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":61.0,"discounted_cash":61.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST HORNET, WHITE FACE IGE - ARUP","code_information":[{"code":"302860033M","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":61.0,"discounted_cash":61.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST MAPLE TREE BOX ELDER IGE - ARUP","code_information":[{"code":"302860033O","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":75.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST HICKORY TREE WHITE (SHAGBARK) IGE - ARUP","code_information":[{"code":"302860033S","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":61.0,"discounted_cash":61.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST ALTERNARIA ALTERNATA IGE - ARUP","code_information":[{"code":"302860033X","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":61.0,"discounted_cash":61.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST MUCOR RACEMOSUS IGE","code_information":[{"code":"302860033Y","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":75.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGEN SPEC IGE - ALLERGEN CARROT IGE","code_information":[{"code":"3028600340","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":75.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST CASHEW IGE","code_information":[{"code":"3028600342","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":32.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST CAT HAIR DANDER IGE","code_information":[{"code":"3028600344","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":75.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST PISTACHIO IGE - ARUP","code_information":[{"code":"302860034A","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":72.0,"discounted_cash":72.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST TREE MULBERRY (MORUS ALBA) IGE - ARUP","code_information":[{"code":"302860034H","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":61.0,"discounted_cash":61.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST STEMPHYLIUM BOTRYOSUM IGE - ARUP","code_information":[{"code":"302860034O","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":14.0,"discounted_cash":14.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST HORSE DANDER IGE - ARUP","code_information":[{"code":"302860034Q","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":75.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST WALNUT TREE IGE - ARUP","code_information":[{"code":"302860034R","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":74.0,"discounted_cash":74.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST MITES BLOMIA TROPICALIS IGE","code_information":[{"code":"302860034T","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":61.0,"discounted_cash":61.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST SHRIMP IGE - ARUP","code_information":[{"code":"302860034V","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":75.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGEN SPEC IGE - ALLERGEN CHERRY, BING IGE","code_information":[{"code":"3028600352","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":61.0,"discounted_cash":61.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST CHICKEN IGE","code_information":[{"code":"3028600353","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":75.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST CLAMS IGE","code_information":[{"code":"3028600359","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":75.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST CLAMS IGE - ARUP","code_information":[{"code":"302860035A","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":75.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST GUM, SWEET IGE - ARUP","code_information":[{"code":"302860035B","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":26.0,"discounted_cash":26.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST RAGWEED SHORT/COMMON IGE - ARUP","code_information":[{"code":"302860035P","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":75.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST WESTERN RAGWEED IGE - ARUP","code_information":[{"code":"302860035Q","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":75.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGEN SPEC IGE - ALLERGEN COCKROACH, AMERICAN IGE","code_information":[{"code":"3028600362","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":70.0,"discounted_cash":70.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST COCONUT IGE","code_information":[{"code":"3028600363","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":75.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST CODFISH IGE","code_information":[{"code":"3028600364","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":75.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST CORN IGE","code_information":[{"code":"3028600366","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":75.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST COTTONWOOD TREE IGE","code_information":[{"code":"3028600369","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":75.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST OLIVE TREE IGE - ARUP","code_information":[{"code":"302860036A","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":75.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST COTTONWOOD TREE IGE - ARUP","code_information":[{"code":"302860036B","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":75.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGEN SPEC IGE - ALLERGEN FOOD: PISTACHIO","code_information":[{"code":"302860036C","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":72.0,"discounted_cash":72.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGEN SPEC IGE - ALLERGEN FOOD: SWEET CHESTNUT","code_information":[{"code":"302860036I","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":61.0,"discounted_cash":61.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST CORN SMUT IGE - ARUP","code_information":[{"code":"302860036J","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":75.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGEN SPEC IGE - ALLERGEN TREE: MULBERRY (MORUS ALBA) IGE","code_information":[{"code":"302860036U","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":61.0,"discounted_cash":61.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST ASPERGILLUS FUMAGATUS IGE - ARUP","code_information":[{"code":"302860036Y","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":75.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST CRAB IGE","code_information":[{"code":"3028600371","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":75.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST CRAB IGE - ARUP","code_information":[{"code":"3028600373","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":75.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGEN SPEC IGE - ALLERGEN CUCUMBER IGE","code_information":[{"code":"3028600374","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":61.0,"discounted_cash":61.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGEN SPEC IGE - ALLERGEN WEED: DANDELION IGE","code_information":[{"code":"3028600377","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":61.0,"discounted_cash":61.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST MAPLE SUGAR TREE IGE - ARUP","code_information":[{"code":"302860037A","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":75.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST ALTERNARIA ALTERNATA  IGE","code_information":[{"code":"302860037S","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":75.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST EGG YOLK IGE - ARUP","code_information":[{"code":"3028600382","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":75.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST EGG YOLK IGE","code_information":[{"code":"3028600383","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":75.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST EGG WHOLE IGE","code_information":[{"code":"3028600384","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":57.0,"discounted_cash":57.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST EGG WHOLE IGE - ARUP","code_information":[{"code":"3028600385","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":57.0,"discounted_cash":57.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST ELM TREE IGE","code_information":[{"code":"3028600386","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":75.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST WEED ENGLISH PLANTAIN IGE","code_information":[{"code":"3028600387","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":75.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST WEED ENGLISH PLANTAIN IGE - ARUP","code_information":[{"code":"3028600389","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":75.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST BAHIA GRASS IGE","code_information":[{"code":"302860038A","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":75.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST BAHIA GRASS IGE - ARUP","code_information":[{"code":"302860038B","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":75.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST CEDAR, MOUNTAIN IGE - ARUP","code_information":[{"code":"302860038L","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":75.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST DERMATOPHAGOIDES FARINAE (HOUSE DUST MITE) IGE","code_information":[{"code":"302860038U","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":75.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST DERMATOPHAGOIDES PTERONYSSINUS (HOUSE DUST MITE) IGE","code_information":[{"code":"302860038V","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":75.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST DOG DANDER IGE","code_information":[{"code":"302860038Z","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":75.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST FESCUE, MEADOW IGE - ARUP","code_information":[{"code":"3028600393","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":72.0,"discounted_cash":72.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGEN SPEC IGE - ALLERGEN FIRE ANT (INVICTA) IGE","code_information":[{"code":"3028600395","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":61.0,"discounted_cash":61.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST EGG WHITE IGE","code_information":[{"code":"302860039B","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":75.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST EGG WHITE IGE - ARUP","code_information":[{"code":"302860039C","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":75.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST HELMINTHOSPORIUM SETOMELANOMMA ROSTRATA IGE","code_information":[{"code":"302860039K","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":26.0,"discounted_cash":26.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGEN SPEC IGE - ALLERGEN HORMODENDRUM HORDEI","code_information":[{"code":"302860039M","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":66.0,"discounted_cash":66.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST HORMODENDRUM (CLADOSPORIUM) IGE - ARUP","code_information":[{"code":"302860039N","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":66.0,"discounted_cash":66.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST JOHNSON GRASS IGE","code_information":[{"code":"302860039Q","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":75.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST JOHNSON GRASS IGE - ARUP","code_information":[{"code":"302860039R","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":75.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST EUCALYPTUS TREE IGE - ARUP","code_information":[{"code":"302860039T","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":75.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST MESQUITE TREE IGE - ARUP","code_information":[{"code":"302860039U","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":75.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST GIANT RAGWEED IGE - ARUP","code_information":[{"code":"30286003A4","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":75.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST WESTERN WATER HEMP (AMARANTHUS SPP) IGE - ARUP","code_information":[{"code":"30286003A5","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":75.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST COW MILK IGE","code_information":[{"code":"30286003AA","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":75.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGEN SPEC IGE - ALLERGEN OAK,WHITE IGE","code_information":[{"code":"30286003AH","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":75.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST PECAN TREE IGE","code_information":[{"code":"30286003AP","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":61.0,"discounted_cash":61.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST PENICILLIUM NOTATUM IGE","code_information":[{"code":"30286003AQ","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":75.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGEN SPEC IGE - ALLERGEN PERCH IGE","code_information":[{"code":"30286003AU","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":61.0,"discounted_cash":61.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST POTATO, WHITE IGE","code_information":[{"code":"30286003AZ","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":75.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST RAGWEED, GIANT IGE","code_information":[{"code":"30286003B0","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":75.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST MOUSE EPITHELIUM IGE - ARUP","code_information":[{"code":"30286003B2","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":61.0,"discounted_cash":61.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGEN SPEC IGE - ALLERGEN SAGEBRUSH, COMMON IGE","code_information":[{"code":"30286003BK","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":61.0,"discounted_cash":61.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGEN SPEC IGE - ALLERGEN SEASONAL INHALANTS PANEL","code_information":[{"code":"30286003BP","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":74.0,"discounted_cash":74.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGEN SPEC IGE - ALLERGEN STEMPHYLIUM BOTRYOSUM IGE","code_information":[{"code":"30286003BU","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":14.0,"discounted_cash":14.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGEN SPEC IGE - ALLERGEN SYCAMORE, AMERICAN IGE","code_information":[{"code":"30286003BZ","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":75.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST PEANUT IGE","code_information":[{"code":"30286003C3","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":75.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST WILLOW TREE IGE - ARUP","code_information":[{"code":"30286003C6","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":75.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST TIMOTHY GRASS IGE","code_information":[{"code":"30286003CB","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":75.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST WHEAT IGE - ARUP","code_information":[{"code":"30286003CF","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":75.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGEN SPEC IGE - LATEX, IGE","code_information":[{"code":"30286003CK","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":75.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST GLUTEN IGE - ARUP","code_information":[{"code":"30286003D1","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":75.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST PECAN NUT IGE - ARUP","code_information":[{"code":"30286003D2","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":75.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST PECAN NUT IGE","code_information":[{"code":"30286003D3","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":75.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST JUNE GRASS IGE","code_information":[{"code":"30286003DA","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":75.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGEN SPEC IGE - ALLERGEN EACH","code_information":[{"code":"30286003DB","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":75.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGEN SPEC IGE - ALLERGEN MUGWORT IGE","code_information":[{"code":"30286003F2","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":75.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGEN SPEC IGE - ALLERGEN YELLOW JACKET IGE","code_information":[{"code":"30286003F6","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":75.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST YELLOW JACKET IGE - ARUP","code_information":[{"code":"30286003F7","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":75.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGEN SPEC IGE - ALLERGEN LAMB IGE","code_information":[{"code":"30286003H1","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":75.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGEN SPEC IGE - ALLERGEN GRAPE IGE","code_information":[{"code":"30286003I0","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":75.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST LAMB'S QUARTER IGE","code_information":[{"code":"30286003I1","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":75.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGEN SPEC IGE - ALLERGEN MUSSEL IGE","code_information":[{"code":"30286003I2","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":72.0,"discounted_cash":72.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGEN SPEC IGE - ALLERGEN RICE IGE","code_information":[{"code":"30286003I4","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":75.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGEN SPEC IGE - ALLERGEN THISTLE, RUSSIAN IGE","code_information":[{"code":"30286003I5","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":75.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST LAMB'S QUARTER IGE - ARUP","code_information":[{"code":"30286003I7","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":75.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST TIMOTHY GRASS IGE - ARUP","code_information":[{"code":"30286003I8","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":75.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST HOUSE DUST STIER IGE","code_information":[{"code":"30286003J0","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":75.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST HOUSE DUST GREER IGE - ARUP","code_information":[{"code":"30286003J8","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":75.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST NETTLE WEED IGE","code_information":[{"code":"30286003K2","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":75.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGEN SPEC IGE - ALLERGEN PEPPER, GREEN BELL IGE","code_information":[{"code":"30286003K3","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":75.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGEN SPEC IGE - ALLERGEN RYE IGE","code_information":[{"code":"30286003K4","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":75.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST TOMATO IGE","code_information":[{"code":"30286003K5","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":75.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST NETTLE WEED IGE - ARUP","code_information":[{"code":"30286003K6","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":75.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGEN SPEC IGE - ALLERGEN GUM, SWEET IGE","code_information":[{"code":"30286003L0","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":26.0,"discounted_cash":26.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST HACKBERRY IGE - ARUP","code_information":[{"code":"30286003M0","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":75.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST OAK, LIVE/VIRGINIA IGE - ARUP","code_information":[{"code":"30286003M2","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":61.0,"discounted_cash":61.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGEN SPEC IGE - ALLERGEN TROUT IGE","code_information":[{"code":"30286003M5","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":61.0,"discounted_cash":61.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGEN SPEC IGE - ALLERGEN LETTUCE IGE","code_information":[{"code":"30286003N1","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":75.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST OAT IGE","code_information":[{"code":"30286003N2","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":75.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST SALMON IGE","code_information":[{"code":"30286003N4","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":75.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST TUNA IGE","code_information":[{"code":"30286003N5","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":75.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST PIGWEED ROUGH IGE","code_information":[{"code":"30286003O3","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":75.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST PIGWEED ROUGH IGE - ARUP","code_information":[{"code":"30286003O6","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":75.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST FOOD HAZELNUT (FILBERT) IGE - ARUP","code_information":[{"code":"30286003OO","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":75.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST FOOD HAZELNUT (FILBERT) IGE","code_information":[{"code":"30286003P0","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":75.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST LOBSTER IGE","code_information":[{"code":"30286003P1","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":75.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST CARELESS WEED IGE - ARUP","code_information":[{"code":"30286003P6","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":75.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGEN SPEC IGE - ALLERGEN YEAST, BAKER'S IGE","code_information":[{"code":"30286003PP","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":75.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGEN SPEC IGE - ALLERGEN PINEAPPLE IGE","code_information":[{"code":"30286003Q3","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":61.0,"discounted_cash":61.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST SCALLOP IGE","code_information":[{"code":"30286003Q4","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":66.0,"discounted_cash":66.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST SCALLOP IGE - ARUP","code_information":[{"code":"30286003Q5","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":75.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGEN SPEC IGE - ALLERGEN HICKORY, WHITE IGE","code_information":[{"code":"30286003R0","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":61.0,"discounted_cash":61.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGEN SPEC IGE - ALLERGEN MACKEREL IGE","code_information":[{"code":"30286003R1","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":61.0,"discounted_cash":61.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST SESAME SEED IGE - ARUP","code_information":[{"code":"30286003R3","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":75.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST SESAME SEED IGE","code_information":[{"code":"30286003R4","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":75.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGEN SPEC IGE - ALLERGEN WALNUT TREE IGE","code_information":[{"code":"30286003R5","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":74.0,"discounted_cash":74.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST WALNUT IGE","code_information":[{"code":"30286003S5","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":75.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST MANGO IGE - ARUP","code_information":[{"code":"30286003S9","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":61.0,"discounted_cash":61.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGEN SPEC IGE - ALLERGEN HOUSE DUST: HOLLISTER IGE","code_information":[{"code":"30286003T0","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":75.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST ORANGE IGE","code_information":[{"code":"30286003T2","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":75.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST PORK IGE","code_information":[{"code":"30286003T3","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":75.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST SHEEP SORREL (DOCK) IGE","code_information":[{"code":"30286003T4","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":74.0,"discounted_cash":74.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST SHEEP SORREL (DOCK) IGE - ARUP","code_information":[{"code":"30286003T6","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":74.0,"discounted_cash":74.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST MUCOR RACEMOSUS IGE - ARUP","code_information":[{"code":"30286003TT","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":75.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST MAPLE TREE BOX ELDER IGE","code_information":[{"code":"30286003U1","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":75.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST SHRIMP IGE","code_information":[{"code":"30286003U4","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":75.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGEN SPEC IGE - ALLERGEN MICROORGANISM: ALTERNARIA ALTERNATA","code_information":[{"code":"30286003U8","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":61.0,"discounted_cash":61.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGEN SPEC IGE - ALLERGEN KIWI FRUIT IGE","code_information":[{"code":"30286003UU","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":61.0,"discounted_cash":61.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGEN SPEC IGE - ALLERGEN HONEYBEE IGE","code_information":[{"code":"30286003V0","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":75.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGEN SPEC IGE - ALLERGEN MARSHELDER, ROUGH IGE","code_information":[{"code":"30286003V1","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":26.0,"discounted_cash":26.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST WHEAT IGE","code_information":[{"code":"30286003V5","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":75.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGEN SPEC IGE - ALLERGEN OYSTER IGE","code_information":[{"code":"30286003W2","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":75.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST CULTIVATED WHEAT POLLEN IGE - ARUP","code_information":[{"code":"30286003W5","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":75.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGEN SPEC IGE - ALLERGEN MESQUITE IGE","code_information":[{"code":"30286003X1","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":74.0,"discounted_cash":74.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST BROME GRASS IGE - ARUP","code_information":[{"code":"30286003X7","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":75.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGEN SPEC IGE - ALLERGEN HORNET, WHITE FACE IGE","code_information":[{"code":"30286003Y0","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":61.0,"discounted_cash":61.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST SOYBEAN IGE","code_information":[{"code":"30286003Y4","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":75.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST SOYBEAN IGE - ARUP","code_information":[{"code":"30286003Y7","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":75.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGEN SPEC IGE - ALLERGEN HORNET, YELLOW IGE","code_information":[{"code":"30286003Z0","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":61.0,"discounted_cash":61.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST RAGWEED SHORT/COMMON IGE","code_information":[{"code":"30286003Z3","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":75.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST PINE, WHITE IGE","code_information":[{"code":"30286003Z5","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":61.0,"discounted_cash":61.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGEN SPEC IGE - FEATHER MIX IGE","code_information":[{"code":"3028600502","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86005","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":75.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGEN SPEC IGE - PURIFIED COMPONENT EACH","code_information":[{"code":"3028600801","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86008","type":"HCPCS"}],"standard_charges":[{"gross_charge":217.0,"discounted_cash":217.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGEN SPEC IGE - PEANUT COMPONENT PANEL IGE","code_information":[{"code":"3028600809","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86008","type":"HCPCS"}],"standard_charges":[{"gross_charge":107.0,"discounted_cash":107.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST CASEIN IGE - ARUP","code_information":[{"code":"3028600814","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86008","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":75.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST SEVERE PEANUT ARA H 1 IGE - PEANUT COMPONENT RFLX- ARUP","code_information":[{"code":"3028600822","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86008","type":"HCPCS"}],"standard_charges":[{"gross_charge":217.0,"discounted_cash":217.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST SEVERE PEANUT ARA H 2 IGE - PEANUT COMPONENT RFLX - ARUP","code_information":[{"code":"3028600823","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86008","type":"HCPCS"}],"standard_charges":[{"gross_charge":217.0,"discounted_cash":217.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST SEVERE PEANUT ARA H 3 IGE - PEANUT COMPONENT RFLX- ARUP","code_information":[{"code":"3028600824","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86008","type":"HCPCS"}],"standard_charges":[{"gross_charge":217.0,"discounted_cash":217.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST SEVERE PEANUT ARA H 9 IGE - PEANUT COMPONENT RFLX - ARUP","code_information":[{"code":"3028600825","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86008","type":"HCPCS"}],"standard_charges":[{"gross_charge":217.0,"discounted_cash":217.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST MILD PEANUT ARA H 8 IGE - PEANUT COMPONENT RFLX - ARUP","code_information":[{"code":"3028600826","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86008","type":"HCPCS"}],"standard_charges":[{"gross_charge":217.0,"discounted_cash":217.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST SEVERE PEANUT ARA H 6 IGE - PEANUT COMPONENT RFLX - ARUP","code_information":[{"code":"3028600827","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86008","type":"HCPCS"}],"standard_charges":[{"gross_charge":217.0,"discounted_cash":217.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC F-ACTIN (SMOOTH MUSCLE), IGG","code_information":[{"code":"3028601501","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86015","type":"HCPCS"}],"standard_charges":[{"gross_charge":135.0,"discounted_cash":135.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC F ACTIN SMOOTH MUSCLE IGA - ARUP","code_information":[{"code":"3028601503","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86015","type":"HCPCS"}],"standard_charges":[{"gross_charge":206.0,"discounted_cash":206.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC F ACTIN SMOOTH MUSCLE IGG WITH REFLEX TITER - ARUP","code_information":[{"code":"3028601505","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86015","type":"HCPCS"}],"standard_charges":[{"gross_charge":135.0,"discounted_cash":135.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC WBC ANTIBODY IDENTIFICATION - ANTI-NEUTROPHIL ANTIBODY","code_information":[{"code":"3028602101","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86021","type":"HCPCS"}],"standard_charges":[{"gross_charge":163.0,"discounted_cash":163.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PLATELET ANTIBODIES - HEPARIN-INDUCED PLATELET ANTIBODY","code_information":[{"code":"3028602201","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86022","type":"HCPCS"}],"standard_charges":[{"gross_charge":495.0,"discounted_cash":495.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PLATELET ANTIBODY SCREEN INDIRECT","code_information":[{"code":"3028602202","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86022","type":"HCPCS"}],"standard_charges":[{"gross_charge":495.0,"discounted_cash":495.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SEROTONIN RELEASE UNFRACTIONATED HEPARIN - ARUP","code_information":[{"code":"3028602206","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86022","type":"HCPCS"}],"standard_charges":[{"gross_charge":495.0,"discounted_cash":495.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PLATELET HIT PF4 IGG WITH REFLEX SEROTONIN RELEASE ASSAY (ARUP)","code_information":[{"code":"3028602210","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86022","type":"HCPCS"}],"standard_charges":[{"gross_charge":495.0,"discounted_cash":495.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IMMUNOGLOBULIN ASSAY - PLATELET ANTIBODIES, DIRECT","code_information":[{"code":"3028602301","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86023","type":"HCPCS"}],"standard_charges":[{"gross_charge":147.0,"discounted_cash":147.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ANTI NEUTROPHIL CYTO ANTIBY SCREEN","code_information":[{"code":"3028603601","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86036","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.0,"discounted_cash":38.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ANCA ASSOCIATED VASCULITIS PROFILE - ARUP","code_information":[{"code":"3028603603","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86036","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.0,"discounted_cash":38.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ANTI-NEUTROPHIL CYTOPLASMIC ANTIBODY, IGG BY IFA - ARUP","code_information":[{"code":"3028603604","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86036","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.0,"discounted_cash":38.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ANCA - ANCA ASSOCIATED VASCULITIS PROFILE - ARUP","code_information":[{"code":"3028603606","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86036","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.0,"discounted_cash":38.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC NEUTROPHIL CYTOPLASMIC ANTIBODY (ANCA) IGG IFA - ARUP","code_information":[{"code":"3028603607","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86036","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.0,"discounted_cash":38.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ANA (ANTINUCLEAR ANTIBODIES)","code_information":[{"code":"3028603801","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86038","type":"HCPCS"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":138.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ANA - ANTINUCLEAR ANTIBODY WRFLX TITER - ARUP","code_information":[{"code":"3028603802","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86038","type":"HCPCS"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":138.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ANA REFLEXIVE PROFILE - ARUP","code_information":[{"code":"3028603804","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86038","type":"HCPCS"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":138.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ANA - LUPUS COMPREHENSIVE REFLEXIVE PANEL - ARUP","code_information":[{"code":"3028603805","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86038","type":"HCPCS"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":138.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ANA TITER","code_information":[{"code":"3028603902","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86039","type":"HCPCS"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":138.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ANA TITER - ANTINUCLEAR ANTIBODY HEP-2 IGG (RFLX) - ARUP","code_information":[{"code":"3028603903","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86039","type":"HCPCS"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":138.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ANA TITER -  ANTINUCLEAR ANTIBODY HEP-2 IGG W REFLEX - ARUP","code_information":[{"code":"3028603904","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86039","type":"HCPCS"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":138.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ANA TITER - ANTINUCLEAR ANTIBODY HEP-2 IGG - ARUP","code_information":[{"code":"3028603907","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86039","type":"HCPCS"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":138.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ACETYLCHOLINE RECEPTOR BINDING ANTIBODY - ARUP","code_information":[{"code":"3028604101","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86041","type":"HCPCS"}],"standard_charges":[{"gross_charge":114.0,"discounted_cash":114.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ACHR BINDING ANTIBODY - ACETYLCHOLINE RECEPTOR AB W/REFLEX PANEL - ARUP","code_information":[{"code":"3028604102","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86041","type":"HCPCS"}],"standard_charges":[{"gross_charge":193.0,"discounted_cash":193.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ACHR BINDING ANTIBODY - ACHR, TITIN, STM AB REFLEX PANEL - ARUP","code_information":[{"code":"3028604103","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86041","type":"HCPCS"}],"standard_charges":[{"gross_charge":193.0,"discounted_cash":193.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ACETYLCHOLINE RECEPTOR BLOCKING ANTIBODY - ARUP","code_information":[{"code":"3028604201","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86042","type":"HCPCS"}],"standard_charges":[{"gross_charge":105.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ACHR BLOCKING ANTIBODY - ACETYLCHOLINE RECEPTOR AB W/REFLEX PANEL - ARUP","code_information":[{"code":"3028604202","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86042","type":"HCPCS"}],"standard_charges":[{"gross_charge":105.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ACHR BLOCKING ANTIBODY - ACHR, TITIN, STM AB REFLEX PANEL - ARUP","code_information":[{"code":"3028604203","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86042","type":"HCPCS"}],"standard_charges":[{"gross_charge":105.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ACETYLCHOLINE REC (ACHR) MOD AB","code_information":[{"code":"3028604301","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86043","type":"HCPCS"}],"standard_charges":[{"gross_charge":142.0,"discounted_cash":142.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC AQUAPORIN-4 RECEPTOR AB","code_information":[{"code":"3028605101","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86051","type":"HCPCS"}],"standard_charges":[{"gross_charge":293.0,"discounted_cash":293.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC AQUAPORIN 4 REC AB CSF","code_information":[{"code":"3028605201","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86052","type":"HCPCS"}],"standard_charges":[{"gross_charge":134.0,"discounted_cash":134.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC NEUROMYELITIS OPTICA/AQPF IGG WITH REFLEX TO TITER SERUM - ARUP","code_information":[{"code":"3028605204","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86052","type":"HCPCS"}],"standard_charges":[{"gross_charge":134.0,"discounted_cash":134.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ANTISTREPTOLYSIN O TITER - ANTISTREPTOLYSIN O TITER","code_information":[{"code":"3028606001","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86060","type":"HCPCS"}],"standard_charges":[{"gross_charge":84.0,"discounted_cash":84.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CRP (C-REACTIVE PROTEIN) INFLAMMATORY","code_information":[{"code":"3028614001","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86140","type":"HCPCS"}],"standard_charges":[{"gross_charge":93.0,"discounted_cash":93.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC C REACTIVE PROTEIN LEVEL MG/DL INFLAMMATORY","code_information":[{"code":"3028614002","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86140","type":"HCPCS"}],"standard_charges":[{"gross_charge":93.0,"discounted_cash":93.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CRP (C-REACTIVE PROTEIN) HIGH SENSITIVITY - CARDIAC","code_information":[{"code":"3028614101","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86141","type":"HCPCS"}],"standard_charges":[{"gross_charge":199.0,"discounted_cash":199.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC C REACTIVE PROTEIN HIGH SENSITIVITY CARDIAC MG/L","code_information":[{"code":"3028614104","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86141","type":"HCPCS"}],"standard_charges":[{"gross_charge":199.0,"discounted_cash":199.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BETA 2 GLYCOPROTEIN I ANTIBODY,EA - BETA-2 GLYCOPROTEIN ABS","code_information":[{"code":"3028614601","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86146","type":"HCPCS"}],"standard_charges":[{"gross_charge":56.0,"discounted_cash":56.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BETA-2 GLYCOPROTEIN ABS IGG - PHOSLIPID ARUP","code_information":[{"code":"3028614605","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86146","type":"HCPCS"}],"standard_charges":[{"gross_charge":56.0,"discounted_cash":56.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BETA-2 GLYCOPROTEIN ABS IGM - PHOSLIPID ARUP","code_information":[{"code":"3028614606","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86146","type":"HCPCS"}],"standard_charges":[{"gross_charge":56.0,"discounted_cash":56.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BETA 2 GLYCOPROTEIN 1 IGA - ARUP","code_information":[{"code":"3028614607","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86146","type":"HCPCS"}],"standard_charges":[{"gross_charge":56.0,"discounted_cash":56.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BETA 2 GLYCOPROTEIN 1 IGA - BETA 2 GLYCOPROTEIN 1 IGA IGG IGM - ARUP","code_information":[{"code":"3028614608","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86146","type":"HCPCS"}],"standard_charges":[{"gross_charge":56.0,"discounted_cash":56.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BETA 2 GLYCOPROTEIN 1 IGG - BETA 2 GLYCOPROTEIN 1 IGA IGG IGM - ARUP","code_information":[{"code":"3028614609","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86146","type":"HCPCS"}],"standard_charges":[{"gross_charge":56.0,"discounted_cash":56.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BETA 2 GLYCOPROTEIN 1 IGM - BETA 2 GLYCOPROTEIN 1 IGA IGG IGM - ARUP","code_information":[{"code":"3028614610","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86146","type":"HCPCS"}],"standard_charges":[{"gross_charge":56.0,"discounted_cash":56.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BETA 2 GLYCOPROTEIN 1 IGG - BETA 2 GLYCOPROTEIN 1 IGG IGM - ARUP","code_information":[{"code":"3028614611","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86146","type":"HCPCS"}],"standard_charges":[{"gross_charge":56.0,"discounted_cash":56.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BETA 2 GLYCOPROTEIN 1 IGM - BETA 2 GLYCOPROTEIN 1 IGG IGM - ARUP","code_information":[{"code":"3028614612","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86146","type":"HCPCS"}],"standard_charges":[{"gross_charge":56.0,"discounted_cash":56.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CARDIOLIPIN ANTIBODY IGA ARUP","code_information":[{"code":"3028614702","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86147","type":"HCPCS"}],"standard_charges":[{"gross_charge":175.0,"discounted_cash":175.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CARDIOLIPIN ANTIBODY IGG ARUP","code_information":[{"code":"3028614703","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86147","type":"HCPCS"}],"standard_charges":[{"gross_charge":175.0,"discounted_cash":175.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CARDIOLIPIN ANTIBODY IGM ARUP","code_information":[{"code":"3028614704","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86147","type":"HCPCS"}],"standard_charges":[{"gross_charge":175.0,"discounted_cash":175.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CARDIOLIPIN ANTIBODY IGG - ARUP PHOSLIPID","code_information":[{"code":"3028614705","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86147","type":"HCPCS"}],"standard_charges":[{"gross_charge":175.0,"discounted_cash":175.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CARDIOLIPIN ANTIBODY IGM - ARUP PHOSLIPID","code_information":[{"code":"3028614706","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86147","type":"HCPCS"}],"standard_charges":[{"gross_charge":175.0,"discounted_cash":175.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CARDIOLIPIN ANTIBODY IGA - ARUP","code_information":[{"code":"3028614707","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86147","type":"HCPCS"}],"standard_charges":[{"gross_charge":175.0,"discounted_cash":175.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CARDIOLIPIN ANTIBODY IGG - ARUP","code_information":[{"code":"3028614708","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86147","type":"HCPCS"}],"standard_charges":[{"gross_charge":175.0,"discounted_cash":175.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CARDIOLIPIN ANTIBODY IGM - ARUP","code_information":[{"code":"3028614709","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86147","type":"HCPCS"}],"standard_charges":[{"gross_charge":175.0,"discounted_cash":175.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CARDIOLIPIN IGG - ANTIPHOSPHOLIPID SYNDROME REFLEX PANEL - ARUP","code_information":[{"code":"3028614710","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86147","type":"HCPCS"}],"standard_charges":[{"gross_charge":175.0,"discounted_cash":175.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CARDIOLIPIN IGM - ANTIPHOSPHOLIPID SYNDROME REFLEX PANEL - ARUP","code_information":[{"code":"3028614711","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86147","type":"HCPCS"}],"standard_charges":[{"gross_charge":175.0,"discounted_cash":175.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CARDIOLIPIN IGG - CARDIOLIPIN IGG IGM ANTIBODIES - ARUP","code_information":[{"code":"3028614712","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86147","type":"HCPCS"}],"standard_charges":[{"gross_charge":175.0,"discounted_cash":175.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CARDIOLIPIN IGM - CARDIOLIPIN IGG IGM ANTIBODIES - ARUP","code_information":[{"code":"3028614713","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86147","type":"HCPCS"}],"standard_charges":[{"gross_charge":175.0,"discounted_cash":175.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PHOSPHOLIPID ANTIBODY - PHOSPHATIDYLSERINE ANTIBODY IGG","code_information":[{"code":"3028614802","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86148","type":"HCPCS"}],"standard_charges":[{"gross_charge":175.0,"discounted_cash":175.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PHOSPHOLIPID ANTIBODY - PHOSPHATIDYLSERINE ANTIBODY IGM","code_information":[{"code":"3028614803","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86148","type":"HCPCS"}],"standard_charges":[{"gross_charge":175.0,"discounted_cash":175.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PHOSPHOLIPID ANTIBODY - PHOSPHATIDYLSERINE ANTIBODY IGA","code_information":[{"code":"3028614804","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86148","type":"HCPCS"}],"standard_charges":[{"gross_charge":50.0,"discounted_cash":50.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PHOSPHOLIPID IGG - PHOSPHATIDYLSERINE ANTIBODIES - ARUP","code_information":[{"code":"3028614806","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86148","type":"HCPCS"}],"standard_charges":[{"gross_charge":175.0,"discounted_cash":175.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PHOSPHOLIPID IGA - PHOSPHATIDYLSERINE ANTIBODIES - ARUP","code_information":[{"code":"3028614807","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86148","type":"HCPCS"}],"standard_charges":[{"gross_charge":175.0,"discounted_cash":175.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PHOSPHOLIPID IGM - PHOSPHATIDYLSERINE ANTIBODIES - ARUP","code_information":[{"code":"3028614808","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86148","type":"HCPCS"}],"standard_charges":[{"gross_charge":175.0,"discounted_cash":175.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC COLD AGGLUTININ SCREEN - COLD AGGLUTININ SCREEN REF LAB","code_information":[{"code":"3028615602","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86156","type":"HCPCS"}],"standard_charges":[{"gross_charge":45.0,"discounted_cash":45.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC COLD AGGLUTININ SCREEN - ARUP","code_information":[{"code":"3028615603","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86156","type":"HCPCS"}],"standard_charges":[{"gross_charge":45.0,"discounted_cash":45.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC C4 COMPLEMENT","code_information":[{"code":"3028616001","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86160","type":"HCPCS"}],"standard_charges":[{"gross_charge":175.0,"discounted_cash":175.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC C3 COMPLEMENT","code_information":[{"code":"3028616002","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86160","type":"HCPCS"}],"standard_charges":[{"gross_charge":175.0,"discounted_cash":175.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC COMPLEMENT, ANTIGEN - C2 COMPLEMENT","code_information":[{"code":"3028616003","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86160","type":"HCPCS"}],"standard_charges":[{"gross_charge":175.0,"discounted_cash":175.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC COMPLEMENT, ANTIGEN - C1 ESTERASE INHIBITOR COMPLEMENT","code_information":[{"code":"3028616004","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86160","type":"HCPCS"}],"standard_charges":[{"gross_charge":147.0,"discounted_cash":147.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC COMPLEMENT, ANTIGEN - C1 COMPLEMENT","code_information":[{"code":"3028616005","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86160","type":"HCPCS"}],"standard_charges":[{"gross_charge":140.0,"discounted_cash":140.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC COMPLEMENT, ANTIGEN - C5 COMPLEMENT","code_information":[{"code":"3028616006","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86160","type":"HCPCS"}],"standard_charges":[{"gross_charge":60.0,"discounted_cash":60.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC C4 LUPUS COMPREHENSIVE REFLEXIVE PANEL - ARUP","code_information":[{"code":"3028616013","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86160","type":"HCPCS"}],"standard_charges":[{"gross_charge":175.0,"discounted_cash":175.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC C3 LUPUS COMPREHENSIVE REFLEXIVE PANEL - ARUP","code_information":[{"code":"3028616015","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86160","type":"HCPCS"}],"standard_charges":[{"gross_charge":175.0,"discounted_cash":175.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC C3 COMPLEMENT - ARUP","code_information":[{"code":"3028616018","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86160","type":"HCPCS"}],"standard_charges":[{"gross_charge":175.0,"discounted_cash":175.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC C1 ESTERASE INHIBITOR FUNCTIONAL -  ARUP","code_information":[{"code":"3028616102","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86161","type":"HCPCS"}],"standard_charges":[{"gross_charge":140.0,"discounted_cash":140.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC C1 ESTERASE INHIBITOR, FUNCTIONAL, ESTERASE INHIB PANEL - ARUP","code_information":[{"code":"3028616104","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86161","type":"HCPCS"}],"standard_charges":[{"gross_charge":140.0,"discounted_cash":140.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC COMPLEMENT, TOTAL (CH50) - COMPLEMENT TOTAL","code_information":[{"code":"3028616201","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86162","type":"HCPCS"}],"standard_charges":[{"gross_charge":168.0,"discounted_cash":168.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC COMPLEMENT TOTAL (CH50) - ARUP","code_information":[{"code":"3028616202","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86162","type":"HCPCS"}],"standard_charges":[{"gross_charge":168.0,"discounted_cash":168.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CYCLIC CIRULLINATED PEPTIDE ANTIBODY - CYCLIC CITRUL PEPTIDE ANTIBDY","code_information":[{"code":"3028620001","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86200","type":"HCPCS"}],"standard_charges":[{"gross_charge":175.0,"discounted_cash":175.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CYCLIC CIRULLINATED PEPTIDE IGG/A - RHEUMATOID ARTHRITIS PANEL - ARUP","code_information":[{"code":"3028620002","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86200","type":"HCPCS"}],"standard_charges":[{"gross_charge":175.0,"discounted_cash":175.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CYCLIC CITRUL PEPTIDE (CCP) IGG & IGA - ARUP","code_information":[{"code":"3028620004","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86200","type":"HCPCS"}],"standard_charges":[{"gross_charge":175.0,"discounted_cash":175.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CYCLIC CITRULLINATED PEPTIDE IGG","code_information":[{"code":"3028620005","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86200","type":"HCPCS"}],"standard_charges":[{"gross_charge":175.0,"discounted_cash":175.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DEOXYRIBONUCLEASE, ANTIBODY - ANTI DNASE B ANTIBODY","code_information":[{"code":"3028621501","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86215","type":"HCPCS"}],"standard_charges":[{"gross_charge":91.0,"discounted_cash":91.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ANTI DNA DOUBLE STRANDED","code_information":[{"code":"3028622501","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86225","type":"HCPCS"}],"standard_charges":[{"gross_charge":135.0,"discounted_cash":135.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ANTI DNA DOUBLE STRANDED - ARUP","code_information":[{"code":"3028622503","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86225","type":"HCPCS"}],"standard_charges":[{"gross_charge":135.0,"discounted_cash":135.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DNA ANTIBODY DOUBLE STRANDED IGG W/REFLEX TO IFA TITER - ARUP","code_information":[{"code":"3028622505","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86225","type":"HCPCS"}],"standard_charges":[{"gross_charge":135.0,"discounted_cash":135.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ENDOMYSIAL IGG ANTIBODY","code_information":[{"code":"3028623101","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86231","type":"HCPCS"}],"standard_charges":[{"gross_charge":97.0,"discounted_cash":97.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ENDOMYSIAL IGA ANTIBODY","code_information":[{"code":"3028623104","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86231","type":"HCPCS"}],"standard_charges":[{"gross_charge":105.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ENDOMYSIAL IGG - ARUP","code_information":[{"code":"3028623105","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86231","type":"HCPCS"}],"standard_charges":[{"gross_charge":97.0,"discounted_cash":97.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ENDOMYSIAL IGA - ARUP","code_information":[{"code":"3028623106","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86231","type":"HCPCS"}],"standard_charges":[{"gross_charge":105.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC NUCLEAR ANTIGEN ANTIBODY - SJOGRENS SYNDROME-A EXT NU AB","code_information":[{"code":"3028623501","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":119.0,"discounted_cash":119.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC NUCLEAR ANTIGEN ANTIBODY - SJOGRENS SYNDROME-B EXT NUC AB","code_information":[{"code":"3028623502","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":119.0,"discounted_cash":119.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC NUCLEAR ANTIGEN ANTIBODY - ANTI JO-1 IGG","code_information":[{"code":"3028623503","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":119.0,"discounted_cash":119.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC NUCLEAR ANTIGEN ANTIBODY - EXTRACTABLE NUCLEAR ANTIGEN ANTIBODIES","code_information":[{"code":"3028623506","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":163.0,"discounted_cash":163.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RNA POLYMERASE III IGG - SYSTEMIC SCLEROSIS PANEL - ARUP","code_information":[{"code":"3028623507","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":119.0,"discounted_cash":119.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC NUCLEAR ANTIGEN ANTIBODY - SMITH ANTIBODY","code_information":[{"code":"3028623508","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":119.0,"discounted_cash":119.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SSB (LA) IGG - ARUP","code_information":[{"code":"3028623521","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":119.0,"discounted_cash":119.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SSA52 (RO52) IGG - EXTRACTABLE NUCLEAR ANTIGEN ANTIBODIES - ARUP","code_information":[{"code":"3028623522","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":119.0,"discounted_cash":119.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SSA60 (RO60) IGG - EXTRACTABLE NUCLEAR ANTIGEN ANTIBODIES - ARUP","code_information":[{"code":"3028623523","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":119.0,"discounted_cash":119.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SSB (LA) IGG - EXTRACTABLE NUCLEAR ANTIGEN ANTIBODIES ARUP","code_information":[{"code":"3028623524","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":119.0,"discounted_cash":119.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SMITH ENA IGG - ENA ANTIBODIES - ARUP","code_information":[{"code":"3028623525","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":119.0,"discounted_cash":119.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SMITH/RNP ENA IGG - ENA ANTIBODIES - ARUP","code_information":[{"code":"3028623526","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":119.0,"discounted_cash":119.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SSB (LA) IGG - EXTRACTABLE NUCLEAR ANTIGEN ANTIBODIES- ARUP","code_information":[{"code":"3028623527","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":277.0,"discounted_cash":277.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SSA52 (RO52) IGG - EXTRACTABLE NUCLEAR ANTIGEN ANTIBODIES- ARUP","code_information":[{"code":"3028623528","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":163.0,"discounted_cash":163.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SSA60 (RO60) IGG- EXTRACTABLE NUCLEAR ANTIGEN ANTIBODIES- ARUP","code_information":[{"code":"3028623529","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":163.0,"discounted_cash":163.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FIBRILLARIN U3 RNP IGG - ARUP","code_information":[{"code":"3028623530","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":119.0,"discounted_cash":119.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC JO1 IGG - EXTENDED MYOSITIS PANEL - ARUP","code_information":[{"code":"3028623532","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":119.0,"discounted_cash":119.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PMSCL 100 IGG - EXTENDED MYOSITIS PANEL - ARUP","code_information":[{"code":"3028623533","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":163.0,"discounted_cash":163.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FIBRILLARIN (U3 RNP) IGG - EXTENDED MYOSITIS PANEL - ARUP","code_information":[{"code":"3028623534","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":163.0,"discounted_cash":163.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SSA52 (RO52) ENA IGG - EXTENDED MYOSITIS PANEL - ARUP","code_information":[{"code":"3028623535","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":163.0,"discounted_cash":163.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SSA60 (RO60) IGG - EXTENDED MYOSITIS PANEL - ARUP","code_information":[{"code":"3028623536","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":163.0,"discounted_cash":163.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SMITH RNP IGG - EXTENDED MYOSITIS PANEL - ARUP","code_information":[{"code":"3028623537","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":119.0,"discounted_cash":119.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PM/SCL 100 IGG IMMUNOBLOT - ARUP","code_information":[{"code":"3028623538","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":163.0,"discounted_cash":163.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SCLERODERMA SCL70 ENA IGG - ARUP","code_information":[{"code":"3028623539","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":163.0,"discounted_cash":163.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SMITH ENA IGG - ARUP","code_information":[{"code":"3028623540","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":163.0,"discounted_cash":163.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SMITH RNP ENA IGG - ARUP","code_information":[{"code":"3028623541","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":163.0,"discounted_cash":163.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SSA52 (RO52) ENA IGG - SSA RO ANTIBODY - ARUP","code_information":[{"code":"3028623542","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":163.0,"discounted_cash":163.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SSA52 (RO52) IGG - CONNECTIVE TISSUE DISEASE PROFILE - ARUP","code_information":[{"code":"3028623545","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":119.0,"discounted_cash":119.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SSA60 (RO60) IGG - CONNECTIVE TISSUE DISEASE PROFILE - ARUP","code_information":[{"code":"3028623546","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":119.0,"discounted_cash":119.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SSB (LA) IGG - CONNECTIVE TISSUE DISEASE PANEL - ARUP","code_information":[{"code":"3028623547","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":119.0,"discounted_cash":119.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC JO1 IGG - CONNECT TISSUE DIS PROFILE - ARUP","code_information":[{"code":"3028623548","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":119.0,"discounted_cash":119.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SCLERODERMA SCL-70 ANTIBODY - CONNECT TISSUE DIS PROFILE - ARUP","code_information":[{"code":"3028623549","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":119.0,"discounted_cash":119.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SMITH ANTIBODY - CONNECTIVE TISSUE DIS PROFILE - ARUP","code_information":[{"code":"3028623550","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":119.0,"discounted_cash":119.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC JO1 IGG - ARUP","code_information":[{"code":"3028623551","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":119.0,"discounted_cash":119.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FLUORESCENT NONINFECTIOUS ANTIBODY - SCREEN EACH","code_information":[{"code":"3028625504","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":616.0,"discounted_cash":616.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FLUORESCENT NONINFECTIOUS ANTIBODY - STRIATED MUSCLE ANTIBODY","code_information":[{"code":"3028625507","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":206.0,"discounted_cash":206.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC N-METHYL-D-ASPARTATE RECEPTOR ANTIBODY","code_information":[{"code":"3028625509","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":141.0,"discounted_cash":141.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC N-METHYL-D-ASPARTATE RECEPTOR ANTIBODY CSF","code_information":[{"code":"3028625510","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":141.0,"discounted_cash":141.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PARANEOPLASTIC ANTIBODIES PCCA/ANNA","code_information":[{"code":"3028625512","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":206.0,"discounted_cash":206.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PARANEOPLASTIC ANTIBODIES PCCA/ANNA CSF","code_information":[{"code":"3028625513","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":124.0,"discounted_cash":124.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TITIN ANTIBODY - MYASTHENIA GRAVIS PANEL - ARUP","code_information":[{"code":"3028625546","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":206.0,"discounted_cash":206.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC N METHYL D ASPARTATE (NMDA) RECEPTOR IGG WITH REFLEX - ARUP","code_information":[{"code":"3028625547","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":206.0,"discounted_cash":206.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PARANEOPLASTIC ANTIBODIES REFLEX TITER & WB - ARUP","code_information":[{"code":"3028625548","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":616.0,"discounted_cash":616.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CV2.1 IGG IFA - PARANEOPLASTIC REFLEX PANEL - ARUP","code_information":[{"code":"3028625549","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":124.0,"discounted_cash":124.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PCCA/ANNA IGG - PARANEOPLASTIC REFLEX PANEL - ARUP","code_information":[{"code":"3028625550","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":124.0,"discounted_cash":124.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PHOSPHOLIPASE A2 RECEPTOR IGG WITH REFLEX - ARUP","code_information":[{"code":"3028625552","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":616.0,"discounted_cash":616.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IGLON5 IGG - AUTOIMMUNE ENCEPHALOPATHY/DEMENTIA PANEL CSF - ARUP","code_information":[{"code":"3028625581","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":616.0,"discounted_cash":616.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC STRIATED MUSCLE AB - ACHR, TITIN, STM AB REFLEX PANEL - ARUP","code_information":[{"code":"3028625587","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":206.0,"discounted_cash":206.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ANTI-SMOOTH MUSCLE ANTIBODY TITER","code_information":[{"code":"3028625602","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86256","type":"HCPCS"}],"standard_charges":[{"gross_charge":103.0,"discounted_cash":103.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FLUORESCENT ANTIBODY; TITER - ENDOMYSIAL ANTIBODY, IGA TITER","code_information":[{"code":"3028625603","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86256","type":"HCPCS"}],"standard_charges":[{"gross_charge":190.0,"discounted_cash":190.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FLUORESCENT ANTIBODY; TITER - DSDNA IGG","code_information":[{"code":"3028625604","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86256","type":"HCPCS"}],"standard_charges":[{"gross_charge":142.0,"discounted_cash":142.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FLUORESCENT NONINFECTIOUS ANTIBODY - TITER - EACH ANTIBODY","code_information":[{"code":"3028625605","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86256","type":"HCPCS"}],"standard_charges":[{"gross_charge":190.0,"discounted_cash":190.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ANTI-SMOOTH MUSCLE ANTIBODY TITER - ARUP","code_information":[{"code":"3028625631","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86256","type":"HCPCS"}],"standard_charges":[{"gross_charge":103.0,"discounted_cash":103.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DOUBLE-STRANDED DNA (DSDNA) IGG IFA - ARUP","code_information":[{"code":"3028625634","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86256","type":"HCPCS"}],"standard_charges":[{"gross_charge":142.0,"discounted_cash":142.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GLIADIN ANTIBODY (DEAMIDATED), IGA","code_information":[{"code":"3028625802","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86258","type":"HCPCS"}],"standard_charges":[{"gross_charge":116.0,"discounted_cash":116.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GLIADIN ANTIBODY (DEAMIDATED), IGG","code_information":[{"code":"3028625803","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86258","type":"HCPCS"}],"standard_charges":[{"gross_charge":116.0,"discounted_cash":116.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GLIADIN IGA - GLIADIN PEPTIDE ANTIBODIES IGA AND IGG - ARUP","code_information":[{"code":"3028625808","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86258","type":"HCPCS"}],"standard_charges":[{"gross_charge":116.0,"discounted_cash":116.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GLIADIN IGG - GLIADIN PEPTIDE ANTIBODIES IGA AND IGG - ARUP","code_information":[{"code":"3028625809","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86258","type":"HCPCS"}],"standard_charges":[{"gross_charge":116.0,"discounted_cash":116.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GLIADIN IGA PEPTIDE ANTIBODIES - ARUP","code_information":[{"code":"3028625810","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86258","type":"HCPCS"}],"standard_charges":[{"gross_charge":116.0,"discounted_cash":116.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GLIADIN IGG PEPTIDE ANTIBODIES - ARUP","code_information":[{"code":"3028625812","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86258","type":"HCPCS"}],"standard_charges":[{"gross_charge":116.0,"discounted_cash":116.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GLIADIN ANTIBODY (DEAMIDATED), IGA - CELIAC DISEASE REFLEX CASCADE -ARUP","code_information":[{"code":"3028625813","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86258","type":"HCPCS"}],"standard_charges":[{"gross_charge":116.0,"discounted_cash":116.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GLIADIN ANTIBODY (DEAMIDATED), IGG - CELIAC DISEASE REFLEX CASCADE -ARUP","code_information":[{"code":"3028625814","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86258","type":"HCPCS"}],"standard_charges":[{"gross_charge":116.0,"discounted_cash":116.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CANCER ANTIGEN 15-3","code_information":[{"code":"3028630001","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86300","type":"HCPCS"}],"standard_charges":[{"gross_charge":145.0,"discounted_cash":145.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IMMUNOASSAY, TUMOR ANTIGEN, CA 15-3 - CANCER ANTIGEN 27.29","code_information":[{"code":"3028630002","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86300","type":"HCPCS"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":138.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CANCER ANTIGEN 15-3 - ARUP","code_information":[{"code":"3028630003","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86300","type":"HCPCS"}],"standard_charges":[{"gross_charge":145.0,"discounted_cash":145.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CANCER ANTIGEN 27.29 - ARUP","code_information":[{"code":"3028630004","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86300","type":"HCPCS"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":138.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CANCER ANTIGEN 19-9","code_information":[{"code":"3028630101","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86301","type":"HCPCS"}],"standard_charges":[{"gross_charge":287.0,"discounted_cash":287.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CANCER ANTIGIEN 19-9 BODY FLUID - ARUP","code_information":[{"code":"3028630103","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86301","type":"HCPCS"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":138.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CA 125","code_information":[{"code":"3028630401","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86304","type":"HCPCS"}],"standard_charges":[{"gross_charge":321.0,"discounted_cash":321.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CA 125 - ARUP","code_information":[{"code":"3028630403","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86304","type":"HCPCS"}],"standard_charges":[{"gross_charge":321.0,"discounted_cash":321.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CA 125 - RISK OF OVARIAN MALIGNANCY ALGORITHM - ARUP","code_information":[{"code":"3028630404","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86304","type":"HCPCS"}],"standard_charges":[{"gross_charge":321.0,"discounted_cash":321.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC EPIDIDYMIS PROTEIN 4","code_information":[{"code":"3028630501","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86305","type":"HCPCS"}],"standard_charges":[{"gross_charge":408.0,"discounted_cash":408.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HE4 - RISK OF OVARIAN MALIGNANCY ALGORITHM - ARUP","code_information":[{"code":"3028630502","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86305","type":"HCPCS"}],"standard_charges":[{"gross_charge":408.0,"discounted_cash":408.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HUMAN EPIDIDYMIS PROTEIN 4 (HE4) - ARUP","code_information":[{"code":"3028630503","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86305","type":"HCPCS"}],"standard_charges":[{"gross_charge":408.0,"discounted_cash":408.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MONONUCLEOSIS SCREEN","code_information":[{"code":"3028630801","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86308","type":"HCPCS"}],"standard_charges":[{"gross_charge":96.0,"discounted_cash":96.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IMMUNOASSAY TUMOR ANTIGEN - CHROMOGRANIN A","code_information":[{"code":"3028631601","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86316","type":"HCPCS"}],"standard_charges":[{"gross_charge":276.0,"discounted_cash":276.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CHROMOGRANIN A - ARUP","code_information":[{"code":"3028631604","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86316","type":"HCPCS"}],"standard_charges":[{"gross_charge":276.0,"discounted_cash":276.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CYFRA 21-1 (CYTOKERATIN 19 FRAGMENT - ARUP","code_information":[{"code":"3028631606","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86316","type":"HCPCS"}],"standard_charges":[{"gross_charge":276.0,"discounted_cash":276.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IMMUNOASSAY,INFECT AGENT,QUANT - TETANUS ANTIBODY, IGG","code_information":[{"code":"3028631702","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":149.0,"discounted_cash":149.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IMMUNOASSAY,INFECT AGENT,QUANT - OTHER","code_information":[{"code":"3028631705","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":223.0,"discounted_cash":223.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HAEMOPHILUS INFLUENZAE B ANTIBODY IGG","code_information":[{"code":"3028631707","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":143.0,"discounted_cash":143.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IMMUNOASSAY,INFECT AGENT,QUANT - DIPHTHERIA","code_information":[{"code":"3028631711","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":138.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IMMUNOASSAY,INFECT AGENT,QUANT - TETANUS","code_information":[{"code":"3028631718","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":138.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASPERGILLUS FUMIGATUS IGG - ARUP","code_information":[{"code":"3028631722","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":223.0,"discounted_cash":223.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DIPHTHERIA IGG - ARUP","code_information":[{"code":"3028631723","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":138.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PNEUMO SEROTYPE 1 IGG (P13,PNX) - PNEUMOCOCCAL AB 23 SEROTYPES - ARUP","code_information":[{"code":"3028631724","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":223.0,"discounted_cash":223.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PNEUMO SEROTYPE 10A IGG (PNX) - PNEUMOCOCCAL AB 23 SEROTYPES - ARUP","code_information":[{"code":"3028631725","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":223.0,"discounted_cash":223.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PNEUMO SEROTYPE 11A IGG (PNX) - PNEUMOCOCCAL AB 23 SEROTYPES - ARUP","code_information":[{"code":"3028631726","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":223.0,"discounted_cash":223.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PNEUMO SEROTYPE 12F IGG (PNX) - PNEUMOCOCCAL AB 23 SEROTYPES - ARUP","code_information":[{"code":"3028631727","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":223.0,"discounted_cash":223.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PNEUMO SEROTYPE 14 IGG (P7,P13,PNX) - PNEUMOCOCCAL AB 23 SEROTYPES - ARUP","code_information":[{"code":"3028631728","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":223.0,"discounted_cash":223.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PNEUMO SEROTYPE 15B IGG (PNX) - PNEUMOCOCCAL AB 23 SEROTYPES - ARUP","code_information":[{"code":"3028631729","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":223.0,"discounted_cash":223.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PNEUMO SEROTYPE 17F IGG (PNX) - PNEUMOCOCCAL AB 23 SEROTYPES - ARUP","code_information":[{"code":"3028631730","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":223.0,"discounted_cash":223.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PNEUMO SEROTYPE 18C IGG (P7,P13,PNX) - PNEUMOCOCCAL AB 23 SEROTYPES - ARUP","code_information":[{"code":"3028631731","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":223.0,"discounted_cash":223.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PNEUMO SEROTYPE 19A IGG (P13,PNX) - PNEUMOCOCCAL AB 23 SEROTYPES - ARUP","code_information":[{"code":"3028631732","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":223.0,"discounted_cash":223.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PNEUMO SEROTYPE 19F IGG (P7,P13,PNX) - PNEUMOCOCCAL AB 23 SEROTYPES - ARUP","code_information":[{"code":"3028631733","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":223.0,"discounted_cash":223.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PNEUMO SEROTYPE 2 IGG (PNX) - PNEUMOCOCCAL AB 23 SEROTYPES - ARUP","code_information":[{"code":"3028631734","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":223.0,"discounted_cash":223.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PNEUMO SEROTYPE 20 IGG (PNX) - PNEUMOCOCCAL AB 23 SEROTYPES - ARUP","code_information":[{"code":"3028631735","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":223.0,"discounted_cash":223.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PNEUMO SEROTYPE 22F IGG (PNX) - PNEUMOCOCCAL AB 23 SEROTYPES - ARUP","code_information":[{"code":"3028631736","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":223.0,"discounted_cash":223.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PNEUMO SEROTYPE 23F IGG (P7,P13,PNX) - PNEUMOCOCCAL AB 23 SEROTYPES - ARUP","code_information":[{"code":"3028631737","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":223.0,"discounted_cash":223.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PNEUMO SEROTYPE 3 IGG (P13,PNX) - PNEUMOCOCCAL AB 23 SEROTYPES - ARUP","code_information":[{"code":"3028631738","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":223.0,"discounted_cash":223.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PNEUMO SEROTYPE 33F IGG (PNX) - PNEUMOCOCCAL AB 23 SEROTYPES - ARUP","code_information":[{"code":"3028631739","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":223.0,"discounted_cash":223.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PNEUMO SEROTYPE 4 IGG (P7,P13,PNX) - PNEUMOCOCCAL AB 23 SEROTYPES - ARUP","code_information":[{"code":"3028631740","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":223.0,"discounted_cash":223.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PNEUMO SEROTYPE 5 IGG (P13,PNX) - PNEUMOCOCCAL AB 23 SEROTYPES - ARUP","code_information":[{"code":"3028631741","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":223.0,"discounted_cash":223.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PNEUMO SEROTYPE 6B IGG (P7,P13,PNX) - PNEUMOCOCCAL AB 23 SEROTYPES - ARUP","code_information":[{"code":"3028631742","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":223.0,"discounted_cash":223.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PNEUMO SEROTYPE 7F IGG (P13,PNX) - PNEUMOCOCCAL AB 23 SEROTYPES - ARUP","code_information":[{"code":"3028631743","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":223.0,"discounted_cash":223.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PNEUMO SEROTYPE 8 IGG (PNX) - PNEUMOCOCCAL AB 23 SEROTYPES - ARUP","code_information":[{"code":"3028631744","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":223.0,"discounted_cash":223.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PNEUMO SEROTYPE 9N IGG (PNX) - PNEUMOCOCCAL AB 23 SEROTYPES - ARUP","code_information":[{"code":"3028631745","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":223.0,"discounted_cash":223.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PNEUMO SEROTYPE 9V IGG (P7,P13,PNX) - PNEUMOCOCCAL AB 23 SEROTYPES - ARUP","code_information":[{"code":"3028631746","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":223.0,"discounted_cash":223.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DIPHTHERIA IGG - DIPHTHERIA AND TETANUS ANTIBODIES IGG - ARUP","code_information":[{"code":"3028631747","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":138.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TETANUS IGG - DIPHTHERIA AND TETANUS ANTIBODIES IGG - ARUP","code_information":[{"code":"3028631748","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":138.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TETANUS IGG - ARUP","code_information":[{"code":"3028631749","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":149.0,"discounted_cash":149.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HAEMOPHILUS INFLUENZAE B IGG - ARUP","code_information":[{"code":"3028631750","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":143.0,"discounted_cash":143.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PNEUMO SEROTYPE 1 IGG (P13,PNX) - PNEUMOCOCCAL AB 14 SEROTYPES - ARUP","code_information":[{"code":"3028631751","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":96.0,"discounted_cash":96.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PNEUMO SEROTYPE 12F IGG (PNX) - PNEUMOCOCCAL AB 14 SEROTYPES - ARUP","code_information":[{"code":"3028631752","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":96.0,"discounted_cash":96.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PNEUMO SEROTYPE 14 IGG (P7,P13,PNX) - PNEUMOCOCCAL AB 14 SEROTYPES - ARUP","code_information":[{"code":"3028631753","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":96.0,"discounted_cash":96.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PNEUMO SEROTYPE 18C IGG (P7,P13,PNX) - PNEUMOCOCCAL AB 14 SEROTYPES - ARUP","code_information":[{"code":"3028631754","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":96.0,"discounted_cash":96.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PNEUMO SEROTYPE 19F IGG (P7,P13,PNX) - PNEUMOCOCCAL AB 14 SEROTYPES - ARUP","code_information":[{"code":"3028631755","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":96.0,"discounted_cash":96.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PNEUMO SEROTYPE 23F IGG (P7,P13,PNX) - PNEUMOCOCCAL AB 14 SEROTYPES - ARUP","code_information":[{"code":"3028631756","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":96.0,"discounted_cash":96.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PNEUMO SEROTYPE 3 IGG (P13,PNX) - PNEUMOCOCCAL AB 14 SEROTYPES - ARUP","code_information":[{"code":"3028631757","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":96.0,"discounted_cash":96.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PNEUMO SEROTYPE 4 IGG (P7,P13,PNX) - PNEUMOCOCCAL AB 14 SEROTYPES - ARUP","code_information":[{"code":"3028631758","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":96.0,"discounted_cash":96.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PNEUMO SEROTYPE 5 IGG (P13,PNX) - PNEUMOCOCCAL AB 14 SEROTYPES - ARUP","code_information":[{"code":"3028631759","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":96.0,"discounted_cash":96.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PNEUMO SEROTYPE 6B IGG (P7,P13,PNX) - PNEUMOCOCCAL AB 14 SEROTYPES - ARUP","code_information":[{"code":"3028631760","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":96.0,"discounted_cash":96.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PNEUMO SEROTYPE 7F IGG (P13,PNX) - PNEUMOCOCCAL AB 14 SEROTYPES - ARUP","code_information":[{"code":"3028631761","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":96.0,"discounted_cash":96.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PNEUMO SEROTYPE 8 IGG (PNX) - PNEUMOCOCCAL AB 14 SEROTYPES - ARUP","code_information":[{"code":"3028631762","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":96.0,"discounted_cash":96.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PNEUMO SEROTYPE 9N IGG (PNX) - PNEUMOCOCCAL AB 14 SEROTYPES - ARUP","code_information":[{"code":"3028631763","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":96.0,"discounted_cash":96.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PNEUMO SEROTYPE 9V IGG (P7,P13,PNX) - PNEUMOCOCCAL AB 14 SEROTYPES - ARUP","code_information":[{"code":"3028631764","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":96.0,"discounted_cash":96.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IMMUNOASSAY GEL DIFFUSION EACH ANTIGEN OR ANTIBODY QUAL","code_information":[{"code":"3028633103","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86331","type":"HCPCS"}],"standard_charges":[{"gross_charge":117.0,"discounted_cash":117.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HYPERSENSITIVITY PNEUMONITIS 2 PANEL","code_information":[{"code":"3028633104","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86331","type":"HCPCS"}],"standard_charges":[{"gross_charge":287.0,"discounted_cash":287.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC S VIRIDIS AB PRECIPITIN - HYPERSENSITIVITY PNEUMONITIS 2 - ARUP","code_information":[{"code":"3028633105","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86331","type":"HCPCS"}],"standard_charges":[{"gross_charge":287.0,"discounted_cash":287.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC T CANDIDUS AB PRECIPITIN - HYPERSENSITIVITY PNEUMONITIS 2 - ARUP","code_information":[{"code":"3028633106","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86331","type":"HCPCS"}],"standard_charges":[{"gross_charge":287.0,"discounted_cash":287.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC A PULLULANS AB PRECIPITIN - HYPER PNEUMO EXTENDED PANEL - ARUP","code_information":[{"code":"3028633107","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86331","type":"HCPCS"}],"standard_charges":[{"gross_charge":117.0,"discounted_cash":117.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC M FAENI AB PRECIPITIN - HYPER PNEUMO EXTENDED PANEL - ARUP","code_information":[{"code":"3028633108","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86331","type":"HCPCS"}],"standard_charges":[{"gross_charge":117.0,"discounted_cash":117.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PIGEON SERUM AB PRECIPITIN - HYPER PNEUMO EXTENDED PANEL - ARUP","code_information":[{"code":"3028633109","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86331","type":"HCPCS"}],"standard_charges":[{"gross_charge":117.0,"discounted_cash":117.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC S VIRIDIS AB PRECIPITIN - HYPER PNEUMO EXTENDED PANEL - ARUP","code_information":[{"code":"3028633110","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86331","type":"HCPCS"}],"standard_charges":[{"gross_charge":117.0,"discounted_cash":117.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC T CANDIDUS AB PRECIPITIN - HYPER PNEUMO EXTENDED PANEL - ARUP","code_information":[{"code":"3028633111","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86331","type":"HCPCS"}],"standard_charges":[{"gross_charge":117.0,"discounted_cash":117.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IMMUNOASSAY IMMUNE COMPLEX ASSAY C1Q","code_information":[{"code":"3028633201","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86332","type":"HCPCS"}],"standard_charges":[{"gross_charge":195.0,"discounted_cash":195.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC C1Q BINDING - ARUP","code_information":[{"code":"3028633207","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86332","type":"HCPCS"}],"standard_charges":[{"gross_charge":195.0,"discounted_cash":195.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IMMUNOFIXATION ELECTROPHORESIS - EACH ANALYTE","code_information":[{"code":"3028633402","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86334","type":"HCPCS"}],"standard_charges":[{"gross_charge":159.0,"discounted_cash":159.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IMMUNOFIXATION ELECTROPHORESIS - ARUP","code_information":[{"code":"3028633406","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86334","type":"HCPCS"}],"standard_charges":[{"gross_charge":159.0,"discounted_cash":159.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IMMUNOFIX ELECTROPHORESIS BILL - ARUP","code_information":[{"code":"3028633407","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86334","type":"HCPCS"}],"standard_charges":[{"gross_charge":159.0,"discounted_cash":159.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IMMUNOFIXATION ELECTROPHORESIS - ARUP","code_information":[{"code":"3028633410","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86334","type":"HCPCS"}],"standard_charges":[{"gross_charge":159.0,"discounted_cash":159.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IMMUNOFIXATION SERUM - ARUP","code_information":[{"code":"3028633413","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86334","type":"HCPCS"}],"standard_charges":[{"gross_charge":159.0,"discounted_cash":159.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IMMUNFIX E-PHORSIS/URINE/CSF - MONOCLONAL PROTEIN URINE","code_information":[{"code":"3028633502","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86335","type":"HCPCS"}],"standard_charges":[{"gross_charge":343.0,"discounted_cash":343.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IMMUNFIX E-PHORSIS/URINE/CSF - EACH ANALYTE","code_information":[{"code":"3028633503","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86335","type":"HCPCS"}],"standard_charges":[{"gross_charge":194.0,"discounted_cash":194.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IMMUNOFIXATION ELECTROPHORESIS 24 HOUR URINE","code_information":[{"code":"3028633504","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86335","type":"HCPCS"}],"standard_charges":[{"gross_charge":194.0,"discounted_cash":194.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IMMUNOFIXATION - IMMUNOFIXATION WITH FREE LIGHT CHAINS URINE - ARUP","code_information":[{"code":"3028633509","type":"CDM"},{"code":"0301","type":"RC"},{"code":"86335","type":"HCPCS"}],"standard_charges":[{"gross_charge":146.0,"discounted_cash":146.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INSULIN ANTIBODIES - INSULIN ANTIBODY","code_information":[{"code":"3028633701","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86337","type":"HCPCS"}],"standard_charges":[{"gross_charge":166.0,"discounted_cash":166.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INSULIN ANTIBODY - ARUP","code_information":[{"code":"3028633702","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86337","type":"HCPCS"}],"standard_charges":[{"gross_charge":166.0,"discounted_cash":166.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INTRINSIC FACTOR BLOCKING ANTIBODY - ARUP","code_information":[{"code":"3028634001","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86340","type":"HCPCS"}],"standard_charges":[{"gross_charge":231.0,"discounted_cash":231.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ISLET CELL ANTIBODY - ANTI-ISLET CELL AB","code_information":[{"code":"3028634101","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86341","type":"HCPCS"}],"standard_charges":[{"gross_charge":124.0,"discounted_cash":124.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GLUTAMIC ACID DECARBOXYLASE CSF","code_information":[{"code":"3028634102","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86341","type":"HCPCS"}],"standard_charges":[{"gross_charge":275.0,"discounted_cash":275.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GLUTAMIC ACID DECARBOXYLASE 65","code_information":[{"code":"3028634104","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86341","type":"HCPCS"}],"standard_charges":[{"gross_charge":259.0,"discounted_cash":259.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ISLET CELL CYTOPLASMIC IGG - ARUP","code_information":[{"code":"3028634105","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86341","type":"HCPCS"}],"standard_charges":[{"gross_charge":124.0,"discounted_cash":124.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ISLET ANTIGEN 2 (IA-2) AUTOANTIBODY - ARUP","code_information":[{"code":"3028634108","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86341","type":"HCPCS"}],"standard_charges":[{"gross_charge":124.0,"discounted_cash":124.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GLUTAMIC ACID DECARBOXYLASE-AUTOIMMUNE ENCEPHALOPATHY/DEMENTIA CSF-ARUP","code_information":[{"code":"3028634111","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86341","type":"HCPCS"}],"standard_charges":[{"gross_charge":275.0,"discounted_cash":275.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GLUTAMIC ACID DECARBOXYLASE ANTIBODY - ARUP","code_information":[{"code":"3028634112","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86341","type":"HCPCS"}],"standard_charges":[{"gross_charge":259.0,"discounted_cash":259.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CELLULAR FUNCTION STIMULATION AND BIOMARKER ASSAY","code_information":[{"code":"3028635201","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86352","type":"HCPCS"}],"standard_charges":[{"gross_charge":1113.0,"discounted_cash":1113.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC B CELLS, TOTAL COUNT - LYMPHOCYTE SUBSET PANEL 5 - ARUP","code_information":[{"code":"3028635501","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86355","type":"HCPCS"}],"standard_charges":[{"gross_charge":331.0,"discounted_cash":331.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MONONUCLEAR ANTIGEN QUANT","code_information":[{"code":"3028635601","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86356","type":"HCPCS"}],"standard_charges":[{"gross_charge":299.0,"discounted_cash":299.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CD57+ MONONUCLEAR CELL ANTIGEN QUANTITATIVE BY FLOW CYTOMETRY - ARUP","code_information":[{"code":"3028635602","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86356","type":"HCPCS"}],"standard_charges":[{"gross_charge":315.0,"discounted_cash":315.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FETAL HEMOGLOBIN DETERMINATION - ARUP","code_information":[{"code":"3028635603","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86356","type":"HCPCS"}],"standard_charges":[{"gross_charge":299.0,"discounted_cash":299.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CD20 CELLS, QUANT - B CELL CD20 EXPRESSION BY FLOW, QUANT - ARUP","code_information":[{"code":"3028635604","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86356","type":"HCPCS"}],"standard_charges":[{"gross_charge":299.0,"discounted_cash":299.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PNH, HIGH SENSITIVITY, RBC AND WBC - ARUP","code_information":[{"code":"3028635605","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86356","type":"HCPCS"}],"standard_charges":[{"gross_charge":299.0,"discounted_cash":299.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC NATURAL KILLER CELLS, TOTAL COUNT - LYMPHOCYTE SUBSET PANEL 5 - ARUP","code_information":[{"code":"3028635701","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86357","type":"HCPCS"}],"standard_charges":[{"gross_charge":331.0,"discounted_cash":331.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC T CELLS TOTAL COUNT","code_information":[{"code":"3028635901","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86359","type":"HCPCS"}],"standard_charges":[{"gross_charge":491.0,"discounted_cash":491.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC T CELL COUNT - LYMPHOCYTE SUBSET PANEL 3 - ARUP","code_information":[{"code":"3028635902","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86359","type":"HCPCS"}],"standard_charges":[{"gross_charge":491.0,"discounted_cash":491.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC T CELL COUNT - LYMPHOCYTE SUBSET PANEL 4 - ARUP","code_information":[{"code":"3028635903","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86359","type":"HCPCS"}],"standard_charges":[{"gross_charge":491.0,"discounted_cash":491.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC T CELL COUNT - LYMPHOCYTE SUBSET PANEL 5 - ARUP","code_information":[{"code":"3028635904","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86359","type":"HCPCS"}],"standard_charges":[{"gross_charge":218.0,"discounted_cash":218.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CD4/CD8 COUNT - LYMPHOCYTE SUBSET PANEL 3 - ARUP","code_information":[{"code":"3028636001","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86360","type":"HCPCS"}],"standard_charges":[{"gross_charge":325.0,"discounted_cash":325.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CD4/CD8 COUNT -  LYMPHOCYTE SUBSET PANEL 5 - ARUP","code_information":[{"code":"3028636003","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86360","type":"HCPCS"}],"standard_charges":[{"gross_charge":331.0,"discounted_cash":331.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CD4/CD8 COUNT - LYMPHOCYTE SUBSET PANEL 4 - ARUP","code_information":[{"code":"3028636006","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86360","type":"HCPCS"}],"standard_charges":[{"gross_charge":325.0,"discounted_cash":325.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC T CELL ABSOLUTE COUNT - T-HELPER CELLS (CD4) COUNT","code_information":[{"code":"3028636101","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86361","type":"HCPCS"}],"standard_charges":[{"gross_charge":411.0,"discounted_cash":411.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CD4 ABSOLUTE COUNT ONLY - LYMPHOCYTE SUBSET PANEL 1 - ARUP","code_information":[{"code":"3028636103","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86361","type":"HCPCS"}],"standard_charges":[{"gross_charge":411.0,"discounted_cash":411.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MOG-IGG IMMUNOFLUOR - AUTOIMMUNE ENCEPHALITIS EXTENDED PANEL - ARUP","code_information":[{"code":"3028636201","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86362","type":"HCPCS"}],"standard_charges":[{"gross_charge":425.0,"discounted_cash":425.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MYELIN OLIGODENTROCYTE GLYCOPROTEIN (MOG) IGG WITH REFLEX - ARUP","code_information":[{"code":"3028636202","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86362","type":"HCPCS"}],"standard_charges":[{"gross_charge":425.0,"discounted_cash":425.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TISSUE TRANSGLUTAMINASE IGG - CELIAC DISEASE REFLEX CASCADE - ARUP","code_information":[{"code":"3028636406","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86364","type":"HCPCS"}],"standard_charges":[{"gross_charge":143.0,"discounted_cash":143.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TISSUE TRANSGLUTAMINASE IGA - CELIAC DISEASE REFLEX CASCADE - ARUP","code_information":[{"code":"3028636407","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86364","type":"HCPCS"}],"standard_charges":[{"gross_charge":109.0,"discounted_cash":109.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MUSCLE-SPECIFIC KINASE (MUSK) IGG BY CBA-IFA WITH REFLEX - ARUP","code_information":[{"code":"3028636602","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86366","type":"HCPCS"}],"standard_charges":[{"gross_charge":52.0,"discounted_cash":52.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MICROSOMAL ANTIBODY - THYROID PEROXIDASE ANTIBODY","code_information":[{"code":"3028637602","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86376","type":"HCPCS"}],"standard_charges":[{"gross_charge":162.0,"discounted_cash":162.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC LIVER KIDNEY MICROSOMAL ANTIBODY","code_information":[{"code":"3028637604","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86376","type":"HCPCS"}],"standard_charges":[{"gross_charge":114.0,"discounted_cash":114.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC LIVER KIDNEY MICROSOME IGG - ARUP","code_information":[{"code":"3028637605","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86376","type":"HCPCS"}],"standard_charges":[{"gross_charge":205.0,"discounted_cash":205.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC THYROID PEROXIDASE (TPO) ANTIBODY - THYROID ANTIBODIES - ARUP","code_information":[{"code":"3028637606","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86376","type":"HCPCS"}],"standard_charges":[{"gross_charge":162.0,"discounted_cash":162.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MICROSOMAL ANTIBODY - THYROID PEROXIDASE ANTIBODY - ARUP","code_information":[{"code":"3028637610","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86376","type":"HCPCS"}],"standard_charges":[{"gross_charge":162.0,"discounted_cash":162.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC THYROID PEROXIDASE ANTIBODY - ARUP","code_information":[{"code":"3028637611","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86376","type":"HCPCS"}],"standard_charges":[{"gross_charge":162.0,"discounted_cash":162.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MITOCHONDRIAL M2 ANTIBODIES - ARUP","code_information":[{"code":"3028638103","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86381","type":"HCPCS"}],"standard_charges":[{"gross_charge":283.0,"discounted_cash":283.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MITOCHONDRIAL ANTIBODY M2 IGG AB","code_information":[{"code":"3028638106","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86381","type":"HCPCS"}],"standard_charges":[{"gross_charge":283.0,"discounted_cash":283.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SARS-COV-2 ABY QUANT","code_information":[{"code":"3028641301","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86413","type":"HCPCS"}],"standard_charges":[{"gross_charge":233.0,"discounted_cash":233.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RHEUMATOID FACTOR TEST - RHEUMATOID FACTOR SCREEN","code_information":[{"code":"3028643001","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86430","type":"HCPCS"}],"standard_charges":[{"gross_charge":121.0,"discounted_cash":121.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RHEUMATOID FACTOR, QUANT - RHEUMATOID FACTOR","code_information":[{"code":"3028643101","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86431","type":"HCPCS"}],"standard_charges":[{"gross_charge":157.0,"discounted_cash":157.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RHEUMATOID FACTOR","code_information":[{"code":"3028643104","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86431","type":"HCPCS"}],"standard_charges":[{"gross_charge":157.0,"discounted_cash":157.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RHEUMATOID FACTOR - LUPUS COMPREHENSIVE REFLEX PANEL - ARUP","code_information":[{"code":"3028643108","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86431","type":"HCPCS"}],"standard_charges":[{"gross_charge":157.0,"discounted_cash":157.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TB TEST CELL MEDIATED ANTIGEN RESPONSE,GAMMA INTERFRON","code_information":[{"code":"3028648001","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86480","type":"HCPCS"}],"standard_charges":[{"gross_charge":234.0,"discounted_cash":234.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC QUANTIFERON TB PLUS - ARUP","code_information":[{"code":"3028648002","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86480","type":"HCPCS"}],"standard_charges":[{"gross_charge":234.0,"discounted_cash":234.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC QUANTIFERON TB PLUS 4 TUBE - ARUP","code_information":[{"code":"3028648003","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86480","type":"HCPCS"}],"standard_charges":[{"gross_charge":234.0,"discounted_cash":234.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PBB TB INTRADERMAL TEST","code_information":[{"code":"30286580PB","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86580","type":"HCPCS"}],"standard_charges":[{"gross_charge":168.0,"discounted_cash":168.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC VDRL CSF","code_information":[{"code":"3028659201","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86592","type":"HCPCS"}],"standard_charges":[{"gross_charge":91.0,"discounted_cash":91.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RPR QUAL","code_information":[{"code":"3028659202","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86592","type":"HCPCS"}],"standard_charges":[{"gross_charge":133.0,"discounted_cash":133.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC VDRL WITH REFLEX TO TITER, CSF - ARUP","code_information":[{"code":"3028659207","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86592","type":"HCPCS"}],"standard_charges":[{"gross_charge":91.0,"discounted_cash":91.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC VDRL WITH REFLEX TO TITER, SERUM - ARUP","code_information":[{"code":"3028659208","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86592","type":"HCPCS"}],"standard_charges":[{"gross_charge":91.0,"discounted_cash":91.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC VDRL CSF - ARUP","code_information":[{"code":"3028659210","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86592","type":"HCPCS"}],"standard_charges":[{"gross_charge":91.0,"discounted_cash":91.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RAPID PLASMA REAGIN (RPR) QUAL","code_information":[{"code":"3028659211","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86592","type":"HCPCS"}],"standard_charges":[{"gross_charge":133.0,"discounted_cash":133.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RPR TITER","code_information":[{"code":"3028659301","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86593","type":"HCPCS"}],"standard_charges":[{"gross_charge":58.0,"discounted_cash":58.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC VDRL TITER - ARUP","code_information":[{"code":"3028659306","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86593","type":"HCPCS"}],"standard_charges":[{"gross_charge":58.0,"discounted_cash":58.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC VOLTAGE GATED CALCIUM CHANNEL AB","code_information":[{"code":"3028659601","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86596","type":"HCPCS"}],"standard_charges":[{"gross_charge":284.0,"discounted_cash":284.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASPERGILLUS ANTIBODY - ASPERGILLUS ABS","code_information":[{"code":"3028660601","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86606","type":"HCPCS"}],"standard_charges":[{"gross_charge":470.0,"discounted_cash":470.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HYPERSENSITIVITY PNEUMONITIS 1 - IMMUNOASSAY ANTIBODY - A FUMIGATUS #1, A FUMIGATUS #6","code_information":[{"code":"3028660602","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86606","type":"HCPCS"}],"standard_charges":[{"gross_charge":127.0,"discounted_cash":127.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HYPERSENSITIVITY PNEUOMONITIS 2 -  IMMUNOASSAY ANTIBODY - A FLAVUS #2, A FUMIGATUS #2, A FUMIGATUS #3","code_information":[{"code":"3028660603","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86606","type":"HCPCS"}],"standard_charges":[{"gross_charge":57.0,"discounted_cash":57.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FUNGAL ANTIBODIES - ASPERGILLUS","code_information":[{"code":"3028660604","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86606","type":"HCPCS"}],"standard_charges":[{"gross_charge":108.0,"discounted_cash":108.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC A FLAVUS AB PRECIPITIN - HYPERSENSITIVITY PNEUMONITIS 2 - ARUP","code_information":[{"code":"3028660608","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86606","type":"HCPCS"}],"standard_charges":[{"gross_charge":57.0,"discounted_cash":57.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC A FUMIGATUS #2 AB PRECIPITIN - HYPERSENSITIVITY PNEUMONITIS 2 - ARUP","code_information":[{"code":"3028660609","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86606","type":"HCPCS"}],"standard_charges":[{"gross_charge":57.0,"discounted_cash":57.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC A FUMIGATUS #3 AB PRECIPITIN - HYPERSENSITIVITY PNEUMONITIS 2 - ARUP","code_information":[{"code":"3028660610","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86606","type":"HCPCS"}],"standard_charges":[{"gross_charge":57.0,"discounted_cash":57.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASPERGILLUS AB BY COMPLEMENT FIXATION - FUNGAL AB W/RFLX SERUM - ARUP","code_information":[{"code":"3028660611","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86606","type":"HCPCS"}],"standard_charges":[{"gross_charge":108.0,"discounted_cash":108.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC A FUMIGATUS #1 AB PRECIPITIN - HYPER PNEUMO EXTENDED PANEL - ARUP","code_information":[{"code":"3028660613","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86606","type":"HCPCS"}],"standard_charges":[{"gross_charge":127.0,"discounted_cash":127.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC A FUMIGATUS #6 AB PRECIPITIN - HYPER PNEUMO EXTENDED PANEL - ARUP","code_information":[{"code":"3028660614","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86606","type":"HCPCS"}],"standard_charges":[{"gross_charge":127.0,"discounted_cash":127.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC A FLAVUS AB PRECIPITIN - HYPER PNEUMO EXTENDED PANEL - ARUP","code_information":[{"code":"3028660615","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86606","type":"HCPCS"}],"standard_charges":[{"gross_charge":57.0,"discounted_cash":57.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC A FUMIGATUS #2 AB PRECIPITIN - HYPER PNEUMO EXTENDED PANEL - ARUP","code_information":[{"code":"3028660616","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86606","type":"HCPCS"}],"standard_charges":[{"gross_charge":57.0,"discounted_cash":57.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC A FUMIGATUS #3 AB PRECIPITIN - HYPER PNEUMO EXTENDED PANEL - ARUP","code_information":[{"code":"3028660617","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86606","type":"HCPCS"}],"standard_charges":[{"gross_charge":57.0,"discounted_cash":57.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BARTONELLA HENSELAE ANTIBODY","code_information":[{"code":"3028661102","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86611","type":"HCPCS"}],"standard_charges":[{"gross_charge":128.0,"discounted_cash":128.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BARTONELLA QUINTANA ANTIBODY","code_information":[{"code":"3028661103","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86611","type":"HCPCS"}],"standard_charges":[{"gross_charge":128.0,"discounted_cash":128.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BARTONELLA HENSELAE IGG - ARUP","code_information":[{"code":"3028661104","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86611","type":"HCPCS"}],"standard_charges":[{"gross_charge":128.0,"discounted_cash":128.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BARTONELLA QUINTANA IGM - ARUP","code_information":[{"code":"3028661105","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86611","type":"HCPCS"}],"standard_charges":[{"gross_charge":128.0,"discounted_cash":128.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BARTONELLA QUINTANA IGG - ARUP","code_information":[{"code":"3028661106","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86611","type":"HCPCS"}],"standard_charges":[{"gross_charge":128.0,"discounted_cash":128.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BARTONELLA HENSELAE IGM - ARUP","code_information":[{"code":"3028661107","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86611","type":"HCPCS"}],"standard_charges":[{"gross_charge":128.0,"discounted_cash":128.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BARTONELLA QUINTANA IGM - BARTONELLA AB PANEL - ARUP","code_information":[{"code":"3028661108","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86611","type":"HCPCS"}],"standard_charges":[{"gross_charge":128.0,"discounted_cash":128.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BARTONELLA HENSELAE IGG - BARTONELLA AB PANEL - ARUP","code_information":[{"code":"3028661109","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86611","type":"HCPCS"}],"standard_charges":[{"gross_charge":128.0,"discounted_cash":128.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BARTONELLA QUINTANA IGG - BARTONELLA AB PANEL - ARUP","code_information":[{"code":"3028661110","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86611","type":"HCPCS"}],"standard_charges":[{"gross_charge":128.0,"discounted_cash":128.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BARTONELLA HENSELAE IGM - BARTONELLA AB PANEL - ARUP","code_information":[{"code":"3028661111","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86611","type":"HCPCS"}],"standard_charges":[{"gross_charge":128.0,"discounted_cash":128.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BLASTOMYCES, ANTIBODY - BLASTOMYCES ANTIBODIES","code_information":[{"code":"3028661201","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86612","type":"HCPCS"}],"standard_charges":[{"gross_charge":39.0,"discounted_cash":39.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FUNGAL ANTIBODIES - BLASTOMYCES","code_information":[{"code":"3028661202","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86612","type":"HCPCS"}],"standard_charges":[{"gross_charge":196.0,"discounted_cash":196.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BLASTOMYCES DERMATITIDIS AB EIA W/ RFLX TO IMMUNODIFFUSION SERUM - ARUP","code_information":[{"code":"3028661203","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86612","type":"HCPCS"}],"standard_charges":[{"gross_charge":39.0,"discounted_cash":39.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BLASTOMYCES ANTIBODY BY EIA - FUNGAL ANTIBODIES W/ REFLEX SERUM - ARUP","code_information":[{"code":"3028661204","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86612","type":"HCPCS"}],"standard_charges":[{"gross_charge":196.0,"discounted_cash":196.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BORDETELLA ANTIBODY - BORDETELLA PERTUSSIS ANTIBODY","code_information":[{"code":"3028661501","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86615","type":"HCPCS"}],"standard_charges":[{"gross_charge":106.0,"discounted_cash":106.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BORDETELLA PERTUSSIS IGA IMMUNOBLOT","code_information":[{"code":"3028661503","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86615","type":"HCPCS"}],"standard_charges":[{"gross_charge":112.0,"discounted_cash":112.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BORDETELLA PERTUSSIS IGG IMMUNOBLOT","code_information":[{"code":"3028661504","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86615","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.0,"discounted_cash":132.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BORDETELLA PERTUSSIS IGM IMMUNOBLOT","code_information":[{"code":"3028661505","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86615","type":"HCPCS"}],"standard_charges":[{"gross_charge":124.0,"discounted_cash":124.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BORDETELLA PERTUSSIS ANTIBODY IGA BLOT - ARUP","code_information":[{"code":"3028661507","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86615","type":"HCPCS"}],"standard_charges":[{"gross_charge":112.0,"discounted_cash":112.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BORDETELLA PERTUSSIS IGG BLOT - ARUP","code_information":[{"code":"3028661508","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86615","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.0,"discounted_cash":132.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BORDETELLA PERTUSSIS IGM BLOT - ARUP","code_information":[{"code":"3028661510","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86615","type":"HCPCS"}],"standard_charges":[{"gross_charge":124.0,"discounted_cash":124.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC LYME DISEASE ANTIBODY, CONFIRMATORY - LYME DISEASE, WESTERN BLOT","code_information":[{"code":"3028661701","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86617","type":"HCPCS"}],"standard_charges":[{"gross_charge":154.0,"discounted_cash":154.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BORRELIA BURGDORFERI IMMUNOBLOT IGM","code_information":[{"code":"3028661703","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86617","type":"HCPCS"}],"standard_charges":[{"gross_charge":130.0,"discounted_cash":130.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BORRELIA BURGDORFERI ANTIBODY IMMUNOBLOT CSF","code_information":[{"code":"3028661704","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86617","type":"HCPCS"}],"standard_charges":[{"gross_charge":145.0,"discounted_cash":145.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BORRELIA BURGDORFERI IMMUNOBLOT IGG","code_information":[{"code":"3028661705","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86617","type":"HCPCS"}],"standard_charges":[{"gross_charge":139.0,"discounted_cash":139.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC B. BURGDORFERI (LYME) IGM CSF","code_information":[{"code":"3028661706","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86617","type":"HCPCS"}],"standard_charges":[{"gross_charge":145.0,"discounted_cash":145.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC B. BURGDORFERI (LYME) IGG - ARUP","code_information":[{"code":"3028661707","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86617","type":"HCPCS"}],"standard_charges":[{"gross_charge":139.0,"discounted_cash":139.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BORRELIA BUGDORFERI/LYME IGG BY IMMUNOBLOT - LYME ANTIBODIES - ARUP","code_information":[{"code":"3028661708","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86617","type":"HCPCS"}],"standard_charges":[{"gross_charge":154.0,"discounted_cash":154.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BORRELIA BUGDORFERI/LYME IGM BY IMMUNOBLOT - LYME ANTIBODIES - ARUP","code_information":[{"code":"3028661709","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86617","type":"HCPCS"}],"standard_charges":[{"gross_charge":154.0,"discounted_cash":154.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC B BURGDORFERI ANTIBODY - LYME STANDARD 2-TIER, 1ST TIER - ARUP","code_information":[{"code":"3028661802","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86618","type":"HCPCS"}],"standard_charges":[{"gross_charge":96.0,"discounted_cash":96.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BRUCELLA SPECIES ANTIBODY TOTAL - ARUP","code_information":[{"code":"3028662202","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86622","type":"HCPCS"}],"standard_charges":[{"gross_charge":99.0,"discounted_cash":99.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CANDIDA, ANTIBODY - CANDIDA ANTIBODY","code_information":[{"code":"3028662801","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86628","type":"HCPCS"}],"standard_charges":[{"gross_charge":77.0,"discounted_cash":77.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CANDIDA IGA - CANDIDA ANTIBODIES IGA IGG IGM - ARUP","code_information":[{"code":"3028662802","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86628","type":"HCPCS"}],"standard_charges":[{"gross_charge":77.0,"discounted_cash":77.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CANDIDA IGG - CANDIDA ANTIBODIES IGA IGG IGM - ARUP","code_information":[{"code":"3028662803","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86628","type":"HCPCS"}],"standard_charges":[{"gross_charge":77.0,"discounted_cash":77.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CANDIDA IGM - CANDIDA ANTIBODIES IGA IGG IGM - ARUP","code_information":[{"code":"3028662804","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86628","type":"HCPCS"}],"standard_charges":[{"gross_charge":77.0,"discounted_cash":77.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC C PSITTACI IGG TITER - CHLAMYDIA ANTIBODY PANEL IGG IGM - ARUP","code_information":[{"code":"3028663101","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86631","type":"HCPCS"}],"standard_charges":[{"gross_charge":235.0,"discounted_cash":235.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC C PSITTACI IGM TITER - CHLAMYDIA ANTIBODY PANEL IGG IGM - ARUP","code_information":[{"code":"3028663201","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86632","type":"HCPCS"}],"standard_charges":[{"gross_charge":327.0,"discounted_cash":327.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FUNGAL ANTIBODIES - COCCIDIOEDES","code_information":[{"code":"3028663502","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86635","type":"HCPCS"}],"standard_charges":[{"gross_charge":128.0,"discounted_cash":128.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC COCCIDIOIDES BY COMPLEMENT FIXATION - FUNGAL AB W/RFLX SERUM - ARUP","code_information":[{"code":"3028663515","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86635","type":"HCPCS"}],"standard_charges":[{"gross_charge":128.0,"discounted_cash":128.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CMV ANTIBODY - CMV IGG","code_information":[{"code":"3028664401","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86644","type":"HCPCS"}],"standard_charges":[{"gross_charge":168.0,"discounted_cash":168.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CYTOMEGALOVIRUS (CMV) IGG - CMV ANTIBODIES IGG IGM - ARUP","code_information":[{"code":"3028664403","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86644","type":"HCPCS"}],"standard_charges":[{"gross_charge":168.0,"discounted_cash":168.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CYTOMEGALOVIRUS (CMV) IGG - ARUP","code_information":[{"code":"3028664404","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86644","type":"HCPCS"}],"standard_charges":[{"gross_charge":168.0,"discounted_cash":168.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CMV ANTIBODY, IGM - CMV IGM","code_information":[{"code":"3028664501","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86645","type":"HCPCS"}],"standard_charges":[{"gross_charge":197.0,"discounted_cash":197.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CYTOMEGALOVIRUS (CMV) IGM - CMV ANTIBODIES IGG IGM - ARUP","code_information":[{"code":"3028664503","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86645","type":"HCPCS"}],"standard_charges":[{"gross_charge":197.0,"discounted_cash":197.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CYTOMEGALOVIRUS (CMV) IGM - ARUP","code_information":[{"code":"3028664505","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86645","type":"HCPCS"}],"standard_charges":[{"gross_charge":197.0,"discounted_cash":197.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CALIFORNIA ENCEPHALITIS IGM - ARBOVIRUS PANEL IGM - ARUP","code_information":[{"code":"3028665109","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86651","type":"HCPCS"}],"standard_charges":[{"gross_charge":175.0,"discounted_cash":175.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC EASTERN EQUINE ENCEPHALITIS IGM - ARBOVIRUS PANEL IGM - ARUP","code_information":[{"code":"3028665207","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86652","type":"HCPCS"}],"standard_charges":[{"gross_charge":175.0,"discounted_cash":175.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ST LOUIS ENCEPHALITIS IGM - ARBOVIRUS PANEL IGM - ARUP","code_information":[{"code":"3028665307","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86653","type":"HCPCS"}],"standard_charges":[{"gross_charge":175.0,"discounted_cash":175.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC WESTERN EQUINE ENCEPHALITIS IGM - ARBOVIRUS PANEL IGM - ARUP","code_information":[{"code":"3028665407","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86654","type":"HCPCS"}],"standard_charges":[{"gross_charge":175.0,"discounted_cash":175.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC EPSTEIN BARR VIRUS EARLY IGG","code_information":[{"code":"3028666301","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86663","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.0,"discounted_cash":87.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC EBV - EARLY IGG - EPSTEIN-BARR VIRUS ANTIBODY PANEL 1 - ARUP","code_information":[{"code":"3028666302","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86663","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.0,"discounted_cash":87.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC EPSTEIN BARR VIRUS EARLY ANTIGEN IGG - ARUP","code_information":[{"code":"3028666303","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86663","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.0,"discounted_cash":87.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC EPSTEIN-BARR NUCLEAR ANTIGEN - EPSTEIN-BARR VIRUS NUCLEAR ANTIGEN AB","code_information":[{"code":"3028666401","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86664","type":"HCPCS"}],"standard_charges":[{"gross_charge":117.0,"discounted_cash":117.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC EBV - NUCLEAR AG, IGG - EPSTEIN-BARR VIRUS ANTIBODY PANEL 1 - ARUP","code_information":[{"code":"3028666402","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86664","type":"HCPCS"}],"standard_charges":[{"gross_charge":117.0,"discounted_cash":117.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC EPSTEIN BARR VIRUS NUCLEAR ANTIGEN-EPSTEIN BARR VIRUS ANTIBODY PNL1-ARUP","code_information":[{"code":"3028666404","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86664","type":"HCPCS"}],"standard_charges":[{"gross_charge":117.0,"discounted_cash":117.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC EPSTEIN-BARR CAPSID VCA, IGG","code_information":[{"code":"3028666501","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86665","type":"HCPCS"}],"standard_charges":[{"gross_charge":110.0,"discounted_cash":110.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC EPSTEIN-BARR CAPSID VCA, IGM","code_information":[{"code":"3028666502","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86665","type":"HCPCS"}],"standard_charges":[{"gross_charge":86.0,"discounted_cash":86.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC VCA IGG - EPSTEIN-BARR VIRUS ANTIBODY PANEL 1 - ARUP","code_information":[{"code":"3028666509","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86665","type":"HCPCS"}],"standard_charges":[{"gross_charge":110.0,"discounted_cash":110.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC VCA IGM - EPSTEIN-BARR VIRUS ANTIBODY PANEL 1 - ARUP","code_information":[{"code":"3028666513","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86665","type":"HCPCS"}],"standard_charges":[{"gross_charge":86.0,"discounted_cash":86.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC EPSTEIN BARR VIRUS CAPSID VCA IGG - ARUP","code_information":[{"code":"3028666515","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86665","type":"HCPCS"}],"standard_charges":[{"gross_charge":110.0,"discounted_cash":110.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC EPSTEIN BARR VIRUS CAPSID VCA IGM - ARUP","code_information":[{"code":"3028666517","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86665","type":"HCPCS"}],"standard_charges":[{"gross_charge":86.0,"discounted_cash":86.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC EPSTEIN BARR VIRUS CAPSID VCA IGG-EPSTEIN BARR VIRUS ANTIBODY PNL 1-ARUP","code_information":[{"code":"3028666518","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86665","type":"HCPCS"}],"standard_charges":[{"gross_charge":110.0,"discounted_cash":110.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC EPSTEIN BARR VIRUS CAPSID VCA IGM-EPSTEIN BARR VIRUS ANTIBODY PNL 1-ARUP","code_information":[{"code":"3028666519","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86665","type":"HCPCS"}],"standard_charges":[{"gross_charge":86.0,"discounted_cash":86.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC EHRLICHIA ANTIBODY - EHRLICHIA CHAFFEENSIS PANEL","code_information":[{"code":"3028666601","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86666","type":"HCPCS"}],"standard_charges":[{"gross_charge":250.0,"discounted_cash":250.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC EHRLICHIA ANTIBODY - ANAPLASMA PHAGOCYTOPHILUM IGG","code_information":[{"code":"3028666602","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86666","type":"HCPCS"}],"standard_charges":[{"gross_charge":250.0,"discounted_cash":250.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC EHRLICHIA ANTIBODY - ANAPLASMA PHAGOCYTOPHILUM IGM","code_information":[{"code":"3028666603","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86666","type":"HCPCS"}],"standard_charges":[{"gross_charge":174.0,"discounted_cash":174.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ANAPLASMA PHGOCYTOPHILUM IGG - ANAPLASMA PHAGOCYTOPHYLLIU IGG IGM - ARUP","code_information":[{"code":"3028666604","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86666","type":"HCPCS"}],"standard_charges":[{"gross_charge":250.0,"discounted_cash":250.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ANAPLASMA PHGOCYTOPHILUM IGM - ANAPLASMA PHAGOCYTOPHYLLIU IGG IGM - ARUP","code_information":[{"code":"3028666605","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86666","type":"HCPCS"}],"standard_charges":[{"gross_charge":174.0,"discounted_cash":174.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FRANCISELLA TULARENSIS - TULAREMIA ANTIBODY","code_information":[{"code":"3028666801","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86668","type":"HCPCS"}],"standard_charges":[{"gross_charge":98.0,"discounted_cash":98.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GIARDIA LAMBLIA AB IGA","code_information":[{"code":"3028667402","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86674","type":"HCPCS"}],"standard_charges":[{"gross_charge":173.0,"discounted_cash":173.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC G LAMBLIA AB IGM","code_information":[{"code":"3028667403","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86674","type":"HCPCS"}],"standard_charges":[{"gross_charge":172.0,"discounted_cash":172.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GIARDIA LAMBLIA AB IGG","code_information":[{"code":"3028667405","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86674","type":"HCPCS"}],"standard_charges":[{"gross_charge":81.0,"discounted_cash":81.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HELMINTH, ANTIBODY - STRONGYLOIDES ANTIBODY, IGG","code_information":[{"code":"3028668206","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86682","type":"HCPCS"}],"standard_charges":[{"gross_charge":283.0,"discounted_cash":283.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC STRONGYLOIDES IGG - ARUP","code_information":[{"code":"3028668207","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86682","type":"HCPCS"}],"standard_charges":[{"gross_charge":283.0,"discounted_cash":283.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SCHISTOSOMA IGG - ARUP","code_information":[{"code":"3028668210","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86682","type":"HCPCS"}],"standard_charges":[{"gross_charge":199.0,"discounted_cash":199.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HTLV/HIV CONFIRMATORY TEST - HIV-1 WESTERN BLOT","code_information":[{"code":"3028668901","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86689","type":"HCPCS"}],"standard_charges":[{"gross_charge":215.0,"discounted_cash":215.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HEPATITIS, DELTA AGENT - HEPATITIS DELTA VIRUS","code_information":[{"code":"3028669201","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86692","type":"HCPCS"}],"standard_charges":[{"gross_charge":178.0,"discounted_cash":178.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HERPES SIMPLEX TEST, UNSPECIFIED TYPE - HSV NON-SPECIFIC TYPE IGG AB","code_information":[{"code":"3028669401","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86694","type":"HCPCS"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HERPES SIMPLEX TEST, UNSPECIFIED TYPE - HSV NON-SPECIFIC ANTIBODY","code_information":[{"code":"3028669402","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86694","type":"HCPCS"}],"standard_charges":[{"gross_charge":123.0,"discounted_cash":123.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HERPES SIMPLEX TEST, UNSPECIFIED TYPE - HSV NON-SPECIFIC TYPE IGM AB","code_information":[{"code":"3028669403","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86694","type":"HCPCS"}],"standard_charges":[{"gross_charge":201.0,"discounted_cash":201.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HERPES SIMPLEX VIRUS (HSV) 1/2 COMBINED IGG - ARUP","code_information":[{"code":"3028669408","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86694","type":"HCPCS"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HERPES SIMPLEX VIRUS (HSV) TYPE 1/2 IGM - ARUP","code_information":[{"code":"3028669409","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86694","type":"HCPCS"}],"standard_charges":[{"gross_charge":123.0,"discounted_cash":123.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HERPES SIMPLEX VIRUS(HSV) 1/2 IGG W/ RFLX TYPE 1/2 GLYCO G SPECIFIC-ARUP","code_information":[{"code":"3028669412","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86694","type":"HCPCS"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HERPES SIMPLEX 1 GLYCOPROTEIN G AB IGG","code_information":[{"code":"3028669503","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86695","type":"HCPCS"}],"standard_charges":[{"gross_charge":99.0,"discounted_cash":99.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TYPE 1 IGG - HERPES SIMPLEX 1/2 GLYCOPROTEIN G IGG AB - ARUP","code_information":[{"code":"3028669506","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86695","type":"HCPCS"}],"standard_charges":[{"gross_charge":110.0,"discounted_cash":110.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HSV TYPE 1 IGG - HSV 1 GLYCOPROTEIN G IGG - ARUP","code_information":[{"code":"3028669509","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86695","type":"HCPCS"}],"standard_charges":[{"gross_charge":99.0,"discounted_cash":99.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HSV 1 GLYCOPROTEIN G-SPECIFIC IGG - HSV 1&2 GLYCOPROTEIN G IGG AB - ARUP","code_information":[{"code":"3028669512","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86695","type":"HCPCS"}],"standard_charges":[{"gross_charge":110.0,"discounted_cash":110.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HSV TYPE 2 IGG - HSV 2 GLYCOPROTEIN G IGG - ARUP","code_information":[{"code":"3028669601","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86696","type":"HCPCS"}],"standard_charges":[{"gross_charge":128.0,"discounted_cash":128.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TYPE 2 IGG - HERPES SIMPLEX VIRUS 2 GLYCOPROTEIN G AB IGG - ARUP","code_information":[{"code":"3028669605","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86696","type":"HCPCS"}],"standard_charges":[{"gross_charge":128.0,"discounted_cash":128.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TYPE 2 IGG - HERPES SIMPLEX 1/2 GLYCOPROTEIN G IGG AB - ARUP","code_information":[{"code":"3028669607","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86696","type":"HCPCS"}],"standard_charges":[{"gross_charge":128.0,"discounted_cash":128.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HSV 2 GLYCOPROTEIN G IGG - ARUP","code_information":[{"code":"3028669609","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86696","type":"HCPCS"}],"standard_charges":[{"gross_charge":128.0,"discounted_cash":128.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HERPES SIMPLEX VIRUS 2 GLYCOPROTEIN G IGG - ARUP","code_information":[{"code":"3028669610","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86696","type":"HCPCS"}],"standard_charges":[{"gross_charge":128.0,"discounted_cash":128.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HSV 2 GLYCOPROTEIN G-SPECIFIC IGG - HSV 1&2 GLYCOPROTEIN G IGG AB - ARUP","code_information":[{"code":"3028669617","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86696","type":"HCPCS"}],"standard_charges":[{"gross_charge":128.0,"discounted_cash":128.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HISTOPLASMA - HISTOPLASMA ANTIBODIES","code_information":[{"code":"3028669801","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86698","type":"HCPCS"}],"standard_charges":[{"gross_charge":171.0,"discounted_cash":171.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FUNGAL ANTIBODIES - HISTOPLASMA","code_information":[{"code":"3028669802","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86698","type":"HCPCS"}],"standard_charges":[{"gross_charge":177.0,"discounted_cash":177.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HISTOPLASMA ABS IMMUNODIFFUSION - HISTOPLASMA ABS BY CF AND ID - ARUP","code_information":[{"code":"3028669805","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86698","type":"HCPCS"}],"standard_charges":[{"gross_charge":171.0,"discounted_cash":171.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HISTOPLASMA MYCELIA ABS CF - HISTOPLASMA ABS BY CF AND ID - ARUP","code_information":[{"code":"3028669806","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86698","type":"HCPCS"}],"standard_charges":[{"gross_charge":171.0,"discounted_cash":171.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HISTOPLASMA YEAST ABS CF - HISTOPLASMA ABS BY CF AND ID - ARUP","code_information":[{"code":"3028669807","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86698","type":"HCPCS"}],"standard_charges":[{"gross_charge":171.0,"discounted_cash":171.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HISTOPLASMA MYCELIA AB BY COMPLEMENTFIXATION-FUNGAL AB W/RFLX SERUM-ARUP","code_information":[{"code":"3028669808","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86698","type":"HCPCS"}],"standard_charges":[{"gross_charge":177.0,"discounted_cash":177.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HISTOPLASMA YEAST AB BY COMPLEMENT FIXATION-FUNGAL AB W/RFLX SERUM-ARUP","code_information":[{"code":"3028669809","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86698","type":"HCPCS"}],"standard_charges":[{"gross_charge":177.0,"discounted_cash":177.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HIV-1 - HIV 1 ANTIBODY EIA","code_information":[{"code":"3028670101","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86701","type":"HCPCS"}],"standard_charges":[{"gross_charge":114.0,"discounted_cash":114.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HIV 1 - HIV 1/2 AB DIFF, SUPPLEMENTAL - ARUP","code_information":[{"code":"3028670103","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86701","type":"HCPCS"}],"standard_charges":[{"gross_charge":114.0,"discounted_cash":114.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HIV-2 - HIV-2 ANTIBODIES","code_information":[{"code":"3028670201","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86702","type":"HCPCS"}],"standard_charges":[{"gross_charge":148.0,"discounted_cash":148.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HIV 2 - HIV 1/2 AB DIFF, SUPPLEMENTAL - ARUP","code_information":[{"code":"3028670202","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86702","type":"HCPCS"}],"standard_charges":[{"gross_charge":148.0,"discounted_cash":148.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HEPATITIS B CORE ANTIBODY TOTAL","code_information":[{"code":"3028670401","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86704","type":"HCPCS"}],"standard_charges":[{"gross_charge":141.0,"discounted_cash":141.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HEPATITIS B CORE ANTIBODY TOTAL - ARUP","code_information":[{"code":"3028670405","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86704","type":"HCPCS"}],"standard_charges":[{"gross_charge":141.0,"discounted_cash":141.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HEPATITIS B CORE ANTIBODY IGM","code_information":[{"code":"3028670501","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86705","type":"HCPCS"}],"standard_charges":[{"gross_charge":133.0,"discounted_cash":133.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HEPATITIS B VIRUS CORE IGM - HEPATITIS PANEL ACUTE","code_information":[{"code":"3028670503","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86705","type":"HCPCS"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":32.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HEPATITIS B SURFACE ANTIBODY","code_information":[{"code":"3028670601","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86706","type":"HCPCS"}],"standard_charges":[{"gross_charge":171.0,"discounted_cash":171.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HEPATITIS B SURFACE ANTIBODY - ARUP","code_information":[{"code":"3028670603","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86706","type":"HCPCS"}],"standard_charges":[{"gross_charge":171.0,"discounted_cash":171.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HEPATITIS BE AB TEST - HEPATITIS B E ANTIBODY","code_information":[{"code":"3028670701","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86707","type":"HCPCS"}],"standard_charges":[{"gross_charge":93.0,"discounted_cash":93.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HEPATITIS B E VIRUS ANTIBODY - ARUP","code_information":[{"code":"3028670702","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86707","type":"HCPCS"}],"standard_charges":[{"gross_charge":93.0,"discounted_cash":93.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HEPATITIS A ANTIBODY TOTAL","code_information":[{"code":"3028670801","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86708","type":"HCPCS"}],"standard_charges":[{"gross_charge":135.0,"discounted_cash":135.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HEPATITIS A ANTIBODY, TOTAL - ARUP","code_information":[{"code":"3028670802","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86708","type":"HCPCS"}],"standard_charges":[{"gross_charge":135.0,"discounted_cash":135.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HEPATITIS A IGM","code_information":[{"code":"3028670901","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86709","type":"HCPCS"}],"standard_charges":[{"gross_charge":151.0,"discounted_cash":151.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HEPATITIS A VIRUS IGM - HEPATITIS PANEL ACUTE","code_information":[{"code":"3028670903","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86709","type":"HCPCS"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":32.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC LEGIONELLA PNEUMONPHILA IGG IGA IGM TYPE 1 THRU 6 BY ELISA - ARUP","code_information":[{"code":"3028671305","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86713","type":"HCPCS"}],"standard_charges":[{"gross_charge":172.0,"discounted_cash":172.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC LEPTOSPIRA IGM - ARUP","code_information":[{"code":"3028672002","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86720","type":"HCPCS"}],"standard_charges":[{"gross_charge":128.0,"discounted_cash":128.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MUMPS - MUMPS IGG ANTIBODY","code_information":[{"code":"3028673501","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86735","type":"HCPCS"}],"standard_charges":[{"gross_charge":131.0,"discounted_cash":131.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MUMPS - MUMPS IGM ANTIBODY","code_information":[{"code":"3028673502","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86735","type":"HCPCS"}],"standard_charges":[{"gross_charge":121.0,"discounted_cash":121.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MUMPS IGG - ARUP","code_information":[{"code":"3028673506","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86735","type":"HCPCS"}],"standard_charges":[{"gross_charge":131.0,"discounted_cash":131.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MYCOPLASMA - MYCOPLASMA PNEUMONIAE ANTIBODY, IGM","code_information":[{"code":"3028673801","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86738","type":"HCPCS"}],"standard_charges":[{"gross_charge":91.0,"discounted_cash":91.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MYCOPLASMA PNEUMONIAE IGG","code_information":[{"code":"3028673802","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86738","type":"HCPCS"}],"standard_charges":[{"gross_charge":91.0,"discounted_cash":91.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MYCOPLASMA PNEUMONIAE IGM - MYCOPLASMA PNEUMONIAE ANTIBODY G/M - ARUP","code_information":[{"code":"3028673805","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86738","type":"HCPCS"}],"standard_charges":[{"gross_charge":91.0,"discounted_cash":91.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MYCOPLASMA PNEUMONIAE IGG - MYCOPLASMA PNEUMONIAE ANTIBODY G/M - ARUP","code_information":[{"code":"3028673806","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86738","type":"HCPCS"}],"standard_charges":[{"gross_charge":91.0,"discounted_cash":91.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MYCOPLASMA PNEUMONIAE IGM - ARUP","code_information":[{"code":"3028673807","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86738","type":"HCPCS"}],"standard_charges":[{"gross_charge":91.0,"discounted_cash":91.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PARVOVIRUS - PARVOVIRUS B19 ANTIBODY, IGG AND IGM","code_information":[{"code":"3028674701","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86747","type":"HCPCS"}],"standard_charges":[{"gross_charge":136.0,"discounted_cash":136.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PARVOVIRUS B19 IGM - ARUP","code_information":[{"code":"3028674706","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86747","type":"HCPCS"}],"standard_charges":[{"gross_charge":136.0,"discounted_cash":136.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PARVOVIRUS B19 IGG - PARVOVIRUS B19 IGG AND IGM - ARUP","code_information":[{"code":"3028674707","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86747","type":"HCPCS"}],"standard_charges":[{"gross_charge":136.0,"discounted_cash":136.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PARVOVIRUS B19 IGM - PARVOVIRUS B19 IGG AND IGM - ARUP","code_information":[{"code":"3028674708","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86747","type":"HCPCS"}],"standard_charges":[{"gross_charge":136.0,"discounted_cash":136.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PROTOZOA, NOT ELSEWHERE - BABESIA MICROTI, IGG","code_information":[{"code":"3028675301","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86753","type":"HCPCS"}],"standard_charges":[{"gross_charge":109.0,"discounted_cash":109.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PROTOZOA, NOT ELSEWHERE - BABESIA MICROTI, IGM","code_information":[{"code":"3028675302","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86753","type":"HCPCS"}],"standard_charges":[{"gross_charge":109.0,"discounted_cash":109.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BABESIA MICROTI IGG -BABESIA IGG IGM AB - ARUP","code_information":[{"code":"3028675310","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86753","type":"HCPCS"}],"standard_charges":[{"gross_charge":109.0,"discounted_cash":109.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BABESIA MICROTI IGM -BABESIA IGG IGM AB - ARUP","code_information":[{"code":"3028675311","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86753","type":"HCPCS"}],"standard_charges":[{"gross_charge":109.0,"discounted_cash":109.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TRYPANOSOMA CRUZI IGG - ARUP","code_information":[{"code":"3028675312","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86753","type":"HCPCS"}],"standard_charges":[{"gross_charge":116.0,"discounted_cash":116.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RICKETTSIA - RICKETTSIA RICKETTSII ANTIBODY","code_information":[{"code":"3028675701","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86757","type":"HCPCS"}],"standard_charges":[{"gross_charge":182.0,"discounted_cash":182.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RICKETTSIA - RICKETTSIA TYPHI (TYPHUS FEVER) ANTIBODY","code_information":[{"code":"3028675702","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86757","type":"HCPCS"}],"standard_charges":[{"gross_charge":182.0,"discounted_cash":182.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ROCKY MOUNTAIN SPOT FEVER IGG - ARUP","code_information":[{"code":"3028675709","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86757","type":"HCPCS"}],"standard_charges":[{"gross_charge":182.0,"discounted_cash":182.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ROCKY MOUNTAIN SPOT FEVER IGG - ROCKY MOUNTAIN SPOT FEVER IGG IGM - ARUP","code_information":[{"code":"3028675710","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86757","type":"HCPCS"}],"standard_charges":[{"gross_charge":182.0,"discounted_cash":182.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ROCKY MOUNTAIN SPOT FEVER IGM - ROCKY MOUNTAIN SPOT FEVER IGG IGM - ARUP","code_information":[{"code":"3028675711","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86757","type":"HCPCS"}],"standard_charges":[{"gross_charge":182.0,"discounted_cash":182.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ROCKY MOUNTAIN SPOTTED FEVER IGM - ARUP","code_information":[{"code":"3028675712","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86757","type":"HCPCS"}],"standard_charges":[{"gross_charge":182.0,"discounted_cash":182.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RUBELLA - RUBELLA ANTIBODY, IGM","code_information":[{"code":"3028676201","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86762","type":"HCPCS"}],"standard_charges":[{"gross_charge":96.0,"discounted_cash":96.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RUBELLA IGG QUANTITATIVE","code_information":[{"code":"3028676202","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86762","type":"HCPCS"}],"standard_charges":[{"gross_charge":96.0,"discounted_cash":96.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RUBELLA AB IGG - ARUP","code_information":[{"code":"3028676203","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86762","type":"HCPCS"}],"standard_charges":[{"gross_charge":96.0,"discounted_cash":96.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RUBELLA IGG - ARUP","code_information":[{"code":"3028676207","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86762","type":"HCPCS"}],"standard_charges":[{"gross_charge":96.0,"discounted_cash":96.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RUBEOLA ANTIBODY IGG","code_information":[{"code":"3028676501","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86765","type":"HCPCS"}],"standard_charges":[{"gross_charge":86.0,"discounted_cash":86.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RUBEOLA - RUBEOLA ANTIBODY, IGM","code_information":[{"code":"3028676502","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86765","type":"HCPCS"}],"standard_charges":[{"gross_charge":168.0,"discounted_cash":168.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RUBEOLA ANTIBODY, IGG - ARUP","code_information":[{"code":"3028676504","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86765","type":"HCPCS"}],"standard_charges":[{"gross_charge":86.0,"discounted_cash":86.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RUBEOLA (MEASLES) IGG - ARUP","code_information":[{"code":"3028676509","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86765","type":"HCPCS"}],"standard_charges":[{"gross_charge":86.0,"discounted_cash":86.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RUBEOLA (MEASLES) IGM - ARUP","code_information":[{"code":"3028676510","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86765","type":"HCPCS"}],"standard_charges":[{"gross_charge":168.0,"discounted_cash":168.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SALMONELLA TYPHY / PARATYPHI ANTIBODY - ARUP","code_information":[{"code":"3028676803","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86768","type":"HCPCS"}],"standard_charges":[{"gross_charge":149.0,"discounted_cash":149.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SARS-COV-2 COVID-19 ANTIBODY - COVID-19 ANTIBODY TITER, IGG AND IGM","code_information":[{"code":"3028676901","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86769","type":"HCPCS"}],"standard_charges":[{"gross_charge":98.0,"discounted_cash":98.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC COVID-19 SARS-COV-2 IGG SPIKE SEMI-QUANTITATIVE BY CIA - ARUP","code_information":[{"code":"3028676903","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86769","type":"HCPCS"}],"standard_charges":[{"gross_charge":98.0,"discounted_cash":98.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC COVID-19 SARS-COV-2 IGG QUALITATIVE - ARUP","code_information":[{"code":"3028676905","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86769","type":"HCPCS"}],"standard_charges":[{"gross_charge":98.0,"discounted_cash":98.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TOXOPLASMA - TOXOPLASMA GONDII IGG ANTIBODY","code_information":[{"code":"3028677701","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86777","type":"HCPCS"}],"standard_charges":[{"gross_charge":361.0,"discounted_cash":361.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TOXOPLASMA GONDII IGG - ARUP","code_information":[{"code":"3028677703","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86777","type":"HCPCS"}],"standard_charges":[{"gross_charge":361.0,"discounted_cash":361.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TOXOPLASMA GONDII IGG - TOXOPLASMA IGG IGM ANTIBODY - ARUP","code_information":[{"code":"3028677707","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86777","type":"HCPCS"}],"standard_charges":[{"gross_charge":361.0,"discounted_cash":361.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TOXOPLASMA, IGM - TOXOPLASMA GONDII ANTIBODY, IGM","code_information":[{"code":"3028677801","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86778","type":"HCPCS"}],"standard_charges":[{"gross_charge":114.0,"discounted_cash":114.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TOXOPLASMA GONDII IGM - ARUP","code_information":[{"code":"3028677805","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86778","type":"HCPCS"}],"standard_charges":[{"gross_charge":114.0,"discounted_cash":114.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TOXOPLASMA GONDII IGM - TOXOPLASMA IGG IGM ANTIBODY - ARUP","code_information":[{"code":"3028677807","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86778","type":"HCPCS"}],"standard_charges":[{"gross_charge":114.0,"discounted_cash":114.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TREPONEMA PALLIDUM CONFIRMATION","code_information":[{"code":"3028678001","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86780","type":"HCPCS"}],"standard_charges":[{"gross_charge":114.0,"discounted_cash":114.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ANTIBODY TREPONEMA PALLIDUM - FTA ANTIBODIES, IGG AND IGM","code_information":[{"code":"3028678002","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86780","type":"HCPCS"}],"standard_charges":[{"gross_charge":98.0,"discounted_cash":98.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TREPONEMA PALLIDUM (SYPHILIS) ANTIBODY - ARUP","code_information":[{"code":"3028678007","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86780","type":"HCPCS"}],"standard_charges":[{"gross_charge":98.0,"discounted_cash":98.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TREPONEMA PALLIDUM ANTIBODY BY TP-PA - ARUP","code_information":[{"code":"3028678011","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86780","type":"HCPCS"}],"standard_charges":[{"gross_charge":98.0,"discounted_cash":98.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TREPONEMA PALLIDUM IGG BY ELISA - ARUP","code_information":[{"code":"3028678012","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86780","type":"HCPCS"}],"standard_charges":[{"gross_charge":98.0,"discounted_cash":98.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TREPONEMA PALLIDUM IGG BY IFA (FTA-ABS) - ARUP","code_information":[{"code":"3028678013","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86780","type":"HCPCS"}],"standard_charges":[{"gross_charge":98.0,"discounted_cash":98.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TRICHINELLA - TRICHINELLA ANTIBODY","code_information":[{"code":"3028678401","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86784","type":"HCPCS"}],"standard_charges":[{"gross_charge":168.0,"discounted_cash":168.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC VARICELLA ZOSTER IGG","code_information":[{"code":"3028678701","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86787","type":"HCPCS"}],"standard_charges":[{"gross_charge":98.0,"discounted_cash":98.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC VARICELLA-ZOSTER - VARICELLA ZOSTER IGM","code_information":[{"code":"3028678702","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86787","type":"HCPCS"}],"standard_charges":[{"gross_charge":98.0,"discounted_cash":98.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC VARICELLA ZOSTER ANTIBODY, IGG - ARUP","code_information":[{"code":"3028678703","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86787","type":"HCPCS"}],"standard_charges":[{"gross_charge":98.0,"discounted_cash":98.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC VARICELLA ZOSTER IGG - ARUP","code_information":[{"code":"3028678707","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86787","type":"HCPCS"}],"standard_charges":[{"gross_charge":98.0,"discounted_cash":98.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC VARICELLA ZOSTER IGM - ARUP","code_information":[{"code":"3028678708","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86787","type":"HCPCS"}],"standard_charges":[{"gross_charge":98.0,"discounted_cash":98.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC VARICELLA ZOSTER IGM - VARICELLA ZOSTER IGG AND IGM - ARUP","code_information":[{"code":"3028678709","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86787","type":"HCPCS"}],"standard_charges":[{"gross_charge":98.0,"discounted_cash":98.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC VARICELLA ZOSTER IGG - VZ IGG AND IGM - ARUP","code_information":[{"code":"3028678710","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86787","type":"HCPCS"}],"standard_charges":[{"gross_charge":98.0,"discounted_cash":98.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC WEST NILE VIRUS AB, IGM - WEST NILE ANTIBODIES, IGG AND IGM","code_information":[{"code":"3028678801","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86788","type":"HCPCS"}],"standard_charges":[{"gross_charge":180.0,"discounted_cash":180.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ENCEPHALITIS PANEL WEST NILE VIRUS ANTIBODY IGM CSF","code_information":[{"code":"3028678804","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86788","type":"HCPCS"}],"standard_charges":[{"gross_charge":180.0,"discounted_cash":180.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC WEST NILE VIRUS IGM - WEST NILE VIRUS CSF - ARUP","code_information":[{"code":"3028678807","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86788","type":"HCPCS"}],"standard_charges":[{"gross_charge":179.0,"discounted_cash":179.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC WEST NILE VIRUS IGM CSF - ARUP","code_information":[{"code":"3028678809","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86788","type":"HCPCS"}],"standard_charges":[{"gross_charge":140.0,"discounted_cash":140.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC WEST NILE VIRUS ANTIBODY - WEST NILE VIRUS ANTIBODY, IGG","code_information":[{"code":"3028678901","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86789","type":"HCPCS"}],"standard_charges":[{"gross_charge":96.0,"discounted_cash":96.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ENCEPHALITIS PANEL WEST NILE VIRUS ANTIBODY IGG CSF","code_information":[{"code":"3028678902","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86789","type":"HCPCS"}],"standard_charges":[{"gross_charge":146.0,"discounted_cash":146.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC WEST NILE VIRUS IGG - WNV CSF - ARUP","code_information":[{"code":"3028678906","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86789","type":"HCPCS"}],"standard_charges":[{"gross_charge":96.0,"discounted_cash":96.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ANTIBODY HTLV I AND II","code_information":[{"code":"3028679009","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86790","type":"HCPCS"}],"standard_charges":[{"gross_charge":86.0,"discounted_cash":86.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ANTIBODY HERPES VIRUS 6 IGM","code_information":[{"code":"3028679012","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86790","type":"HCPCS"}],"standard_charges":[{"gross_charge":175.0,"discounted_cash":175.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DENGUE FEVER IGG - DENGUE FEVER IGG IGM AB - ARUP","code_information":[{"code":"3028679028","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86790","type":"HCPCS"}],"standard_charges":[{"gross_charge":86.0,"discounted_cash":86.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DENGUE FEVER IGM - DENGUE FEVER IGG IGM AB - ARUP","code_information":[{"code":"3028679029","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86790","type":"HCPCS"}],"standard_charges":[{"gross_charge":150.0,"discounted_cash":150.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HEPATITIS E IGM - ARUP","code_information":[{"code":"3028679032","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86790","type":"HCPCS"}],"standard_charges":[{"gross_charge":193.15,"discounted_cash":193.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HERPES VIRUS 6 IGG - ARUP","code_information":[{"code":"3028679033","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86790","type":"HCPCS"}],"standard_charges":[{"gross_charge":86.0,"discounted_cash":86.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HERPES VIRUS 6 IGM - ARUP","code_information":[{"code":"3028679034","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86790","type":"HCPCS"}],"standard_charges":[{"gross_charge":86.0,"discounted_cash":86.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ZIKA VIRUS IGM - ARUP","code_information":[{"code":"3028679402","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86794","type":"HCPCS"}],"standard_charges":[{"gross_charge":197.0,"discounted_cash":197.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC THYROGLOBULIN ANTIBODY - ANTI-THYROGLOBULIN AB","code_information":[{"code":"3028680001","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86800","type":"HCPCS"}],"standard_charges":[{"gross_charge":186.0,"discounted_cash":186.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC THYROGLOBULIN ANTIBODY - ANTI-THYROGLOBULIN AB WITH REFLEX TO THYROGLOBULIN","code_information":[{"code":"3028680003","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86800","type":"HCPCS"}],"standard_charges":[{"gross_charge":157.0,"discounted_cash":157.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ANTI THYROGLOBULIN (ATHYG) ANTIBODY - ARUP","code_information":[{"code":"3028680005","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86800","type":"HCPCS"}],"standard_charges":[{"gross_charge":186.0,"discounted_cash":186.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC THYROGLOBULIN ANTIBODY WITH REFLEX - ARUP","code_information":[{"code":"3028680007","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86800","type":"HCPCS"}],"standard_charges":[{"gross_charge":186.0,"discounted_cash":186.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC THYROGLOBULIN ANTIBODY - THYROID ANTIBODIES - ARUP","code_information":[{"code":"3028680008","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86800","type":"HCPCS"}],"standard_charges":[{"gross_charge":186.0,"discounted_cash":186.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HEPATITIS C ANTIBODY - HEPATITIS PANEL ACUTE","code_information":[{"code":"3028680301","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86803","type":"HCPCS"}],"standard_charges":[{"gross_charge":105.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HEPATITUS C VIRUS ANTIBODY - HEPATITIS PANEL, ACUTE","code_information":[{"code":"3028680304","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86803","type":"HCPCS"}],"standard_charges":[{"gross_charge":40.0,"discounted_cash":40.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HEPATITIS C ANTIBODY BY CIA WITH REFLEX - ARUP","code_information":[{"code":"3028680306","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86803","type":"HCPCS"}],"standard_charges":[{"gross_charge":105.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HEPATITIS C ANTIBODY WITH REFLEX HCV PCR- ARUP","code_information":[{"code":"3028680311","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86803","type":"HCPCS"}],"standard_charges":[{"gross_charge":105.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HLA TYPING, A,B,OR C /SINGLE - HLA-B27 ANTIGEN","code_information":[{"code":"3028681201","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86812","type":"HCPCS"}],"standard_charges":[{"gross_charge":385.0,"discounted_cash":385.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HLA B27 ANTIGEN - ARUP","code_information":[{"code":"3028681202","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86812","type":"HCPCS"}],"standard_charges":[{"gross_charge":385.0,"discounted_cash":385.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HLA ANTIBODY SCREEN CLASS I AND CLASS II","code_information":[{"code":"3028682801","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86828","type":"HCPCS"}],"standard_charges":[{"gross_charge":411.0,"discounted_cash":411.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ANTIBODY PROCEDURE UNLISTED","code_information":[{"code":"3028684903","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86849","type":"HCPCS"}],"standard_charges":[{"gross_charge":268.0,"discounted_cash":268.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OVA AND PARASITE COMPLEX STAIN - O&P EXAM BODY FLUID OR URINE - ARUP","code_information":[{"code":"3028720903","type":"CDM"},{"code":"0302","type":"RC"},{"code":"87209","type":"HCPCS"}],"standard_charges":[{"gross_charge":187.0,"discounted_cash":187.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OVA AND PARASITE COMPLEX STAIN - O&P FECAL - ARUP","code_information":[{"code":"3028720904","type":"CDM"},{"code":"0302","type":"RC"},{"code":"87209","type":"HCPCS"}],"standard_charges":[{"gross_charge":187.0,"discounted_cash":187.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HIV1/2 ANTIBODY/ANTIGEN SCREEN","code_information":[{"code":"3028738901","type":"CDM"},{"code":"0302","type":"RC"},{"code":"87389","type":"HCPCS"}],"standard_charges":[{"gross_charge":126.0,"discounted_cash":126.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HIV 1 & 2 ANTIBODY/ANTIGEN WITH REFLEX DIFF -ARUP","code_information":[{"code":"3028738903","type":"CDM"},{"code":"0302","type":"RC"},{"code":"87389","type":"HCPCS"}],"standard_charges":[{"gross_charge":126.0,"discounted_cash":126.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HIV 1 & 2 ANTIGEN/ANTIBODY WITH REFLEX HIV1WB - ARUP","code_information":[{"code":"3028738904","type":"CDM"},{"code":"0302","type":"RC"},{"code":"87389","type":"HCPCS"}],"standard_charges":[{"gross_charge":126.0,"discounted_cash":126.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HIV 1 & 2 ANTIGEN/ANTIBODY WITH REFLEX CIA - ARUP","code_information":[{"code":"3028738906","type":"CDM"},{"code":"0302","type":"RC"},{"code":"87389","type":"HCPCS"}],"standard_charges":[{"gross_charge":126.0,"discounted_cash":126.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SARS COVID-19 AG BY IMMUNOASSAY","code_information":[{"code":"3028742601","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87426","type":"HCPCS"}],"standard_charges":[{"gross_charge":166.0,"discounted_cash":166.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SARS COV2 2019 DNA RNA AMP HIGH THROUGHPUT","code_information":[{"code":"302U000301","type":"CDM"},{"code":"0306","type":"RC"},{"code":"U0003","type":"HCPCS"}],"standard_charges":[{"gross_charge":553.0,"discounted_cash":553.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BLOOD SMEAR,MICRO EXAM,MANUAL DIFF WBC - MANUAL DIFFERENTIAL","code_information":[{"code":"3058500701","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85007","type":"HCPCS"}],"standard_charges":[{"gross_charge":25.0,"discounted_cash":25.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MANUAL DIFFERENTIAL","code_information":[{"code":"3058500702","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85007","type":"HCPCS"}],"standard_charges":[{"gross_charge":25.0,"discounted_cash":25.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HEMATOCRIT","code_information":[{"code":"3058501401","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85014","type":"HCPCS"}],"standard_charges":[{"gross_charge":40.0,"discounted_cash":40.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HEMOGLOBIN","code_information":[{"code":"3058501801","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85018","type":"HCPCS"}],"standard_charges":[{"gross_charge":36.0,"discounted_cash":36.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC COMPLETE CBC & AUTO WBC DIFF","code_information":[{"code":"3058502501","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85025","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.0,"discounted_cash":83.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CBC","code_information":[{"code":"3058502701","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85027","type":"HCPCS"}],"standard_charges":[{"gross_charge":70.0,"discounted_cash":70.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RETICULOCYTE COUNT, AUTO - RETICULOCYTES","code_information":[{"code":"3058504501","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85045","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.0,"discounted_cash":83.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC LEUKOCYTE (WBC) COUNT - WHITE BLOOD COUNT","code_information":[{"code":"3058504803","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85048","type":"HCPCS"}],"standard_charges":[{"gross_charge":27.0,"discounted_cash":27.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PLATELET COUNT","code_information":[{"code":"3058504902","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85049","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.0,"discounted_cash":87.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PERIPHERAL BLOOD SMEAR INTERPRETATION","code_information":[{"code":"3058506001","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85060","type":"HCPCS"}],"standard_charges":[{"gross_charge":76.0,"discounted_cash":76.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BONE MARROW SMEAR INTERPRETATION","code_information":[{"code":"3058509702","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85097","type":"HCPCS"}],"standard_charges":[{"gross_charge":60.0,"discounted_cash":60.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FACTOR 2 ACTIVITY - ARUP","code_information":[{"code":"3058521003","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85210","type":"HCPCS"}],"standard_charges":[{"gross_charge":174.0,"discounted_cash":174.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FACTOR 5 ACTIVITY - ARUP","code_information":[{"code":"3058522003","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85220","type":"HCPCS"}],"standard_charges":[{"gross_charge":340.0,"discounted_cash":340.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FACTOR 7 ACTIVITY - ARUP","code_information":[{"code":"3058523003","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85230","type":"HCPCS"}],"standard_charges":[{"gross_charge":225.0,"discounted_cash":225.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FACTOR 8 ACTIVITY","code_information":[{"code":"3058524001","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85240","type":"HCPCS"}],"standard_charges":[{"gross_charge":193.0,"discounted_cash":193.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FACTOR 8 ACTIVITY (ARUP)","code_information":[{"code":"3058524003","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85240","type":"HCPCS"}],"standard_charges":[{"gross_charge":193.0,"discounted_cash":193.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FACTOR 8 ACTIVITY - VON WILLEBRAND PANEL (ARUP)","code_information":[{"code":"3058524004","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85240","type":"HCPCS"}],"standard_charges":[{"gross_charge":193.0,"discounted_cash":193.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FACTOR 8 ACTIVITY - VON WILLEBRAND MULTIMERIC (ARUP)","code_information":[{"code":"3058524005","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85240","type":"HCPCS"}],"standard_charges":[{"gross_charge":193.0,"discounted_cash":193.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CLOT FACTOR VIII VW RISTOCTN - FACTOR VIII RISTOCETIN COFACTR","code_information":[{"code":"3058524501","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85245","type":"HCPCS"}],"standard_charges":[{"gross_charge":319.0,"discounted_cash":319.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC VON WILLEBRAND RISTOCETIN FACTOR ACIVITY - VON WILLEBRAND PANEL- (ARUP)","code_information":[{"code":"3058524502","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85245","type":"HCPCS"}],"standard_charges":[{"gross_charge":319.0,"discounted_cash":319.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC VON WILLEBRAND RISTOCETIN FACTOR ACIVITY - VON WILLEBRAND MULTIMERIC PANEL(ARUP)","code_information":[{"code":"3058524503","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85245","type":"HCPCS"}],"standard_charges":[{"gross_charge":319.0,"discounted_cash":319.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FACTOR 8 RISTOCETIN COFACTOR - ARUP","code_information":[{"code":"3058524504","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85245","type":"HCPCS"}],"standard_charges":[{"gross_charge":319.0,"discounted_cash":319.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CLOT FACTOR VIII VW ANTIGEN - VON WILLEBRAND ANTIGEN","code_information":[{"code":"3058524603","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85246","type":"HCPCS"}],"standard_charges":[{"gross_charge":247.0,"discounted_cash":247.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC VON WILLEBRAND FACTOR ANTIGEN - VON WILLEBRAND PANEL- (ARUP)","code_information":[{"code":"3058524604","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85246","type":"HCPCS"}],"standard_charges":[{"gross_charge":364.0,"discounted_cash":364.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC VON WILLEBRAND FACTOR ANTIGEN - VON WILLEBRAND MULTIMERIC PANEL(ARUP)","code_information":[{"code":"3058524605","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85246","type":"HCPCS"}],"standard_charges":[{"gross_charge":364.0,"discounted_cash":364.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC VON WILLEBRAND FACTOR (VWF) ANTIGEN - ARUP","code_information":[{"code":"3058524606","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85246","type":"HCPCS"}],"standard_charges":[{"gross_charge":247.0,"discounted_cash":247.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CLOT FACTOR VIII VWF MULTIMETRIC ANALYSIS - VON WILLEBRAND MULTIMERIC PANEL(ARUP)","code_information":[{"code":"3058524702","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85247","type":"HCPCS"}],"standard_charges":[{"gross_charge":412.0,"discounted_cash":412.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CLOT FACTOR IX PTC/CHRSTMAS - FACTOR 9 ACTIVITY","code_information":[{"code":"3058525001","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85250","type":"HCPCS"}],"standard_charges":[{"gross_charge":298.0,"discounted_cash":298.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CLOT FACTOR X STUART-POWER - FACTOR 10 ACTIVITY","code_information":[{"code":"3058526001","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85260","type":"HCPCS"}],"standard_charges":[{"gross_charge":502.0,"discounted_cash":502.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FACTOR 10 ACTIVITY - ARUP","code_information":[{"code":"3058526002","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85260","type":"HCPCS"}],"standard_charges":[{"gross_charge":567.2,"discounted_cash":567.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ANTITHROMBIN III","code_information":[{"code":"3058530001","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85300","type":"HCPCS"}],"standard_charges":[{"gross_charge":162.0,"discounted_cash":162.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ANTITHROMBIN III - ARUP","code_information":[{"code":"3058530004","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85300","type":"HCPCS"}],"standard_charges":[{"gross_charge":162.0,"discounted_cash":162.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ANTITHROMBIN III ANTIGEN","code_information":[{"code":"3058530101","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85301","type":"HCPCS"}],"standard_charges":[{"gross_charge":194.0,"discounted_cash":194.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ANTITHROMBIN III ANTIGEN - ARUP","code_information":[{"code":"3058530102","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85301","type":"HCPCS"}],"standard_charges":[{"gross_charge":194.0,"discounted_cash":194.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CLOT INHIB PROTEIN C,ANTIGEN - PROTEIN C ANTIGEN TOTAL","code_information":[{"code":"3058530201","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85302","type":"HCPCS"}],"standard_charges":[{"gross_charge":213.0,"discounted_cash":213.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PROTEIN C ANTIGEN TOTAL - ARUP","code_information":[{"code":"3058530202","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85302","type":"HCPCS"}],"standard_charges":[{"gross_charge":213.0,"discounted_cash":213.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PROTEIN C ANTIGEN TOTAL - PROTEIN C AND S ANTIGEN PANEL - ARUP","code_information":[{"code":"3058530203","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85302","type":"HCPCS"}],"standard_charges":[{"gross_charge":213.0,"discounted_cash":213.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CLOT INHIB PROTEIN C,ACTIV - PROTEIN C ACTIVITY","code_information":[{"code":"3058530301","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85303","type":"HCPCS"}],"standard_charges":[{"gross_charge":172.0,"discounted_cash":172.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PROTEIN C ACTIVITY - ARUP","code_information":[{"code":"3058530302","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85303","type":"HCPCS"}],"standard_charges":[{"gross_charge":172.0,"discounted_cash":172.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CLOT INHIB PROTEIN S,TOTAL - PROTEIN S ANTIGEN TOTAL","code_information":[{"code":"3058530502","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85305","type":"HCPCS"}],"standard_charges":[{"gross_charge":130.0,"discounted_cash":130.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PROTEIN S ANTIGEN TOTAL - ARUP","code_information":[{"code":"3058530503","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85305","type":"HCPCS"}],"standard_charges":[{"gross_charge":130.0,"discounted_cash":130.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PROTEIN S ANTIGEN TOTAL - PROTEIN C AND S ANTIGEN PANEL - ARUP","code_information":[{"code":"3058530504","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85305","type":"HCPCS"}],"standard_charges":[{"gross_charge":130.0,"discounted_cash":130.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CLOT INHIB PROTEIN S,FREE - PROTEIN S ACTIVITY","code_information":[{"code":"3058530601","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85306","type":"HCPCS"}],"standard_charges":[{"gross_charge":155.0,"discounted_cash":155.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CLOT INHIB PROTEIN S,FREE - PROTEIN S ANTIGEN FREE","code_information":[{"code":"3058530602","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85306","type":"HCPCS"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":125.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PROTEIN S ACTIVITY - ARUP","code_information":[{"code":"3058530603","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85306","type":"HCPCS"}],"standard_charges":[{"gross_charge":155.0,"discounted_cash":155.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PROTEIN S ANTIGEN FREE - ARUP","code_information":[{"code":"3058530604","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85306","type":"HCPCS"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":125.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ACTIVATED PROT C (APC) RESISTNCE ASSAY - APC RESISTANCE","code_information":[{"code":"3058530701","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85307","type":"HCPCS"}],"standard_charges":[{"gross_charge":181.0,"discounted_cash":181.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ACTIVATED PROTEIN C (APC) RESISTANCE - APC RESISTANCE PANEL - ARUP","code_information":[{"code":"3058530702","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85307","type":"HCPCS"}],"standard_charges":[{"gross_charge":181.0,"discounted_cash":181.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FIBRIN DEGRAD PRODUCTS, AGGLUTINATION - FIBRIN SPLIT PRODUCTS","code_information":[{"code":"3058536201","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85362","type":"HCPCS"}],"standard_charges":[{"gross_charge":70.0,"discounted_cash":70.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FIBRIN SPLITS PRODUCTS - ARUP","code_information":[{"code":"3058536202","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85362","type":"HCPCS"}],"standard_charges":[{"gross_charge":70.0,"discounted_cash":70.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC D-DIMER QUANTITATIVE","code_information":[{"code":"3058537901","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85379","type":"HCPCS"}],"standard_charges":[{"gross_charge":102.0,"discounted_cash":102.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FIBRINOGEN QUANTITATIVE","code_information":[{"code":"3058538401","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85384","type":"HCPCS"}],"standard_charges":[{"gross_charge":166.0,"discounted_cash":166.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FIBRINOGEN ANTIGEN - ARUP","code_information":[{"code":"3058538502","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85385","type":"HCPCS"}],"standard_charges":[{"gross_charge":181.0,"discounted_cash":181.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ADAMTS13 ACTIVITY","code_information":[{"code":"3058539701","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85397","type":"HCPCS"}],"standard_charges":[{"gross_charge":415.0,"discounted_cash":415.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PLASMINOGEN ACTIVATOR INHIBITOR","code_information":[{"code":"3058541501","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85415","type":"HCPCS"}],"standard_charges":[{"gross_charge":272.0,"discounted_cash":272.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FETAL HEMOGLOBIN BY KLEIHAUER BETKE STAIN ON MATERNAL BLOOD - CFD","code_information":[{"code":"3058546001","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85460","type":"HCPCS"}],"standard_charges":[{"gross_charge":93.0,"discounted_cash":93.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HEMOGLOBIN FETAL,ROSETTE - FETAL BLEED SCREEN","code_information":[{"code":"3058546101","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85461","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.0,"discounted_cash":87.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HEPARIN LEVEL - ANTI XA LOW MOLECULAR WEIGHT HEPARIN - ARUP","code_information":[{"code":"3058552005","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85520","type":"HCPCS"}],"standard_charges":[{"gross_charge":312.0,"discounted_cash":312.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HEPARIN ANTI-XA QUALITATIVE REFLEXED - ARUP","code_information":[{"code":"3058552006","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85520","type":"HCPCS"}],"standard_charges":[{"gross_charge":312.0,"discounted_cash":312.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HEPARIN NEUTRALIZATION","code_information":[{"code":"3058552501","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85525","type":"HCPCS"}],"standard_charges":[{"gross_charge":194.0,"discounted_cash":194.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MURAMIDASE - LYSOZYME, SERUM","code_information":[{"code":"3058554901","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85549","type":"HCPCS"}],"standard_charges":[{"gross_charge":100.0,"discounted_cash":100.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC LYSOZYME SERUM - ARUP","code_information":[{"code":"3058554903","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85549","type":"HCPCS"}],"standard_charges":[{"gross_charge":100.0,"discounted_cash":100.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RBC OSMOTIC FRAGILITY - OSMOTIC FRAGILITY RBC","code_information":[{"code":"3058555502","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85555","type":"HCPCS"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":138.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PHOSPHOLIPID NEUTRALIZATION,PLATELET - PLATELET NEUTRALIZATION","code_information":[{"code":"3058559701","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85597","type":"HCPCS"}],"standard_charges":[{"gross_charge":107.0,"discounted_cash":107.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PHOSPHOLIPID NEUTRALIZATION - HEXAGONAL PHOSPHOLIPID","code_information":[{"code":"3058559801","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85598","type":"HCPCS"}],"standard_charges":[{"gross_charge":170.0,"discounted_cash":170.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HEXAGONAL PHOSPHOLIPID NEUTRAL - ARUP","code_information":[{"code":"3058559803","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85598","type":"HCPCS"}],"standard_charges":[{"gross_charge":170.0,"discounted_cash":170.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HEXAGONAL PHOSPHOLIPID NEUTRAL REFLEX - ARUP","code_information":[{"code":"3058559804","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85598","type":"HCPCS"}],"standard_charges":[{"gross_charge":170.0,"discounted_cash":170.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PROTHROMBIN TIME INR","code_information":[{"code":"3058561001","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85610","type":"HCPCS"}],"standard_charges":[{"gross_charge":39.0,"discounted_cash":39.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PROTHROMBIN TIME INR - ARUP PHOSLIPID","code_information":[{"code":"3058561009","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85610","type":"HCPCS"}],"standard_charges":[{"gross_charge":39.0,"discounted_cash":39.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PROTHROMBIN TIME INR - LUPUS ANTICOAGULANT PANEL WITH REFLEX -ARUP","code_information":[{"code":"3058561010","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85610","type":"HCPCS"}],"standard_charges":[{"gross_charge":39.0,"discounted_cash":39.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PROTHROMBIN TIME - PT AND PTT PANEL","code_information":[{"code":"3058561013","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85610","type":"HCPCS"}],"standard_charges":[{"gross_charge":39.0,"discounted_cash":39.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PROTHROMBIN TIME -ANTIPHOSPHOLIPID SYNDROME REFLEX PANEL - ARUP","code_information":[{"code":"3058561014","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85610","type":"HCPCS"}],"standard_charges":[{"gross_charge":39.0,"discounted_cash":39.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RUSSELL VIPER VENOM, DILUTED - DRVVT (DILUTE RUSSEL VV TIME)","code_information":[{"code":"3058561301","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85613","type":"HCPCS"}],"standard_charges":[{"gross_charge":70.0,"discounted_cash":70.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RUSSELL VIPER VENOM, DILUTED - DRVVT (DILUTE RUSSEL VV TIME) - PHOSLIPID ARUP","code_information":[{"code":"3058561302","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85613","type":"HCPCS"}],"standard_charges":[{"gross_charge":70.0,"discounted_cash":70.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RUSSELL VIPER VENOM, DILUTED - LUPUS ANTICOAGULANT PANEL W/REFLEX -ARUP","code_information":[{"code":"3058561303","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85613","type":"HCPCS"}],"standard_charges":[{"gross_charge":70.0,"discounted_cash":70.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DILUTED RUSSEL VIPER VENOM (DRVVT) - ARUP","code_information":[{"code":"3058561309","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85613","type":"HCPCS"}],"standard_charges":[{"gross_charge":70.0,"discounted_cash":70.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DRVVT - ANTIPHOSPHOLIPID SYNDROME REFLX PANEL - ARUP","code_information":[{"code":"3058561310","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85613","type":"HCPCS"}],"standard_charges":[{"gross_charge":70.0,"discounted_cash":70.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC REPTILASE TIME","code_information":[{"code":"3058563501","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85635","type":"HCPCS"}],"standard_charges":[{"gross_charge":90.0,"discounted_cash":90.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RBC SED RATE, AUTO - SEDIMENTATION RATE, AUTOMATED","code_information":[{"code":"3058565201","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85652","type":"HCPCS"}],"standard_charges":[{"gross_charge":81.0,"discounted_cash":81.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RBC SICKLE CELL TEST - SICKLE CELL SCREEN","code_information":[{"code":"3058566001","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85660","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.0,"discounted_cash":87.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SICKLE CELL SOLUBILITY BILL - ARUP","code_information":[{"code":"3058566003","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85660","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.0,"discounted_cash":87.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC THROMBIN TIME, PLASMA - THROMBIN TIME","code_information":[{"code":"3058567001","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85670","type":"HCPCS"}],"standard_charges":[{"gross_charge":130.0,"discounted_cash":130.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC THROMBIN TIME 1:1 MIX - ARUP","code_information":[{"code":"3058567004","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85670","type":"HCPCS"}],"standard_charges":[{"gross_charge":130.0,"discounted_cash":130.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC THROMBIN TIME - ARUP","code_information":[{"code":"3058567005","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85670","type":"HCPCS"}],"standard_charges":[{"gross_charge":130.0,"discounted_cash":130.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC APTT","code_information":[{"code":"3058573001","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85730","type":"HCPCS"}],"standard_charges":[{"gross_charge":81.0,"discounted_cash":81.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC THROMBOPLAS TIME PARTIAL - APTT - PHOSLIPID ARUP","code_information":[{"code":"3058573004","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85730","type":"HCPCS"}],"standard_charges":[{"gross_charge":81.0,"discounted_cash":81.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC APTT - LUPUS ANTICOAGULANT PANEL WITH REFLEX - ARUP","code_information":[{"code":"3058573011","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85730","type":"HCPCS"}],"standard_charges":[{"gross_charge":81.0,"discounted_cash":81.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC APTT-D 1:1 MIX BILL (ARUP)","code_information":[{"code":"3058573013","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85730","type":"HCPCS"}],"standard_charges":[{"gross_charge":81.0,"discounted_cash":81.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ACTIVATED PARTIAL THROMBOPLASTIN TIME (APTT) - PT AND PTT PANEL","code_information":[{"code":"3058573017","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85730","type":"HCPCS"}],"standard_charges":[{"gross_charge":81.0,"discounted_cash":81.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC APTT - ANTIPHOSPHOLIPID SYNDROME REFLEX PANEL - ARUP","code_information":[{"code":"3058573018","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85730","type":"HCPCS"}],"standard_charges":[{"gross_charge":81.0,"discounted_cash":81.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ACTIVATED PARTIAL THROMBOPLASTIN TIME 1 TO 1 MIX","code_information":[{"code":"3058573204","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85732","type":"HCPCS"}],"standard_charges":[{"gross_charge":115.0,"discounted_cash":115.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BLOOD VISCOSITY EXAMINATION - VISCOSITY, SERUM","code_information":[{"code":"3058581001","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85810","type":"HCPCS"}],"standard_charges":[{"gross_charge":77.0,"discounted_cash":77.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC VISCOSITY SERUM - ARUP","code_information":[{"code":"3058581002","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85810","type":"HCPCS"}],"standard_charges":[{"gross_charge":77.0,"discounted_cash":77.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PHYSICIAN TRANSFUSION REACTION INTERP & REPORT","code_information":[{"code":"3058607801","type":"CDM"},{"code":"0305","type":"RC"},{"code":"86078","type":"HCPCS"}],"standard_charges":[{"gross_charge":901.0,"discounted_cash":901.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CONCENTRATION - PNEUMOCYSTIS SMEAR BY DFA - ARUP","code_information":[{"code":"3068701501","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87015","type":"HCPCS"}],"standard_charges":[{"gross_charge":109.0,"discounted_cash":109.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC AFB CONCENTRATION","code_information":[{"code":"3068701503","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87015","type":"HCPCS"}],"standard_charges":[{"gross_charge":106.0,"discounted_cash":106.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CONCENTRATION -  (ARUP)","code_information":[{"code":"3068701507","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87015","type":"HCPCS"}],"standard_charges":[{"gross_charge":109.0,"discounted_cash":109.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SPECIMEN CONCENTRATION BODY FLUID CULTURE","code_information":[{"code":"3068701509","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87015","type":"HCPCS"}],"standard_charges":[{"gross_charge":109.0,"discounted_cash":109.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PNEUMOCYSTIS JIROVECII CONC - P JIROVECII DFA W/REFLEX TO PCR - ARUP","code_information":[{"code":"3068701511","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87015","type":"HCPCS"}],"standard_charges":[{"gross_charge":109.0,"discounted_cash":109.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PNEUMOCYSTIS JIROVECII CONC - P JIROVECII DFA - ARUP","code_information":[{"code":"3068701514","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87015","type":"HCPCS"}],"standard_charges":[{"gross_charge":109.0,"discounted_cash":109.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SPECIMEN CONCENTRATION - SPINAL FLUID CULTURE","code_information":[{"code":"3068701515","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87015","type":"HCPCS"}],"standard_charges":[{"gross_charge":109.0,"discounted_cash":109.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CULTURE BLOOD","code_information":[{"code":"3068704001","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87040","type":"HCPCS"}],"standard_charges":[{"gross_charge":263.0,"discounted_cash":263.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MICROBIOLOGY - CULTURE STOOL - SALMONELLA SHIGELLA","code_information":[{"code":"3068704501","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87045","type":"HCPCS"}],"standard_charges":[{"gross_charge":131.0,"discounted_cash":131.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC STOOL CULTURE, ADDL PATHOGENS - YERSINIA CULTURE, STOOL","code_information":[{"code":"3068704602","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87046","type":"HCPCS"}],"standard_charges":[{"gross_charge":148.0,"discounted_cash":148.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MICROBIOLOGY - CULTURE AEROBIC","code_information":[{"code":"3068707001","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87070","type":"HCPCS"}],"standard_charges":[{"gross_charge":195.0,"discounted_cash":195.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HELICOBACTER PYLORI CULTURE","code_information":[{"code":"3068707002","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87070","type":"HCPCS"}],"standard_charges":[{"gross_charge":325.0,"discounted_cash":325.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC NOSE OR NP CULTURE","code_information":[{"code":"3068707005","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87070","type":"HCPCS"}],"standard_charges":[{"gross_charge":195.0,"discounted_cash":195.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC THROAT CULTURE COMPREHENSIVE","code_information":[{"code":"3068707007","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87070","type":"HCPCS"}],"standard_charges":[{"gross_charge":195.0,"discounted_cash":195.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BRONCHIAL LAVAGE CULTURE","code_information":[{"code":"3068707011","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87070","type":"HCPCS"}],"standard_charges":[{"gross_charge":185.0,"discounted_cash":185.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CSF CULTURE WITH GRAM STAIN","code_information":[{"code":"3068707013","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87070","type":"HCPCS"}],"standard_charges":[{"gross_charge":195.0,"discounted_cash":195.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC EAR CULTURE","code_information":[{"code":"3068707014","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87070","type":"HCPCS"}],"standard_charges":[{"gross_charge":195.0,"discounted_cash":195.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC EYE CULTURE","code_information":[{"code":"3068707018","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87070","type":"HCPCS"}],"standard_charges":[{"gross_charge":195.0,"discounted_cash":195.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GENITAL CULTURE","code_information":[{"code":"3068707019","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87070","type":"HCPCS"}],"standard_charges":[{"gross_charge":195.0,"discounted_cash":195.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SPUTUM CULTURE","code_information":[{"code":"3068707022","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87070","type":"HCPCS"}],"standard_charges":[{"gross_charge":195.0,"discounted_cash":195.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SINUS CULTURE","code_information":[{"code":"3068707025","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87070","type":"HCPCS"}],"standard_charges":[{"gross_charge":195.0,"discounted_cash":195.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CULTURE WOUND DRAINAGE-SUPERFICIAL","code_information":[{"code":"3068707027","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87070","type":"HCPCS"}],"standard_charges":[{"gross_charge":195.0,"discounted_cash":195.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BONE CULTURE","code_information":[{"code":"3068707030","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87070","type":"HCPCS"}],"standard_charges":[{"gross_charge":325.0,"discounted_cash":325.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HELIOBACTER PYLORI CULTURE - ARUP","code_information":[{"code":"3068707033","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87070","type":"HCPCS"}],"standard_charges":[{"gross_charge":325.0,"discounted_cash":325.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MICROBIOLOGY - CULTURE ANAEROBIC","code_information":[{"code":"3068707501","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87075","type":"HCPCS"}],"standard_charges":[{"gross_charge":164.0,"discounted_cash":164.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CLOSTRIDIUM DIFFICILE CULTURE - ARUP","code_information":[{"code":"3068707503","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87075","type":"HCPCS"}],"standard_charges":[{"gross_charge":164.0,"discounted_cash":164.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ANEROBIC CULTURE - ARUP","code_information":[{"code":"3068707504","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87075","type":"HCPCS"}],"standard_charges":[{"gross_charge":164.0,"discounted_cash":164.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MICROBIOLOGY - CULTURE ANAEROBIC ADDITIONAL ID METHOD","code_information":[{"code":"3068707601","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87076","type":"HCPCS"}],"standard_charges":[{"gross_charge":112.0,"discounted_cash":112.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ANAEROBIC CULTURE IDENTIFICATION - ARUP","code_information":[{"code":"3068707602","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87076","type":"HCPCS"}],"standard_charges":[{"gross_charge":112.0,"discounted_cash":112.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BACTERIA IDENTIFICATION AEROBIC","code_information":[{"code":"3068707702","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87077","type":"HCPCS"}],"standard_charges":[{"gross_charge":97.0,"discounted_cash":97.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ORGANISM IDENTIFICATION AEROBIC ARUP","code_information":[{"code":"3068707703","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87077","type":"HCPCS"}],"standard_charges":[{"gross_charge":97.0,"discounted_cash":97.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BACTERIA CULTURE SCREEN - LEGIONELLA CULTURE","code_information":[{"code":"3068708101","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87081","type":"HCPCS"}],"standard_charges":[{"gross_charge":130.0,"discounted_cash":130.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BACTERIA CULTURE SCREEN - PRESUMPTIVE MRSA CULTURE","code_information":[{"code":"3068708105","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87081","type":"HCPCS"}],"standard_charges":[{"gross_charge":166.0,"discounted_cash":166.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BACTERIA CULTURE SCREEN - PRESUMPTIVE GROUP B STREP CULTURE","code_information":[{"code":"3068708109","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87081","type":"HCPCS"}],"standard_charges":[{"gross_charge":166.0,"discounted_cash":166.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BACTERIA CULTURE SCREEN - PRESUMPTIVE GROUP A STREP CULTURE","code_information":[{"code":"3068708110","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87081","type":"HCPCS"}],"standard_charges":[{"gross_charge":166.0,"discounted_cash":166.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC STREP THROAT A CULTURE","code_information":[{"code":"3068708122","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87081","type":"HCPCS"}],"standard_charges":[{"gross_charge":166.0,"discounted_cash":166.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CULTURE URINE QUANTITATIVE","code_information":[{"code":"3068708601","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87086","type":"HCPCS"}],"standard_charges":[{"gross_charge":178.0,"discounted_cash":178.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MICROBIOLOGY - CULTURE FUNGUS","code_information":[{"code":"3068710201","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87102","type":"HCPCS"}],"standard_charges":[{"gross_charge":263.0,"discounted_cash":263.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MICROBIOLOGY - CULTURE FUNGUS SEND OUT","code_information":[{"code":"3068710202","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87102","type":"HCPCS"}],"standard_charges":[{"gross_charge":156.0,"discounted_cash":156.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FUNGAL CULTURE - ARUP","code_information":[{"code":"3068710204","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87102","type":"HCPCS"}],"standard_charges":[{"gross_charge":263.0,"discounted_cash":263.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FUNGUS BLOOD CULTURE - ARUP","code_information":[{"code":"3068710302","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87103","type":"HCPCS"}],"standard_charges":[{"gross_charge":263.0,"discounted_cash":263.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MICROBIOLOGY - YEAST ID","code_information":[{"code":"3068710601","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87106","type":"HCPCS"}],"standard_charges":[{"gross_charge":205.0,"discounted_cash":205.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FUNGUS IDENTIFICATION, MOLD - FUNGAL IDENTIFICATION, MOLD","code_information":[{"code":"3068710701","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87107","type":"HCPCS"}],"standard_charges":[{"gross_charge":90.0,"discounted_cash":90.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MYCOPLASMA CULTURE - MYCOPLASMA / UREAPLASMA CULTURE","code_information":[{"code":"3068710901","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87109","type":"HCPCS"}],"standard_charges":[{"gross_charge":144.0,"discounted_cash":144.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MYCOPLASMA / UREAPLASMA CULTURE - ARUP","code_information":[{"code":"3068710902","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87109","type":"HCPCS"}],"standard_charges":[{"gross_charge":144.0,"discounted_cash":144.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MICROBIOLOGY - CULTURE CHLAMYDIA","code_information":[{"code":"3068711001","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87110","type":"HCPCS"}],"standard_charges":[{"gross_charge":185.0,"discounted_cash":185.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC AFB CULTURE","code_information":[{"code":"3068711601","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87116","type":"HCPCS"}],"standard_charges":[{"gross_charge":227.0,"discounted_cash":227.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC AFB CULTURE - AFB CULTURE REFLEX TO MTBRIF PCR - ARUP","code_information":[{"code":"3068711603","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87116","type":"HCPCS"}],"standard_charges":[{"gross_charge":227.0,"discounted_cash":227.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC AFB CULTURE - ARUP","code_information":[{"code":"3068711605","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87116","type":"HCPCS"}],"standard_charges":[{"gross_charge":227.0,"discounted_cash":227.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CULTURE TYPING, FLUORESCENT - HERPES SIMPLEX TYPING","code_information":[{"code":"3068714001","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87140","type":"HCPCS"}],"standard_charges":[{"gross_charge":107.0,"discounted_cash":107.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CULTURE TYPING, FLUORESCENT - TYPING EACH","code_information":[{"code":"3068714002","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87140","type":"HCPCS"}],"standard_charges":[{"gross_charge":97.0,"discounted_cash":97.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HERPES SIMPLEX VIRUS (HSV) TYPING - ARUP","code_information":[{"code":"3068714004","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87140","type":"HCPCS"}],"standard_charges":[{"gross_charge":107.0,"discounted_cash":107.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FUNGAL/YEAST ID DNA/RNA SEQUENCE","code_information":[{"code":"3068715301","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87153","type":"HCPCS"}],"standard_charges":[{"gross_charge":707.0,"discounted_cash":707.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MICROORGANISM IDENTIFICATION - NGS","code_information":[{"code":"3068715302","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87153","type":"HCPCS"}],"standard_charges":[{"gross_charge":390.0,"discounted_cash":390.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MICROBIOLOGY - CULTURE TYPING OTHER","code_information":[{"code":"3068715801","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87158","type":"HCPCS"}],"standard_charges":[{"gross_charge":104.0,"discounted_cash":104.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ARTHROPOD AND PARASITE IDENTIFICATION MACROSCOPIC - ARUP","code_information":[{"code":"3068716902","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87169","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.0,"discounted_cash":87.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TISSUE HOMOGENIZATION FOR CULTURE","code_information":[{"code":"3068717601","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87176","type":"HCPCS"}],"standard_charges":[{"gross_charge":78.0,"discounted_cash":78.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OVA AND PARASITES SMEARS - OVA AND PARASITE EXAMINATION","code_information":[{"code":"3068717701","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87177","type":"HCPCS"}],"standard_charges":[{"gross_charge":187.0,"discounted_cash":187.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OVA & PARASITE DIR SMEARS, CONC, ID - O&P EXAM BODY FLUID/URINE - ARUP","code_information":[{"code":"3068717705","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87177","type":"HCPCS"}],"standard_charges":[{"gross_charge":187.0,"discounted_cash":187.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OVA AND PARASITE EXAMINATION - OVA AND PARISITE FECAL - ARUP","code_information":[{"code":"3068717706","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87177","type":"HCPCS"}],"standard_charges":[{"gross_charge":187.0,"discounted_cash":187.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MICROBIOLOGY - SUSCEPTIBILITY EPSILOMETER TEST/E-TEST","code_information":[{"code":"3068718103","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87181","type":"HCPCS"}],"standard_charges":[{"gross_charge":266.0,"discounted_cash":266.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SUSCEPTIBILITY KIRBY BAUER SINGLE ANTIBIOTIC","code_information":[{"code":"3068718401","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87184","type":"HCPCS"}],"standard_charges":[{"gross_charge":133.0,"discounted_cash":133.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SUSCEPTIBILITY KIRBY BAUER MULTIPLE ANTIBIOTICS","code_information":[{"code":"3068718402","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87184","type":"HCPCS"}],"standard_charges":[{"gross_charge":140.0,"discounted_cash":140.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MICROBIOLOGY - CULTURE SUSCEPTIBILITY ENZYME","code_information":[{"code":"3068718501","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87185","type":"HCPCS"}],"standard_charges":[{"gross_charge":147.0,"discounted_cash":147.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SUSCEPTIBILITY MIC GRAM NEGATIVE","code_information":[{"code":"3068718601","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87186","type":"HCPCS"}],"standard_charges":[{"gross_charge":197.0,"discounted_cash":197.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SUSCEPTIBILITY MIC MICRODILUTION GRAM NEGATIVE","code_information":[{"code":"3068718602","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87186","type":"HCPCS"}],"standard_charges":[{"gross_charge":256.0,"discounted_cash":256.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SUSCEPTIBILITY MIC URINE","code_information":[{"code":"3068718603","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87186","type":"HCPCS"}],"standard_charges":[{"gross_charge":256.0,"discounted_cash":256.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SUSCEPTIBILITY MIC MOLD","code_information":[{"code":"3068718604","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87186","type":"HCPCS"}],"standard_charges":[{"gross_charge":256.0,"discounted_cash":256.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SUSCEPTIBILITY MIC MICRODILUTION YEAST","code_information":[{"code":"3068718605","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87186","type":"HCPCS"}],"standard_charges":[{"gross_charge":197.0,"discounted_cash":197.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SUSCEPTIBILITY MIC MICRODILUTION GRAM POSITIVE","code_information":[{"code":"3068718606","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87186","type":"HCPCS"}],"standard_charges":[{"gross_charge":197.0,"discounted_cash":197.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SUSCEPTIBILITY MIC GRAM POSITIVE","code_information":[{"code":"3068718607","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87186","type":"HCPCS"}],"standard_charges":[{"gross_charge":197.0,"discounted_cash":197.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SUSCEPTIBILITY MIC STREPTOCOCCUS","code_information":[{"code":"3068718610","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87186","type":"HCPCS"}],"standard_charges":[{"gross_charge":197.0,"discounted_cash":197.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SUSCEPTIBILITY MIC YEAST","code_information":[{"code":"3068718611","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87186","type":"HCPCS"}],"standard_charges":[{"gross_charge":197.0,"discounted_cash":197.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC EOSINOPHILS SMEAR URINE","code_information":[{"code":"3068720502","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87205","type":"HCPCS"}],"standard_charges":[{"gross_charge":95.0,"discounted_cash":95.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GRAM STAIN","code_information":[{"code":"3068720503","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87205","type":"HCPCS"}],"standard_charges":[{"gross_charge":102.0,"discounted_cash":102.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC EOSINOPHILS SMEAR URINE - EOSINOPHILS PRESENCE IN URINE","code_information":[{"code":"3068720508","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87205","type":"HCPCS"}],"standard_charges":[{"gross_charge":95.0,"discounted_cash":95.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FUNGAL STAIN, FLUORESCENT","code_information":[{"code":"3068720602","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87206","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.0,"discounted_cash":83.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FUNGAL STAIN, KOH WITH CALCOFLUOR WHITE - ARUP","code_information":[{"code":"3068720607","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87206","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.0,"discounted_cash":83.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SMEAR,INCLUSION BODIES/PARASITES,INTERP - MALARIA SMEAR","code_information":[{"code":"3068720701","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87207","type":"HCPCS"}],"standard_charges":[{"gross_charge":109.0,"discounted_cash":109.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC AMOEBA SCREEN CSF","code_information":[{"code":"3068720702","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87207","type":"HCPCS"}],"standard_charges":[{"gross_charge":118.0,"discounted_cash":118.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MALARIA RAPID SCREEN WITH GIEMSA - ARUP","code_information":[{"code":"3068720709","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87207","type":"HCPCS"}],"standard_charges":[{"gross_charge":94.0,"discounted_cash":94.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PARASITE BLOOD SMEAR - ARUP","code_information":[{"code":"3068720712","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87207","type":"HCPCS"}],"standard_charges":[{"gross_charge":118.0,"discounted_cash":118.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC WET PREP GENITAL","code_information":[{"code":"3068721001","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87210","type":"HCPCS"}],"standard_charges":[{"gross_charge":142.0,"discounted_cash":142.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TISSUE EXAM BY KOH - KOH PREP","code_information":[{"code":"3068722001","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87220","type":"HCPCS"}],"standard_charges":[{"gross_charge":37.0,"discounted_cash":37.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FUNGAL (KOH) STAIN","code_information":[{"code":"3068722002","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87220","type":"HCPCS"}],"standard_charges":[{"gross_charge":37.0,"discounted_cash":37.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY, TOXIN OR ANTITOXIN - CLOSTRIDIUM DIFFICILE TOXINS TISSUE CULT","code_information":[{"code":"3068723001","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87230","type":"HCPCS"}],"standard_charges":[{"gross_charge":265.0,"discounted_cash":265.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MICROBIOLOGY - CULTURE VIRUS TISSUE","code_information":[{"code":"3068725201","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87252","type":"HCPCS"}],"standard_charges":[{"gross_charge":216.0,"discounted_cash":216.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC VIRAL CULTURE NONRESPIRATORY - ARUP","code_information":[{"code":"3068725203","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87252","type":"HCPCS"}],"standard_charges":[{"gross_charge":216.0,"discounted_cash":216.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC VIRAL CULTURE RESPIRATORY - ARUP","code_information":[{"code":"3068725204","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87252","type":"HCPCS"}],"standard_charges":[{"gross_charge":216.0,"discounted_cash":216.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MICROBIOLOGY - CULTURE VIRUS ADDITIONAL STUDY","code_information":[{"code":"3068725301","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87253","type":"HCPCS"}],"standard_charges":[{"gross_charge":249.0,"discounted_cash":249.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HERPES SIMPLEX VIRUS (HSV) CULTURE - ARUP","code_information":[{"code":"3068725304","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87253","type":"HCPCS"}],"standard_charges":[{"gross_charge":249.0,"discounted_cash":249.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MICROBIOLOGY - VIRUS IMMUNO ID","code_information":[{"code":"3068725401","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87254","type":"HCPCS"}],"standard_charges":[{"gross_charge":249.0,"discounted_cash":249.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HERPES SIMPLEX VIRUS CULTURE - ARUP","code_information":[{"code":"3068725502","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87255","type":"HCPCS"}],"standard_charges":[{"gross_charge":114.0,"discounted_cash":114.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HERPES SIMPLEX VIRUS (HSV) WITH REFLEX TO HSV TYPING CULTURE - ARUP","code_information":[{"code":"3068725503","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87255","type":"HCPCS"}],"standard_charges":[{"gross_charge":114.0,"discounted_cash":114.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ADENOVIRUS DFA - RESPIRATORY VIRUSES DFA WITH REFLEX - ARUP","code_information":[{"code":"3068726004","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87260","type":"HCPCS"}],"standard_charges":[{"gross_charge":40.4,"discounted_cash":40.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INFLUENZA B AG, DFA","code_information":[{"code":"3068727501","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87275","type":"HCPCS"}],"standard_charges":[{"gross_charge":110.0,"discounted_cash":110.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INFLUENZA A AG, DFA","code_information":[{"code":"3068727601","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87276","type":"HCPCS"}],"standard_charges":[{"gross_charge":134.0,"discounted_cash":134.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC LEGIONELLA PNEUMOPHILA DFA - ARUP","code_information":[{"code":"3068727803","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87278","type":"HCPCS"}],"standard_charges":[{"gross_charge":169.0,"discounted_cash":169.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PARAINFLUENZA AG BY DFA","code_information":[{"code":"3068727901","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87279","type":"HCPCS"}],"standard_charges":[{"gross_charge":135.0,"discounted_cash":135.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RESP SYNCYTIAL AG, DFA","code_information":[{"code":"3068728001","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87280","type":"HCPCS"}],"standard_charges":[{"gross_charge":180.0,"discounted_cash":180.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PNEUMOCYSTIS CARINII AG, DFA - PNEUMOCYSTIS SMEAR BY DFA","code_information":[{"code":"3068728101","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87281","type":"HCPCS"}],"standard_charges":[{"gross_charge":172.0,"discounted_cash":172.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PNEUMOCYSTIS JIROVECII AG, DFA -  (ARUP)","code_information":[{"code":"3068728102","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87281","type":"HCPCS"}],"standard_charges":[{"gross_charge":126.0,"discounted_cash":126.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PNEUMOCYSTIS JIROVECII DFA - P JIROVECII DFA W/REFLEX TO PCR - ARUP","code_information":[{"code":"3068728103","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87281","type":"HCPCS"}],"standard_charges":[{"gross_charge":172.0,"discounted_cash":172.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC AG DETECTION IMMUNOFLOUR EA ORG","code_information":[{"code":"3068729902","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87299","type":"HCPCS"}],"standard_charges":[{"gross_charge":113.0,"discounted_cash":113.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IAAD IA QUAL/SEMIQUAN MULTIPLE STEP ASPERGILLUS - ASPERGILLUS GALACT","code_information":[{"code":"3068730501","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87305","type":"HCPCS"}],"standard_charges":[{"gross_charge":332.0,"discounted_cash":332.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASPERGILLUS GALACTOMANNAN ANTIGEN - ARUP","code_information":[{"code":"3068730504","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87305","type":"HCPCS"}],"standard_charges":[{"gross_charge":332.0,"discounted_cash":332.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASPERGILLUS GALACTOMANNAN ANTIGEN BRONCH - ARUP","code_information":[{"code":"3068730505","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87305","type":"HCPCS"}],"standard_charges":[{"gross_charge":332.0,"discounted_cash":332.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CLOSTRIDIOIDES DIFFICILE TOXINS EIA","code_information":[{"code":"3068732401","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87324","type":"HCPCS"}],"standard_charges":[{"gross_charge":140.0,"discounted_cash":140.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MICROBIOLOGY - IMMUNOASSAY CRYPTOCOCCAL AG","code_information":[{"code":"3068732701","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87327","type":"HCPCS"}],"standard_charges":[{"gross_charge":135.0,"discounted_cash":135.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CRYPTOCOCCAL ANTIGEN CSF - ARUP","code_information":[{"code":"3068732703","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87327","type":"HCPCS"}],"standard_charges":[{"gross_charge":135.0,"discounted_cash":135.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CRYPTOSPORIDIUM - OVA AND PARASITE ANTIGEN SCREEN","code_information":[{"code":"3068732801","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87328","type":"HCPCS"}],"standard_charges":[{"gross_charge":179.0,"discounted_cash":179.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CRYPTOSPORIDIUM ANTIGEN STOOL - ARUP","code_information":[{"code":"3068732802","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87328","type":"HCPCS"}],"standard_charges":[{"gross_charge":179.0,"discounted_cash":179.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GIARDIA LAMBLIA - OVA AND PARASITE ANTIGEN SCREEN","code_information":[{"code":"3068732901","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87329","type":"HCPCS"}],"standard_charges":[{"gross_charge":179.0,"discounted_cash":179.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GIARDIA ANTIGEN STOOL - ARUP","code_information":[{"code":"3068732902","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87329","type":"HCPCS"}],"standard_charges":[{"gross_charge":179.0,"discounted_cash":179.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IAAD IA ENTAMOEBA HISTOLYTICA GRP - ENTAMOEBA HYSTOLYTICA GRP EIA","code_information":[{"code":"3068733701","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87337","type":"HCPCS"}],"standard_charges":[{"gross_charge":179.0,"discounted_cash":179.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ENTAMOEBA HISTOLYTICA ANTIGEN - ARUP","code_information":[{"code":"3068733702","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87337","type":"HCPCS"}],"standard_charges":[{"gross_charge":179.0,"discounted_cash":179.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HELICOBACTER PYLORI ANTIGEN STOOL","code_information":[{"code":"3068733801","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87338","type":"HCPCS"}],"standard_charges":[{"gross_charge":266.0,"discounted_cash":266.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HELICOBACTER PYLORI ANTIGEN STOOL - ARUP","code_information":[{"code":"3068733803","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87338","type":"HCPCS"}],"standard_charges":[{"gross_charge":266.0,"discounted_cash":266.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HEPATITIS B SURFACE ANTIGEN","code_information":[{"code":"3068734001","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87340","type":"HCPCS"}],"standard_charges":[{"gross_charge":164.0,"discounted_cash":164.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HEPATITIS B VIRUS SURFACE ANTIGEN - HEPATITIS PANEL ACUTE","code_information":[{"code":"3068734004","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87340","type":"HCPCS"}],"standard_charges":[{"gross_charge":33.29,"discounted_cash":33.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IAAD IA HEPATITIS B SURFACE AG NEUTRALIZATION - HEPATITIS B SURFACE","code_information":[{"code":"3068734101","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87341","type":"HCPCS"}],"standard_charges":[{"gross_charge":157.0,"discounted_cash":157.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HEPATITIS B SURFACE ANTIGEN CONFIRMATION - ARUP","code_information":[{"code":"3068734102","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87341","type":"HCPCS"}],"standard_charges":[{"gross_charge":157.0,"discounted_cash":157.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IAAD IA HEPATITIS BE ANTIGEN - HEPATITIS B E ANTIGEN","code_information":[{"code":"3068735001","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87350","type":"HCPCS"}],"standard_charges":[{"gross_charge":95.0,"discounted_cash":95.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HEAPATITIS B E ANTIGEN - ARUP","code_information":[{"code":"3068735002","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87350","type":"HCPCS"}],"standard_charges":[{"gross_charge":95.0,"discounted_cash":95.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IAAD IA HISTOPLASM CAPSULATUM - HISTOPLASMA ANTIGEN URINE","code_information":[{"code":"3068738501","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87385","type":"HCPCS"}],"standard_charges":[{"gross_charge":190.0,"discounted_cash":190.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IAAD IA HISTOPLASM CAPSULATUM - HISTOPLASMA ANTIGEN, SERUM","code_information":[{"code":"3068738502","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87385","type":"HCPCS"}],"standard_charges":[{"gross_charge":399.0,"discounted_cash":399.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HISTOPLASM ANTIGEN URINE - ARUP","code_information":[{"code":"3068738503","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87385","type":"HCPCS"}],"standard_charges":[{"gross_charge":190.0,"discounted_cash":190.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IAAD IA RESPIRATORY SYNCTIAL VIRUS - RSV RAPID ANTIGEN SCREEN","code_information":[{"code":"3068742001","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87420","type":"HCPCS"}],"standard_charges":[{"gross_charge":175.0,"discounted_cash":175.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IAAD IA ROTAVIRUS - ROTAVIRUS ANTIGEN STOOL","code_information":[{"code":"3068742501","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87425","type":"HCPCS"}],"standard_charges":[{"gross_charge":114.0,"discounted_cash":114.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ROTAVIRUS ANTIGEN EIA STOOL - ARUP","code_information":[{"code":"3068742503","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87425","type":"HCPCS"}],"standard_charges":[{"gross_charge":114.0,"discounted_cash":114.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IAAD IA SHIGA-LIKE TOXIN - SHIGA-LIKE TOXIN ANTIGEN, EIA","code_information":[{"code":"3068742701","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87427","type":"HCPCS"}],"standard_charges":[{"gross_charge":190.0,"discounted_cash":190.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IAAD IA SHIGA-LIKE TOXIN - SHIGA-LIKE TOXIN ANTIGEN,  FECES","code_information":[{"code":"3068742702","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87427","type":"HCPCS"}],"standard_charges":[{"gross_charge":175.0,"discounted_cash":175.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SHIGA-LIKE TOXIN ANTIGEN EIA STOOL","code_information":[{"code":"3068742703","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87427","type":"HCPCS"}],"standard_charges":[{"gross_charge":190.0,"discounted_cash":190.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SARS-COV-2  ATGN DETECT IMMUNOASSAY QUAL / SEMIQUANT PLUS FLU A AND B","code_information":[{"code":"3068742801","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87428","type":"HCPCS"}],"standard_charges":[{"gross_charge":98.0,"discounted_cash":98.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC LEGIONELLA ANTIGEN URINE","code_information":[{"code":"3068744901","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87449","type":"HCPCS"}],"standard_charges":[{"gross_charge":142.0,"discounted_cash":142.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CAMPYLOBACTER AG TOXINS EIA - ARUP","code_information":[{"code":"3068744904","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87449","type":"HCPCS"}],"standard_charges":[{"gross_charge":267.0,"discounted_cash":267.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC 1,3 BETA D-GLUCAN (FUNGITELL)","code_information":[{"code":"3068744905","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87449","type":"HCPCS"}],"standard_charges":[{"gross_charge":178.0,"discounted_cash":178.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC 1,3 BETA-D-GLUCAN (FUNGITELL) (ARUP)","code_information":[{"code":"3068744909","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87449","type":"HCPCS"}],"standard_charges":[{"gross_charge":178.0,"discounted_cash":178.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC LEGIONELLA PNEUMOPHILA ANTIGEN URINE - ARUP","code_information":[{"code":"3068744915","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87449","type":"HCPCS"}],"standard_charges":[{"gross_charge":142.0,"discounted_cash":142.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ANAPLASMA PHAGOCYTOPHILUM AMP PROBE","code_information":[{"code":"3068746801","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87468","type":"HCPCS"}],"standard_charges":[{"gross_charge":119.0,"discounted_cash":119.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ANAPLASMA PHAGOCYTOPHILUM PCR - EHRLICHIA & ANAPLASMA SPECIES PCR - ARUP","code_information":[{"code":"3068746802","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87468","type":"HCPCS"}],"standard_charges":[{"gross_charge":119.0,"discounted_cash":119.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ANAPLASMA PHAGOCYTOPHILUM PCR - TICK BORNE DISEASE PANEL PCR - ARUP","code_information":[{"code":"3068746803","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87468","type":"HCPCS"}],"standard_charges":[{"gross_charge":119.0,"discounted_cash":119.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BABESIA MICROTI AMP PROBE","code_information":[{"code":"3068746901","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87469","type":"HCPCS"}],"standard_charges":[{"gross_charge":119.0,"discounted_cash":119.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BABESIA MICROTI PCR - TICK BORNE DISEASE PANEL PCR - ARUP","code_information":[{"code":"3068746902","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87469","type":"HCPCS"}],"standard_charges":[{"gross_charge":119.0,"discounted_cash":119.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC LYME DIS, DNA, AMP PROBE - LYME DISEASE (BORRELIA BURGDORFERI), PCR","code_information":[{"code":"3068747601","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87476","type":"HCPCS"}],"standard_charges":[{"gross_charge":416.0,"discounted_cash":416.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC LYME DISEASE (BORRELIA BURGDORFERI) PCR - ARUP","code_information":[{"code":"3068747603","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87476","type":"HCPCS"}],"standard_charges":[{"gross_charge":416.0,"discounted_cash":416.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CANDIDA, DNA, AMP PROBE - CANDIDA DNA, PCR","code_information":[{"code":"3068748101","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87481","type":"HCPCS"}],"standard_charges":[{"gross_charge":421.0,"discounted_cash":421.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC C ALBICANS - CANDIDA SPECIES BY PCR - ARUP","code_information":[{"code":"3068748119","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87481","type":"HCPCS"}],"standard_charges":[{"gross_charge":421.0,"discounted_cash":421.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC C GLABRATA - CANDIDA SPECIES BY PCR - ARUP","code_information":[{"code":"3068748120","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87481","type":"HCPCS"}],"standard_charges":[{"gross_charge":421.0,"discounted_cash":421.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC C PARAPSILOSIS COMPLEX - CANDIDA SPECIES BY PCR - ARUP","code_information":[{"code":"3068748121","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87481","type":"HCPCS"}],"standard_charges":[{"gross_charge":421.0,"discounted_cash":421.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC C TROPICALIS - CANDIDA SPECIES BY PCR - ARUP","code_information":[{"code":"3068748122","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87481","type":"HCPCS"}],"standard_charges":[{"gross_charge":421.0,"discounted_cash":421.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC C KRUSEI - CANDIDA SPECIES BY PCR - ARUP","code_information":[{"code":"3068748123","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87481","type":"HCPCS"}],"standard_charges":[{"gross_charge":421.0,"discounted_cash":421.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC C DUBLINIENSIS - CANDIDA SPECIES BY PCR - ARUP","code_information":[{"code":"3068748124","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87481","type":"HCPCS"}],"standard_charges":[{"gross_charge":421.0,"discounted_cash":421.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MICROBIOLOGY - DNA AMP PROBE 12-25 TARGETS","code_information":[{"code":"3068748301","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87483","type":"HCPCS"}],"standard_charges":[{"gross_charge":1195.0,"discounted_cash":1195.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MENINGITIS ENCEPHALITIS PCR PANEL CSF - ARUP","code_information":[{"code":"3068748302","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87483","type":"HCPCS"}],"standard_charges":[{"gross_charge":1195.0,"discounted_cash":1195.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC EHRLICHIA CHAFEENSIS AMP PROBE","code_information":[{"code":"3068748401","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87484","type":"HCPCS"}],"standard_charges":[{"gross_charge":119.0,"discounted_cash":119.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC EHRLICHIA CHAFFEENSIS PCR  - EHRLICHIA & ANAPLASMA SPECIES PCR - ARUP","code_information":[{"code":"3068748402","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87484","type":"HCPCS"}],"standard_charges":[{"gross_charge":119.0,"discounted_cash":119.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC EHRLICHIA CHAFFEENSIS PCR - TICK BORNE DISEASE PANEL PCR - ARUP","code_information":[{"code":"3068748403","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87484","type":"HCPCS"}],"standard_charges":[{"gross_charge":119.0,"discounted_cash":119.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CHLAMYDIA TRACHOMATIS DNA PROBE AMPLIFIED","code_information":[{"code":"3068749101","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87491","type":"HCPCS"}],"standard_charges":[{"gross_charge":178.0,"discounted_cash":178.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CHYLMD TRACH,  DNA,  AMP PROBE - CHLAMYDIA DNA PCR TMA","code_information":[{"code":"3068749103","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87491","type":"HCPCS"}],"standard_charges":[{"gross_charge":424.0,"discounted_cash":424.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CHLAMYDIA TRACHOMATIS - C TRACHOMATIS & N GONNORRHOEAE BY TMA - ARUP","code_information":[{"code":"3068749106","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87491","type":"HCPCS"}],"standard_charges":[{"gross_charge":178.0,"discounted_cash":178.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CHLAMYDIA TRACHOMATIS-C TRACHOMATIS & N GONNORRHOEAE BY TMA W/ RFLX-ARUP","code_information":[{"code":"3068749107","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87491","type":"HCPCS"}],"standard_charges":[{"gross_charge":225.94,"discounted_cash":225.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC C TRACHOMATIS - C TRACHOMATIS, N GONORRHOEAE, RNA TMA UROGENITAL - QDID","code_information":[{"code":"3068749112","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87491","type":"HCPCS"}],"standard_charges":[{"gross_charge":178.0,"discounted_cash":178.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC C TRACHOMATIS - C TRACHOMATIS, N GONORRHOEAE, RNA TMA RECTAL - QDID","code_information":[{"code":"3068749113","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87491","type":"HCPCS"}],"standard_charges":[{"gross_charge":178.0,"discounted_cash":178.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CLOSTRIDIOIDES DIFFICILE TOXIN TCBD GENE PCR","code_information":[{"code":"3068749301","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87493","type":"HCPCS"}],"standard_charges":[{"gross_charge":293.08,"discounted_cash":293.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CLOSTRIDIOIDES DIFFICILE TCDB GENE PCR STOOL - ARUP","code_information":[{"code":"3068749302","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87493","type":"HCPCS"}],"standard_charges":[{"gross_charge":293.0,"discounted_cash":293.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CYTOMEG, DNA, AMP PROBE - CYTOMEGALOVIRUS DNA PROBE, AMPLIFIED","code_information":[{"code":"3068749601","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87496","type":"HCPCS"}],"standard_charges":[{"gross_charge":337.0,"discounted_cash":337.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CYTOMEGALOVIRUS (CMV) PCR QUAL - ARUP","code_information":[{"code":"3068749604","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87496","type":"HCPCS"}],"standard_charges":[{"gross_charge":337.0,"discounted_cash":337.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CMV QUANT PCR","code_information":[{"code":"3068749701","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87497","type":"HCPCS"}],"standard_charges":[{"gross_charge":575.0,"discounted_cash":575.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CYTOMEGALOVIRUS QUANT NAAT - ARUP","code_information":[{"code":"3068749703","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87497","type":"HCPCS"}],"standard_charges":[{"gross_charge":575.0,"discounted_cash":575.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ENTEROVIRUS PROBE&REVRS TRNS - ENTEROVIRUS DNA PROBE, AMPLIFIED","code_information":[{"code":"3068749801","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87498","type":"HCPCS"}],"standard_charges":[{"gross_charge":471.0,"discounted_cash":471.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ENTEROVIRUS PCR QUAL - ARUP","code_information":[{"code":"3068749803","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87498","type":"HCPCS"}],"standard_charges":[{"gross_charge":471.0,"discounted_cash":471.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INFLUENZA A & B PCR","code_information":[{"code":"3068750201","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87502","type":"HCPCS"}],"standard_charges":[{"gross_charge":821.0,"discounted_cash":821.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GASTROINTESTINAL PARASITE PANELY BY PCR 5 TARGETS - ARUP","code_information":[{"code":"3068750501","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87505","type":"HCPCS"}],"standard_charges":[{"gross_charge":434.0,"discounted_cash":434.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MICROBIOLOGY AMP PROBE - GI PATHOGEN 3-5 TARGETS","code_information":[{"code":"3068750502","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87505","type":"HCPCS"}],"standard_charges":[{"gross_charge":2277.0,"discounted_cash":2277.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GASTROINTESTINAL PARASITE PCR PANEL STOOL - 5 TARGETS - ARUP","code_information":[{"code":"3068750505","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87505","type":"HCPCS"}],"standard_charges":[{"gross_charge":434.0,"discounted_cash":434.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IADNA-DNA/RNA PROBE TQ 12-25 - GASTROINTESTINAL PANEL","code_information":[{"code":"3068750701","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87507","type":"HCPCS"}],"standard_charges":[{"gross_charge":1668.0,"discounted_cash":1668.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GASTROINTESTINAL PATHOGENS PANEL PCR STOOL - 21 TARGETS - ARUP","code_information":[{"code":"3068750703","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87507","type":"HCPCS"}],"standard_charges":[{"gross_charge":1668.0,"discounted_cash":1668.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HEPATITIS B , DNA, QUANT - HEPATITIS B DNA, ULTRAQUANTITATIVE, PCR","code_information":[{"code":"3068751701","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87517","type":"HCPCS"}],"standard_charges":[{"gross_charge":548.0,"discounted_cash":548.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HEPATITIS B , DNA, QUANT - HEPATITIS B DNA PROBE, DIRECT","code_information":[{"code":"3068751702","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87517","type":"HCPCS"}],"standard_charges":[{"gross_charge":389.0,"discounted_cash":389.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HEPATITIS B DNA BY QUANT NAAT - HEPATITIS BE DNA PROBE DIRECT - ARUP","code_information":[{"code":"3068751703","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87517","type":"HCPCS"}],"standard_charges":[{"gross_charge":389.0,"discounted_cash":389.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IADNA HEPATITIS C QUANT & REVERSE TRANSCRIPTION - HCV QUANT PCR","code_information":[{"code":"3068752201","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87522","type":"HCPCS"}],"standard_charges":[{"gross_charge":584.0,"discounted_cash":584.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HEPATITIS C QUANT NAAT - ARUP","code_information":[{"code":"3068752205","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87522","type":"HCPCS"}],"standard_charges":[{"gross_charge":584.0,"discounted_cash":584.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HEPATITIS C BY QUANT NAAT WITH REFLEX GENOTYPE - ARUP","code_information":[{"code":"3068752206","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87522","type":"HCPCS"}],"standard_charges":[{"gross_charge":584.0,"discounted_cash":584.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HSV QUAL PCR","code_information":[{"code":"3068752901","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87529","type":"HCPCS"}],"standard_charges":[{"gross_charge":471.0,"discounted_cash":471.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HERPES SIMPLEX VIRUS 1 & 2 PCR QUALITATIVE","code_information":[{"code":"3068752902","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87529","type":"HCPCS"}],"standard_charges":[{"gross_charge":275.0,"discounted_cash":275.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HSV 1 PCR QUAL - HSV 1 AND 2 SUBTYPE BY PCR - ARUP","code_information":[{"code":"3068752907","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87529","type":"HCPCS"}],"standard_charges":[{"gross_charge":275.0,"discounted_cash":275.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HSV 2 PCR QUAL - HSV 1 AND 2 SUBTYPE BY PCR - ARUP","code_information":[{"code":"3068752908","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87529","type":"HCPCS"}],"standard_charges":[{"gross_charge":275.0,"discounted_cash":275.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HSV-1 - T PALLIDUM, HSV-1, HSV-2 BY PCR - ARUP","code_information":[{"code":"3068752911","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87529","type":"HCPCS"}],"standard_charges":[{"gross_charge":471.0,"discounted_cash":471.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HSV-2 - T PALLIDUM, HSV-1, HSV-2 BY PCR - ARUP","code_information":[{"code":"3068752912","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87529","type":"HCPCS"}],"standard_charges":[{"gross_charge":471.0,"discounted_cash":471.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HIV-1 PROBE&REVERSE TRNSCRPJ - HIV-1 DNA PROBE, AMPLIFIED","code_information":[{"code":"3068753501","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87535","type":"HCPCS"}],"standard_charges":[{"gross_charge":532.0,"discounted_cash":532.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HIV-1 - HIV-1/HIV-2 QUALITATIVE NAAT - ARUP","code_information":[{"code":"3068753504","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87535","type":"HCPCS"}],"standard_charges":[{"gross_charge":462.29,"discounted_cash":462.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HIV 1 RNA QUANT PCR - QDID","code_information":[{"code":"3068753601","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87536","type":"HCPCS"}],"standard_charges":[{"gross_charge":489.0,"discounted_cash":489.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HIV 1 BY QUANTITATIVE NAAT, PLASMA (ARUP)","code_information":[{"code":"3068753605","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87536","type":"HCPCS"}],"standard_charges":[{"gross_charge":489.0,"discounted_cash":489.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HIV-2 - HIV-1/HIV-2 QUALITATIVE NAAT - ARUP","code_information":[{"code":"3068753803","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87538","type":"HCPCS"}],"standard_charges":[{"gross_charge":409.0,"discounted_cash":409.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC LEGIONELLA PNEUMOPHILA PCR - LEGIONELLA SPECIES QUALITATIVE PCR - ARUP","code_information":[{"code":"3068754102","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87541","type":"HCPCS"}],"standard_charges":[{"gross_charge":248.0,"discounted_cash":248.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MYCOBACTERIUM TUBERCULOSIS PCR - DIRECT M TUBERCULOSIS RIFAMPIN - ARUP","code_information":[{"code":"3068755604","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87556","type":"HCPCS"}],"standard_charges":[{"gross_charge":537.0,"discounted_cash":537.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC M GENITALIUM AMP PROBE","code_information":[{"code":"3068756301","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87563","type":"HCPCS"}],"standard_charges":[{"gross_charge":321.0,"discounted_cash":321.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MYCOPLASMA GENITALIUM - UREAPLASMA AND MYCOPLASMA SPECIES BY PCR - ARUP","code_information":[{"code":"3068756302","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87563","type":"HCPCS"}],"standard_charges":[{"gross_charge":321.0,"discounted_cash":321.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MYCOPLASMA PNEUMONIAE PCR","code_information":[{"code":"3068758101","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87581","type":"HCPCS"}],"standard_charges":[{"gross_charge":449.0,"discounted_cash":449.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MYCOPLASMA PNEUMONIAE PCR - ARUP","code_information":[{"code":"3068758103","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87581","type":"HCPCS"}],"standard_charges":[{"gross_charge":449.0,"discounted_cash":449.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC NEISSERIA GONORRHOEA DNA PROBE","code_information":[{"code":"3068759101","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87591","type":"HCPCS"}],"standard_charges":[{"gross_charge":178.0,"discounted_cash":178.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC N.GONORRHOEAE,  DNA,  AMP PROB - GC DNA PCR REFER","code_information":[{"code":"3068759103","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87591","type":"HCPCS"}],"standard_charges":[{"gross_charge":156.0,"discounted_cash":156.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC NEISSERIA GONNORRHOEAE-CHLAMYDIA T & N GONNORRHOEAE BY TMA W/ RFLX-QWDL","code_information":[{"code":"3068759107","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87591","type":"HCPCS"}],"standard_charges":[{"gross_charge":225.94,"discounted_cash":225.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC NEISSERIA GONNORRHOEAE - CHLAMYDIA T & N GONNORRHOEAE BY TMA - ARUP","code_information":[{"code":"3068759108","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87591","type":"HCPCS"}],"standard_charges":[{"gross_charge":178.0,"discounted_cash":178.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC N GONORRHOEAE - C TRACHOMATIS, N GONORRHOEAE, RNA TMA RECTAL - QDID","code_information":[{"code":"3068759114","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87591","type":"HCPCS"}],"standard_charges":[{"gross_charge":178.0,"discounted_cash":178.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC N GONORRHOEAE - C TRACHOMATIS, N GONORRHOEAE, RNA TMA THROAT - QDID","code_information":[{"code":"3068759115","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87591","type":"HCPCS"}],"standard_charges":[{"gross_charge":178.0,"discounted_cash":178.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MONKEYPOX (ORTHOPOXVIRUS) DNA PCR - ARUP","code_information":[{"code":"3068759302","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87593","type":"HCPCS"}],"standard_charges":[{"gross_charge":292.0,"discounted_cash":292.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IADNA HUMAN PAPILLOMAVIRUS HIGH-RISK TYPES - HPV DNA PROBE, AMP","code_information":[{"code":"3068762401","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87624","type":"HCPCS"}],"standard_charges":[{"gross_charge":423.0,"discounted_cash":423.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IADNA HUMAN PAPILLOMAVIRUS HIGH-RISK TYPES - HPV HIGH RISK PCR","code_information":[{"code":"3068762402","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87624","type":"HCPCS"}],"standard_charges":[{"gross_charge":443.0,"discounted_cash":443.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RESPIRATORY VIRUS MINI PANEL PCR - 3 TARGETS - ARUP","code_information":[{"code":"3068763102","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87631","type":"HCPCS"}],"standard_charges":[{"gross_charge":1477.0,"discounted_cash":1477.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IADNA RESPIRATRY PROBE & REV TRNSCR 6-11 TARGET - ADDITIONAL CHARGE","code_information":[{"code":"3068763201","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87632","type":"HCPCS"}],"standard_charges":[{"gross_charge":1239.0,"discounted_cash":1239.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RESPIRATORY VIRAL PANEL PCR - ARUP","code_information":[{"code":"3068763202","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87632","type":"HCPCS"}],"standard_charges":[{"gross_charge":1239.0,"discounted_cash":1239.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC COVID-19 SARS-COV-2 AMPLIFIED PROBE","code_information":[{"code":"3068763501","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87635","type":"HCPCS"}],"standard_charges":[{"gross_charge":535.0,"discounted_cash":535.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC COVID-19, FLU A, FLU B PCR","code_information":[{"code":"3068763601","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87636","type":"HCPCS"}],"standard_charges":[{"gross_charge":438.0,"discounted_cash":438.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC STAPH AUREUS PCR - MRSA AND STAPH AUREUS PCR SCREEN NARES","code_information":[{"code":"3068764001","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87640","type":"HCPCS"}],"standard_charges":[{"gross_charge":400.0,"discounted_cash":400.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MRSA PCR - MRSA AND STAPH AUREUS PCR SCREEN NARES","code_information":[{"code":"3068764101","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87641","type":"HCPCS"}],"standard_charges":[{"gross_charge":535.0,"discounted_cash":535.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC STREP A, DNA, AMP PROBE - STREP A DNA PROBE, AMPLIFICATION","code_information":[{"code":"3068765101","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87651","type":"HCPCS"}],"standard_charges":[{"gross_charge":590.0,"discounted_cash":590.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC STREP A DNA PROBE AMPLIFICATION THROAT","code_information":[{"code":"3068765102","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87651","type":"HCPCS"}],"standard_charges":[{"gross_charge":353.0,"discounted_cash":353.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TRICHOMONAS VAGIN, DIR PROBE - TRICHOMONAS VAGINALIS DNA PROBE","code_information":[{"code":"3068766001","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87660","type":"HCPCS"}],"standard_charges":[{"gross_charge":118.0,"discounted_cash":118.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TRICHOMONAS VAGINALIS BY TMA","code_information":[{"code":"3068766102","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87661","type":"HCPCS"}],"standard_charges":[{"gross_charge":202.0,"discounted_cash":202.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TRICHOMONAS VAGINALIS BY TMA - ARUP","code_information":[{"code":"3068766109","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87661","type":"HCPCS"}],"standard_charges":[{"gross_charge":202.0,"discounted_cash":202.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TRICHOMONAS VAGINALIS RNA TMA QUAL MALES - QDID","code_information":[{"code":"3068766114","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87661","type":"HCPCS"}],"standard_charges":[{"gross_charge":1880.67,"discounted_cash":1880.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DETECT AGENT NOS, DNA, AMP - BORDETELLA PERTUSSIS PCR","code_information":[{"code":"3068779802","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":259.0,"discounted_cash":259.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DETECT AGENT NOS, DNA, AMP","code_information":[{"code":"3068779804","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":537.0,"discounted_cash":537.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MYCOBACTERIA TB COMPLEX PCR","code_information":[{"code":"3068779807","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":553.0,"discounted_cash":553.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC JC VIRUS PCR","code_information":[{"code":"3068779810","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":259.0,"discounted_cash":259.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC VARICELLA ZOSTER VIRUS PCR.","code_information":[{"code":"3068779813","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":553.0,"discounted_cash":553.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC EHRLICHIA PCR","code_information":[{"code":"3068779819","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":401.0,"discounted_cash":401.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC NOROVIRUS PCR","code_information":[{"code":"3068779821","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":471.0,"discounted_cash":471.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DNA/RNA AMP PROBE - PARVOVIRUS B19/HUMAN","code_information":[{"code":"3068779827","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":475.0,"discounted_cash":475.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DNA/RNA AMP PROBE - BORDETELLA PARAPERTUSSIS","code_information":[{"code":"3068779829","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":259.0,"discounted_cash":259.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC NOROVIRUS 1 QUAL - NOROVIRUS GROUPS 1 AND 2 BY PCR - ARUP","code_information":[{"code":"3068779835","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":401.0,"discounted_cash":401.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC NOROVIRUS 2 QUAL - NOROVIRUS GROUPS 1 AND 2 BY PCR - ARUP","code_information":[{"code":"3068779836","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":401.0,"discounted_cash":401.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PNEUMOCYSTIS JIROVECII PCR - ARUP","code_information":[{"code":"3068779842","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":537.0,"discounted_cash":537.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MTB RIFAMPIN PCR - DIRECT M. TUBERCULOSIS RIFAMPIN - ARUP","code_information":[{"code":"3068779844","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":553.0,"discounted_cash":553.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC EHRLICHIA EWINGII/CANIS PCR - EHRLICHIA & ANAPLASMA SPECIES PCR - ARUP","code_information":[{"code":"3068779847","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":401.0,"discounted_cash":401.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC EHRLICHIA MURIS-LIKE PCR - EHRLICHIA & ANAPLASMA SPECIES PCR - ARUP","code_information":[{"code":"3068779848","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":401.0,"discounted_cash":401.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BABESIA SPECIES PCR - TICK BORNE DISEASE PANEL PCR - ARUP","code_information":[{"code":"3068779855","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":537.0,"discounted_cash":537.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC EHRLICHIA EWINGII/CANIS PCR - TICK BORNE DISEASE PANEL PCR - ARUP","code_information":[{"code":"3068779856","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":401.0,"discounted_cash":401.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC EHRLICHIA MURIS LIKE PCR - TICK BORNE DISEASE PANEL PCR - ARUP","code_information":[{"code":"3068779857","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":401.0,"discounted_cash":401.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC LEGIONELLA SPECIES PCR - LEGIONELLA SPECIES QUALITATIVE PCR - ARUP","code_information":[{"code":"3068779859","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":553.0,"discounted_cash":553.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MYCOPLASMA HOMINIS - UREAPLASMA AND MYCOPLASMA SPECIES BY PCR - ARUP","code_information":[{"code":"3068779862","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":537.0,"discounted_cash":537.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC UREAPLASMA PARVUM - UREAPLASMA AND MYCOPLASMA SPECIES BY PCR - ARUP","code_information":[{"code":"3068779863","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":537.0,"discounted_cash":537.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC UREAPLASMA UREALYTICUM - UREAPLASMA AND MYCOPLASMA SPECIES BY PCR - ARUP","code_information":[{"code":"3068779864","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":537.0,"discounted_cash":537.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC VARICELLA ZOSTER VIRUS PCR QUAL - ARUP","code_information":[{"code":"3068779865","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":553.0,"discounted_cash":553.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BORDETELLA PERTUSSIS PCR -BORDETELLA PERTUSSIS/PARAPERTUSSIS PCR - ARUP","code_information":[{"code":"3068779876","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":259.0,"discounted_cash":259.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BORDETELLA PARAPERTUSSIS PCR-BORDETELLA PERTUSSIS/PARAPERTUSSIS PCR-ARUP","code_information":[{"code":"3068779877","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":259.0,"discounted_cash":259.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MEASLES (RUBEOLA) QUALITATIVE PCR, NP/THROAT - QUEST","code_information":[{"code":"3068779879","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":98.25,"discounted_cash":98.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MEASLES - MEASLES VIRUS BY QUAL NAAT - ARUP","code_information":[{"code":"3068779880","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":98.25,"discounted_cash":98.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MEASLES VACCINE STRAIN - MEASLES VIRUS BY QUAL NAAT - ARUP","code_information":[{"code":"3068779881","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":98.25,"discounted_cash":98.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BK VIRUS PCR QUANT BLOOD","code_information":[{"code":"3068779901","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87799","type":"HCPCS"}],"standard_charges":[{"gross_charge":743.0,"discounted_cash":743.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC EPSTEIN BARR VIRUS (EBV) PCR QUANTITATIVE/QUALITATIVE","code_information":[{"code":"3068779902","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87799","type":"HCPCS"}],"standard_charges":[{"gross_charge":548.0,"discounted_cash":548.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BK VIRUS PCR QUANT PLASMA - ARUP","code_information":[{"code":"3068779904","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87799","type":"HCPCS"}],"standard_charges":[{"gross_charge":743.0,"discounted_cash":743.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC EPSTEIN BARR VIRUS (EBV) QUANT NAAT PLASMA - ARUP","code_information":[{"code":"3068779905","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87799","type":"HCPCS"}],"standard_charges":[{"gross_charge":548.0,"discounted_cash":548.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DETECT AGENT,IMMUN,DIR OBS,INFLUENZA - RAPID FLU","code_information":[{"code":"3068780401","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87804","type":"HCPCS"}],"standard_charges":[{"gross_charge":59.0,"discounted_cash":59.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RAPID HIV ANTIBODY/ANTIGEN SCREEN","code_information":[{"code":"3068780601","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87806","type":"HCPCS"}],"standard_charges":[{"gross_charge":79.0,"discounted_cash":79.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MICROBIOLOGY - IMMUNOASSAY RSV AG","code_information":[{"code":"3068780701","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87807","type":"HCPCS"}],"standard_charges":[{"gross_charge":154.0,"discounted_cash":154.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC STREP A RAPID SCREEN, DIRECT OPTICAL OBSERVATION","code_information":[{"code":"3068788001","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87880","type":"HCPCS"}],"standard_charges":[{"gross_charge":179.0,"discounted_cash":179.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC AGENT NOS ASSAY W/OPTIC - STREP PNEUMO","code_information":[{"code":"3068789908","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87899","type":"HCPCS"}],"standard_charges":[{"gross_charge":244.0,"discounted_cash":244.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC AGENT NOS ASSAY W/OPTIC - UNLISTED ORGANISM","code_information":[{"code":"3068789909","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87899","type":"HCPCS"}],"standard_charges":[{"gross_charge":286.0,"discounted_cash":286.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC STREPTOCOCCUS PNEUMONIAE ANTIGEN URINE - ARUP","code_information":[{"code":"3068789912","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87899","type":"HCPCS"}],"standard_charges":[{"gross_charge":244.0,"discounted_cash":244.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MALARIA SMEAR - RAPID SCREEN (WITH GIEMSA) - ARUP","code_information":[{"code":"3068789913","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87899","type":"HCPCS"}],"standard_charges":[{"gross_charge":244.0,"discounted_cash":244.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HEPATITIS C GENOTYPE","code_information":[{"code":"3068790201","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87902","type":"HCPCS"}],"standard_charges":[{"gross_charge":2436.0,"discounted_cash":2436.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HEPATITIS C GENOTYPE - ARUP","code_information":[{"code":"3068790206","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87902","type":"HCPCS"}],"standard_charges":[{"gross_charge":2436.0,"discounted_cash":2436.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IA SIALIDASE ENZYME ASSAY POC","code_information":[{"code":"3068790501","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87905","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.0,"discounted_cash":83.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MICROBIOLOGY - NA GENOTYPE HEP B VIRUS","code_information":[{"code":"3068791201","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87912","type":"HCPCS"}],"standard_charges":[{"gross_charge":2627.0,"discounted_cash":2627.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC URINALYSIS AUTO WITH MICROSCOPIC","code_information":[{"code":"3078100101","type":"CDM"},{"code":"0307","type":"RC"},{"code":"81001","type":"HCPCS"}],"standard_charges":[{"gross_charge":74.0,"discounted_cash":74.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC URINALYSIS, NON-AUTO W/O MICROSCPY","code_information":[{"code":"3078100201","type":"CDM"},{"code":"0307","type":"RC"},{"code":"81002","type":"HCPCS"}],"standard_charges":[{"gross_charge":48.0,"discounted_cash":48.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PBB URINALYSIS NONAUTO W/O SCOPE","code_information":[{"code":"30781002PB","type":"CDM"},{"code":"0307","type":"RC"},{"code":"81002","type":"HCPCS"}],"standard_charges":[{"gross_charge":67.0,"discounted_cash":67.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC URINALYSIS DIPSTICK","code_information":[{"code":"3078100301","type":"CDM"},{"code":"0307","type":"RC"},{"code":"81003","type":"HCPCS"}],"standard_charges":[{"gross_charge":71.0,"discounted_cash":71.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC URINALYSIS, AUTO, W/O SCOPE - URINALYSIS CHEM ONLY - SPECIFIC GRAVITY","code_information":[{"code":"3078100304","type":"CDM"},{"code":"0307","type":"RC"},{"code":"81003","type":"HCPCS"}],"standard_charges":[{"gross_charge":162.0,"discounted_cash":162.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC URINALYSIS MICROSCOPIC ONLY","code_information":[{"code":"3078101501","type":"CDM"},{"code":"0307","type":"RC"},{"code":"81015","type":"HCPCS"}],"standard_charges":[{"gross_charge":71.0,"discounted_cash":71.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC URINE PREGNANCY TEST - PREGNANCY URINE","code_information":[{"code":"3078102501","type":"CDM"},{"code":"0307","type":"RC"},{"code":"81025","type":"HCPCS"}],"standard_charges":[{"gross_charge":120.0,"discounted_cash":120.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PLA: MERKEL CELL CARC A/B, SERUM, QUANT","code_information":[{"code":"3100058U01","type":"CDM"},{"code":"0310","type":"RC"},{"code":"0058U","type":"HCPCS"}],"standard_charges":[{"gross_charge":2233.0,"discounted_cash":2233.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MERKEL CELL CARCINOMA ANTIBODIES - ARUP","code_information":[{"code":"3100058U02","type":"CDM"},{"code":"0310","type":"RC"},{"code":"0058U","type":"HCPCS"}],"standard_charges":[{"gross_charge":2233.0,"discounted_cash":2233.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MERKEL POLYOMAVIRUS VP1 CAPSID ANTIBODY - ARUP","code_information":[{"code":"3100059U02","type":"CDM"},{"code":"0310","type":"RC"},{"code":"0059U","type":"HCPCS"}],"standard_charges":[{"gross_charge":904.29,"discounted_cash":904.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RESP VIRUS PNL 4 TARGETS SARS-COV-2 FLU A FLU B RSV QUAL","code_information":[{"code":"3100241U01","type":"CDM"},{"code":"0310","type":"RC"},{"code":"0241U","type":"HCPCS"}],"standard_charges":[{"gross_charge":354.0,"discounted_cash":354.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HPA1 GENOTYPING","code_information":[{"code":"3108110501","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81105","type":"HCPCS"}],"standard_charges":[{"gross_charge":342.0,"discounted_cash":342.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BRCA 1&2 SEQUENCING - ARUP","code_information":[{"code":"3108116202","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81162","type":"HCPCS"}],"standard_charges":[{"gross_charge":14463.0,"discounted_cash":14463.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MOLECULAR PATHOLOGY - BCR/ABL1 GENE ANALYSIS","code_information":[{"code":"3108120601","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81206","type":"HCPCS"}],"standard_charges":[{"gross_charge":1299.0,"discounted_cash":1299.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MOLECULAR PATHOLOGY - BCR/ABL T(9;22)","code_information":[{"code":"3108120602","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81206","type":"HCPCS"}],"standard_charges":[{"gross_charge":1175.0,"discounted_cash":1175.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BCR-ABL1 MAJOR QUANTITATIVE PCR - ARUP","code_information":[{"code":"3108120605","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81206","type":"HCPCS"}],"standard_charges":[{"gross_charge":1299.0,"discounted_cash":1299.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BCR-ABL1 MAJOR - BCR-ABL1 QUAL W/ REFLEX TO MAJOR OR MINOR QUANT - ARUP","code_information":[{"code":"3108120607","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81206","type":"HCPCS"}],"standard_charges":[{"gross_charge":1299.0,"discounted_cash":1299.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BCR-ABL1 MINOR - BCR-ABL1 QUAL W/ REFLEX TO MAJOR OR MINOR QUANT - ARUP","code_information":[{"code":"3108120702","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81207","type":"HCPCS"}],"standard_charges":[{"gross_charge":345.0,"discounted_cash":345.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BCR/ABL T922 QNT MINOR BREAKPOINT","code_information":[{"code":"3108120703","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81207","type":"HCPCS"}],"standard_charges":[{"gross_charge":345.0,"discounted_cash":345.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BCR-ABL1 MICRO - BCR-ABL1 QUAL W/ REFLEX TO MAJOR OR MINOR QUANT - ARUP","code_information":[{"code":"3108120802","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81208","type":"HCPCS"}],"standard_charges":[{"gross_charge":522.0,"discounted_cash":522.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MOLECULAR PATHOLOGY - BRAF GENE ANALYSIS","code_information":[{"code":"3108121001","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81210","type":"HCPCS"}],"standard_charges":[{"gross_charge":842.0,"discounted_cash":842.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BRAF MUTATIONAL ANALYSIS","code_information":[{"code":"3108121002","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81210","type":"HCPCS"}],"standard_charges":[{"gross_charge":842.0,"discounted_cash":842.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CALR GENE ANALYSIS, COMMON, EXON 9 - MPN JAK2 REFLEX PANEL","code_information":[{"code":"3108121901","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81219","type":"HCPCS"}],"standard_charges":[{"gross_charge":494.0,"discounted_cash":494.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MOLECULAR PATHOLOGY - DPYD GENE ANALYSIS","code_information":[{"code":"3108123201","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81232","type":"HCPCS"}],"standard_charges":[{"gross_charge":1369.0,"discounted_cash":1369.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DIHYDROPYRIMIDINE DEHYDROGENASE (DPYD) - ARUP","code_information":[{"code":"3108123202","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81232","type":"HCPCS"}],"standard_charges":[{"gross_charge":1369.0,"discounted_cash":1369.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FACTOR 2 GENE MUTATION - ARUP","code_information":[{"code":"3108124003","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81240","type":"HCPCS"}],"standard_charges":[{"gross_charge":767.0,"discounted_cash":767.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FACTOR 5 LEIDEN - ARUP","code_information":[{"code":"3108124105","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81241","type":"HCPCS"}],"standard_charges":[{"gross_charge":409.0,"discounted_cash":409.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HEMOCHROMATOSIS (HFE) 3 MUTATION - ARUP","code_information":[{"code":"3108125602","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81256","type":"HCPCS"}],"standard_charges":[{"gross_charge":482.0,"discounted_cash":482.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MOLECULAR PATHOLOGY - JAK2 / V617F MUTATION GENE ANALYSIS","code_information":[{"code":"3108127001","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81270","type":"HCPCS"}],"standard_charges":[{"gross_charge":711.0,"discounted_cash":711.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC JAK2 GENE V617F QUALITATIVE WITH REFLEX JAK2 EXON 12 - ARUP","code_information":[{"code":"3108127003","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81270","type":"HCPCS"}],"standard_charges":[{"gross_charge":711.0,"discounted_cash":711.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC JAK2 GENE V617F QUALITATIVE WITH REFLEX CALR AND MPL - ARUP","code_information":[{"code":"3108127004","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81270","type":"HCPCS"}],"standard_charges":[{"gross_charge":711.0,"discounted_cash":711.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC JAK2 GENE V617F MUTATION QUALITATIVE - ARUP","code_information":[{"code":"3108127005","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81270","type":"HCPCS"}],"standard_charges":[{"gross_charge":711.0,"discounted_cash":711.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MOLECULAR PATHOLOGY - KIT SEQUENCE","code_information":[{"code":"3108127201","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81272","type":"HCPCS"}],"standard_charges":[{"gross_charge":2622.0,"discounted_cash":2622.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC JAK2 TARGETED SEQUENCE EXONS 12-15 - MPN JAK2 REFLEX PANEL","code_information":[{"code":"3108127901","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81279","type":"HCPCS"}],"standard_charges":[{"gross_charge":1276.0,"discounted_cash":1276.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC JAK2 EXON 12 MUTATION PCR - ARUP","code_information":[{"code":"3108127902","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81279","type":"HCPCS"}],"standard_charges":[{"gross_charge":1276.0,"discounted_cash":1276.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MOLECULAR PATHOLOGY - MLH1 GENE ANALYSIS","code_information":[{"code":"3108128801","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81288","type":"HCPCS"}],"standard_charges":[{"gross_charge":658.0,"discounted_cash":658.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MTHFR MUTATION PCR - ARUP","code_information":[{"code":"3108129102","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81291","type":"HCPCS"}],"standard_charges":[{"gross_charge":763.0,"discounted_cash":763.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MSH6 GENE DUP/DELETE VARIANT","code_information":[{"code":"3108130001","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81300","type":"HCPCS"}],"standard_charges":[{"gross_charge":6720.0,"discounted_cash":6720.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC NUDT15 VARIANTS - TPMT AND NUDT15 GENETICS - ARUP","code_information":[{"code":"3108130601","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81306","type":"HCPCS"}],"standard_charges":[{"gross_charge":2321.0,"discounted_cash":2321.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MOLECULAR PATHOLOGY - PDGFRA (GIST) GENE ANAL, TARGET SEQ ANAL","code_information":[{"code":"3108131401","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81314","type":"HCPCS"}],"standard_charges":[{"gross_charge":2361.0,"discounted_cash":2361.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MOLECULAR PATHOLOGY - PMR/RARALPHA COMMON BREAKPOINTS","code_information":[{"code":"3108131501","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81315","type":"HCPCS"}],"standard_charges":[{"gross_charge":1016.0,"discounted_cash":1016.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PML-RARA DETECTION BY RT-PCR QUANTITATIVE - ARUP","code_information":[{"code":"3108131502","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81315","type":"HCPCS"}],"standard_charges":[{"gross_charge":1016.0,"discounted_cash":1016.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALPHA 1 ANTITRYPSIN GENOTYPE (SERPINA1) - A1A GENOTYPE - ARUP","code_information":[{"code":"3108133202","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81332","type":"HCPCS"}],"standard_charges":[{"gross_charge":447.0,"discounted_cash":447.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MPL GENE ANALYSIS COMMON VARIANTS","code_information":[{"code":"3108133801","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81338","type":"HCPCS"}],"standard_charges":[{"gross_charge":724.0,"discounted_cash":724.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MPL MUTATION ANALYSIS - NIRL","code_information":[{"code":"3108133802","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81338","type":"HCPCS"}],"standard_charges":[{"gross_charge":724.0,"discounted_cash":724.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MPL MUTATION DETECTION BY CAPILLARY ELECTROPHORESIS - ARUP","code_information":[{"code":"3108133803","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81338","type":"HCPCS"}],"standard_charges":[{"gross_charge":724.0,"discounted_cash":724.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MOLECULAR PATHOLOGY - GENE ANALYSIS - TRG T CELL VARIANTS","code_information":[{"code":"3108134201","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81342","type":"HCPCS"}],"standard_charges":[{"gross_charge":1123.0,"discounted_cash":1123.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HEMOGLOBIN SUBUNIT BETA - HBB DEL/DUP VARIANT","code_information":[{"code":"3108136301","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81363","type":"HCPCS"}],"standard_charges":[{"gross_charge":1611.86,"discounted_cash":1611.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HEMOGLOBIN SUBUNIT BETA - HBB FULL GENE SEQUENCE","code_information":[{"code":"3108136401","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81364","type":"HCPCS"}],"standard_charges":[{"gross_charge":2326.0,"discounted_cash":2326.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ANKLYOSING SPONDYLITIS (HLAB27) GENOTYPING - ARUP","code_information":[{"code":"3108137403","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81374","type":"HCPCS"}],"standard_charges":[{"gross_charge":776.0,"discounted_cash":776.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HLA CLASS I ONE LOCUS, HIGH RESOLUTION","code_information":[{"code":"3108138001","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81380","type":"HCPCS"}],"standard_charges":[{"gross_charge":1217.0,"discounted_cash":1217.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HLA CLASS I TYPING ALLELE, HIGH RESOLUTION","code_information":[{"code":"3108138101","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81381","type":"HCPCS"}],"standard_charges":[{"gross_charge":1377.0,"discounted_cash":1377.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MOLECULAR PATHOLOGY LEVEL 1","code_information":[{"code":"3108140002","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81400","type":"HCPCS"}],"standard_charges":[{"gross_charge":503.0,"discounted_cash":503.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC APOLIPOPROTEIN E (APOE) MUTATION","code_information":[{"code":"3108140101","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81401","type":"HCPCS"}],"standard_charges":[{"gross_charge":1142.0,"discounted_cash":1142.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC APOLIPOPROTEIN E (APOE) GENOTYPING, CARDIOVASCULAR RISK - ARUP","code_information":[{"code":"3108140102","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81401","type":"HCPCS"}],"standard_charges":[{"gross_charge":982.0,"discounted_cash":982.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC APOLIPOPROTEIN E (APOE) GENOTYPING, ALZHEIMER DISEASE RISK - ARUP","code_information":[{"code":"3108140107","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81401","type":"HCPCS"}],"standard_charges":[{"gross_charge":1142.0,"discounted_cash":1142.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MOLECULAR PATHOLOGY - TIER 2 LEVEL 3","code_information":[{"code":"3108140201","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81402","type":"HCPCS"}],"standard_charges":[{"gross_charge":1487.0,"discounted_cash":1487.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MPL CODON 515 MUTATION - ARUP","code_information":[{"code":"3108140202","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81402","type":"HCPCS"}],"standard_charges":[{"gross_charge":1487.0,"discounted_cash":1487.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MOLECULAR PATHOLOGY - AORTIC DYSFUNCTION","code_information":[{"code":"3108141001","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81410","type":"HCPCS"}],"standard_charges":[{"gross_charge":4014.0,"discounted_cash":4014.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SOLID TUMOR PROFILING BY NGS 50 GENES NON-LUNG RNA ANALYSIS","code_information":[{"code":"3108144902","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81449","type":"HCPCS"}],"standard_charges":[{"gross_charge":1758.0,"discounted_cash":1758.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MOLECULAR PATHOLOGY - HEMATOLYMPHOID SEQUENCE VARIANTS","code_information":[{"code":"3108145001","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81450","type":"HCPCS"}],"standard_charges":[{"gross_charge":4680.0,"discounted_cash":4680.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MOLECULAR PATHOLOGY - TIER 2 UNLISTED","code_information":[{"code":"3108147901","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81479","type":"HCPCS"}],"standard_charges":[{"gross_charge":1910.0,"discounted_cash":1910.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MOLECULAR PATHOLOGY UNLISTED PX - TIER 2 UNLISTED","code_information":[{"code":"3108147911","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81479","type":"HCPCS"}],"standard_charges":[{"gross_charge":1910.0,"discounted_cash":1910.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SPRED1, NF1 DEL/DUP - NEUROFIBROMATOSIS 1, LS PANEL - ARUP","code_information":[{"code":"3108147914","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81479","type":"HCPCS"}],"standard_charges":[{"gross_charge":1782.0,"discounted_cash":1782.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MALIGNANCY RISK ASSESSMENT PELVIC MASS OVA1 PLUS - ARUP","code_information":[{"code":"3108150302","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81503","type":"HCPCS"}],"standard_charges":[{"gross_charge":5670.0,"discounted_cash":5670.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FETAL CONGENITAL ABNORM PANEL, MATERNAL SERUM","code_information":[{"code":"3108151101","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81511","type":"HCPCS"}],"standard_charges":[{"gross_charge":143.0,"discounted_cash":143.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MATERNAL SERUM SCREEN QUAD TEST - ARUP","code_information":[{"code":"3108151102","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81511","type":"HCPCS"}],"standard_charges":[{"gross_charge":143.0,"discounted_cash":143.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MOLECULAR PATHOLOGY MAAA - PROSTATE ONCOLOGY","code_information":[{"code":"3108153901","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81539","type":"HCPCS"}],"standard_charges":[{"gross_charge":1768.0,"discounted_cash":1768.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PROSTATE SPECIFIC KALLIKREIN 4K SCORE - ARUP","code_information":[{"code":"3108153902","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81539","type":"HCPCS"}],"standard_charges":[{"gross_charge":1768.0,"discounted_cash":1768.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FLOW CYTOMETRY LEUK/LYMPH 16 OR MORE MARKERS - ARUP","code_information":[{"code":"3108818901","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88189","type":"HCPCS"}],"standard_charges":[{"gross_charge":182.0,"discounted_cash":182.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FLOW CYTOMETRY INTERPRETATION 16+ MARKERS","code_information":[{"code":"3108818902","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88189","type":"HCPCS"}],"standard_charges":[{"gross_charge":182.0,"discounted_cash":182.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TISSUE CULTURE, LYMPHOCYTE - CHROMOSOME ANALYSIS","code_information":[{"code":"3108823001","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88230","type":"HCPCS"}],"standard_charges":[{"gross_charge":289.0,"discounted_cash":289.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TISSUE CULTURE NEOPLASTIC DISORDER - CHROMOSOME ANALYSIS - BONE MARROW, BLOOD CELLS","code_information":[{"code":"3108823701","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88237","type":"HCPCS"}],"standard_charges":[{"gross_charge":1751.0,"discounted_cash":1751.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PATHOLOGY - 15 - 20 CELL 2 KAROTYPE BANDING","code_information":[{"code":"3108826201","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88262","type":"HCPCS"}],"standard_charges":[{"gross_charge":1726.0,"discounted_cash":1726.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CYTOGENETICS, DNA PROBE - FISH","code_information":[{"code":"3108827103","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88271","type":"HCPCS"}],"standard_charges":[{"gross_charge":215.0,"discounted_cash":215.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PATHOLOGY - INTERPHASE IN SITU HYBRID 100-300 CELL ANALYSIS","code_information":[{"code":"3108827502","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88275","type":"HCPCS"}],"standard_charges":[{"gross_charge":538.0,"discounted_cash":538.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PATHOLOGY - CHROM ANALYSIS ADDITIONAL KARYOTYPE","code_information":[{"code":"3108828001","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88280","type":"HCPCS"}],"standard_charges":[{"gross_charge":149.0,"discounted_cash":149.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PATHOLOGY - GENETIC STUDY INTERP & REPORT","code_information":[{"code":"3108829101","type":"CDM"},{"code":"0998","type":"RC"},{"code":"88291","type":"HCPCS"}],"standard_charges":[{"gross_charge":278.0,"discounted_cash":278.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PATHOLOGY - INTRAOP CONSULT INITIAL SITE PREP EXAM","code_information":[{"code":"3108833301","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88333","type":"HCPCS"}],"standard_charges":[{"gross_charge":238.0,"discounted_cash":238.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PATHOLOGY - IMMUNOCYTOCHEM MULTIPLEX ABY STAIN","code_information":[{"code":"3108834401","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88344","type":"HCPCS"}],"standard_charges":[{"gross_charge":718.0,"discounted_cash":718.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IMMUNOHISTOCHEMISTRY (IHC) MANUAL MORPHOMETRIC ANALYSIS EACH ANTIBODY","code_information":[{"code":"3108836001","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88360","type":"HCPCS"}],"standard_charges":[{"gross_charge":584.0,"discounted_cash":584.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PATHOLOGY - MORPH ANALYSIS IHC STAIN SINGLE ABY QUANT/QUAL COMPUTER ASSIST","code_information":[{"code":"3108836101","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88361","type":"HCPCS"}],"standard_charges":[{"gross_charge":1756.0,"discounted_cash":1756.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PATHOLOGY - MORPH ANALYSIS  IHC STAIN SINGLE ABY QUANT/QUAL COMPTR HER2","code_information":[{"code":"3108836105","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88361","type":"HCPCS"}],"standard_charges":[{"gross_charge":1859.0,"discounted_cash":1859.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC EXAMINATION AND SELECTION OF ARCHIVED TISSUE FOR MOLECULAR ANALYSIS","code_information":[{"code":"3108836301","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88363","type":"HCPCS"}],"standard_charges":[{"gross_charge":169.0,"discounted_cash":169.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IN SITU HYBRIDIZATION EACH ADDITIONAL SINGLE PROBE STAIN","code_information":[{"code":"3108836401","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88364","type":"HCPCS"}],"standard_charges":[{"gross_charge":752.0,"discounted_cash":752.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IN SITU HYBRIDIZATION INITIAL SINGLE PROBE STAIN","code_information":[{"code":"3108836501","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88365","type":"HCPCS"}],"standard_charges":[{"gross_charge":1846.0,"discounted_cash":1846.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC EBER BY ISH","code_information":[{"code":"3108836502","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88365","type":"HCPCS"}],"standard_charges":[{"gross_charge":1209.0,"discounted_cash":1209.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PATHOLOGY - MORPH ANALYSIS IN SITU HYB MULTIPLX STAIN COMPUTER ASSIST","code_information":[{"code":"3108837401","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88374","type":"HCPCS"}],"standard_charges":[{"gross_charge":928.0,"discounted_cash":928.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PATHOLOGY - MORPH ANALYSIS IN SITU HYB MANUAL EACH MULTIPLEX STAIN PROCEDURE","code_information":[{"code":"3108837702","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88377","type":"HCPCS"}],"standard_charges":[{"gross_charge":984.0,"discounted_cash":984.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PATHOLOGY - MICRODISSECTION MANUAL","code_information":[{"code":"3108838101","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88381","type":"HCPCS"}],"standard_charges":[{"gross_charge":619.0,"discounted_cash":619.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CYTOPATHOLOGY CONCENTRATION, SMEARS, AND INTERPRETATION, FLUIDS","code_information":[{"code":"3118810801","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88108","type":"HCPCS"}],"standard_charges":[{"gross_charge":99.15,"discounted_cash":99.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC LAB CYTOPATH CELL ENHANCE TECH - ANAL PAP","code_information":[{"code":"3118811201","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88112","type":"HCPCS"}],"standard_charges":[{"gross_charge":674.0,"discounted_cash":674.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CYTO-WASHING","code_information":[{"code":"3118811202","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88112","type":"HCPCS"}],"standard_charges":[{"gross_charge":372.0,"discounted_cash":372.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CYTO-BRUSH WASHINGS","code_information":[{"code":"3118811203","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88112","type":"HCPCS"}],"standard_charges":[{"gross_charge":215.0,"discounted_cash":215.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CYTOPATH CELL ENHANCE TECH - LAB CYTOPATH,  CELL ENHANCE TECH INTERM","code_information":[{"code":"3118811204","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88112","type":"HCPCS"}],"standard_charges":[{"gross_charge":555.0,"discounted_cash":555.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PAP SMEAR PATHOLOGIST INTERPRETATION NO ALT CODE","code_information":[{"code":"3118814101","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88141","type":"HCPCS"}],"standard_charges":[{"gross_charge":198.0,"discounted_cash":198.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FINE NEEDLE ASPIRATION IMMEDIATE EVALUATION FOR ADEQUACY FIRST SITE","code_information":[{"code":"3118817201","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88172","type":"HCPCS"}],"standard_charges":[{"gross_charge":371.0,"discounted_cash":371.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FINE NEEDLE ASPIRATION INTERPRETATION AND REPORT","code_information":[{"code":"3118817301","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88173","type":"HCPCS"}],"standard_charges":[{"gross_charge":217.0,"discounted_cash":217.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CYTOPATH C/V AUTO FLUID - PAPSM THIN LAYER,INTER DIAG NO ALT CODE","code_information":[{"code":"3118817501","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88175","type":"HCPCS"}],"standard_charges":[{"gross_charge":354.0,"discounted_cash":354.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PAP SMEAR DIAGNOSTIC IMAGED NO ALT CODE","code_information":[{"code":"3118817502","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88175","type":"HCPCS"}],"standard_charges":[{"gross_charge":389.0,"discounted_cash":389.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FINE NEEDLE ASPIRATION IMMEDIATE EVALUATION FOR ADEQUACY EACH ADDL SITE","code_information":[{"code":"3118817701","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88177","type":"HCPCS"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":125.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FLOW CYTOMETRY FIRST MARKER","code_information":[{"code":"3118818405","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88184","type":"HCPCS"}],"standard_charges":[{"gross_charge":697.0,"discounted_cash":697.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC LYMPHOCYTE SUBSETS","code_information":[{"code":"3118818408","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88184","type":"HCPCS"}],"standard_charges":[{"gross_charge":1859.0,"discounted_cash":1859.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FLOWCYTOMETRY/ TECH COMPONENT, 1 MARKER - FLOWCYTOMETRY","code_information":[{"code":"3118818415","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88184","type":"HCPCS"}],"standard_charges":[{"gross_charge":1025.0,"discounted_cash":1025.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RBC BAND 3 PROTEIN REDUCTION - ARUP","code_information":[{"code":"3118818420","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88184","type":"HCPCS"}],"standard_charges":[{"gross_charge":697.0,"discounted_cash":697.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FLOW CYTOMETRY LEUKEMIA/LYMPHOMA PHENOTYPE 1ST OF 35 MARKERS - ARUP","code_information":[{"code":"3118818423","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88184","type":"HCPCS"}],"standard_charges":[{"gross_charge":697.0,"discounted_cash":697.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FLOW CYTOMETRY LEUKEMIA/LYMPHOMA PHENOTYPE 1ST OF 10 MARKERS - ARUP","code_information":[{"code":"3118818424","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88184","type":"HCPCS"}],"standard_charges":[{"gross_charge":697.0,"discounted_cash":697.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FLOW CYTOMETRY LEUKEMIA/LYMPHOMA PHENOTYPE 1ST OF 11 MARKERS - ARUP","code_information":[{"code":"3118818425","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88184","type":"HCPCS"}],"standard_charges":[{"gross_charge":697.0,"discounted_cash":697.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FLOW CYTOMETRY LEUKEMIA/LYMPHOMA PHENOTYPE 1ST OF 12 MARKERS - ARUP","code_information":[{"code":"3118818426","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88184","type":"HCPCS"}],"standard_charges":[{"gross_charge":697.0,"discounted_cash":697.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FLOW CYTOMETRY LEUKEMIA/LYMPHOMA PHENOTYPE 1ST OF 13 MARKERS - ARUP","code_information":[{"code":"3118818427","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88184","type":"HCPCS"}],"standard_charges":[{"gross_charge":697.0,"discounted_cash":697.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FLOW CYTOMETRY LEUKEMIA/LYMPHOMA PHENOTYPE 1ST OF 14 MARKERS - ARUP","code_information":[{"code":"3118818428","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88184","type":"HCPCS"}],"standard_charges":[{"gross_charge":697.0,"discounted_cash":697.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FLOW CYTOMETRY LEUKEMIA/LYMPHOMA PHENOTYPE 1ST OF 15 MARKERS - ARUP","code_information":[{"code":"3118818429","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88184","type":"HCPCS"}],"standard_charges":[{"gross_charge":697.0,"discounted_cash":697.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FLOW CYTOMETRY LEUKEMIA/LYMPHOMA PHENOTYPE 1ST OF 16 MARKERS - ARUP","code_information":[{"code":"3118818430","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88184","type":"HCPCS"}],"standard_charges":[{"gross_charge":697.0,"discounted_cash":697.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FLOW CYTOMETRY LEUKEMIA/LYMPHOMA PHENOTYPE 1ST OF 17 MARKERS - ARUP","code_information":[{"code":"3118818431","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88184","type":"HCPCS"}],"standard_charges":[{"gross_charge":697.0,"discounted_cash":697.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FLOW CYTOMETRY LEUKEMIA/LYMPHOMA PHENOTYPE 1ST OF 18 MARKERS - ARUP","code_information":[{"code":"3118818432","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88184","type":"HCPCS"}],"standard_charges":[{"gross_charge":697.0,"discounted_cash":697.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FLOW CYTOMETRY LEUKEMIA/LYMPHOMA PHENOTYPE 1ST OF 19 MARKERS - ARUP","code_information":[{"code":"3118818433","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88184","type":"HCPCS"}],"standard_charges":[{"gross_charge":697.0,"discounted_cash":697.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FLOW CYTOMETRY LEUKEMIA/LYMPHOMA PHENOTYPE 1ST OF 20 MARKERS - ARUP","code_information":[{"code":"3118818434","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88184","type":"HCPCS"}],"standard_charges":[{"gross_charge":697.0,"discounted_cash":697.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FLOW CYTOMETRY LEUKEMIA/LYMPHOMA PHENOTYPE 1ST OF 21 MARKERS - ARUP","code_information":[{"code":"3118818435","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88184","type":"HCPCS"}],"standard_charges":[{"gross_charge":697.0,"discounted_cash":697.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FLOW CYTOMETRY LEUKEMIA/LYMPHOMA PHENOTYPE 1ST OF 22 MARKERS - ARUP","code_information":[{"code":"3118818436","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88184","type":"HCPCS"}],"standard_charges":[{"gross_charge":697.0,"discounted_cash":697.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FLOW CYTOMETRY LEUKEMIA/LYMPHOMA PHENOTYPE 1ST OF 23 MARKERS - ARUP","code_information":[{"code":"3118818437","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88184","type":"HCPCS"}],"standard_charges":[{"gross_charge":697.0,"discounted_cash":697.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FLOW CYTOMETRY LEUKEMIA/LYMPHOMA PHENOTYPE 1ST OF 24 MARKERS - ARUP","code_information":[{"code":"3118818438","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88184","type":"HCPCS"}],"standard_charges":[{"gross_charge":697.0,"discounted_cash":697.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FLOW CYTOMETRY LEUKEMIA/LYMPHOMA PHENOTYPE 1ST OF 25 MARKERS - ARUP","code_information":[{"code":"3118818439","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88184","type":"HCPCS"}],"standard_charges":[{"gross_charge":697.0,"discounted_cash":697.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FLOW CYTOMETRY LEUKEMIA/LYMPHOMA PHENOTYPE 1ST OF 26 MARKERS - ARUP","code_information":[{"code":"3118818440","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88184","type":"HCPCS"}],"standard_charges":[{"gross_charge":697.0,"discounted_cash":697.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FLOW CYTOMETRY LEUKEMIA/LYMPHOMA PHENOTYPE 1ST OF 27 MARKERS - ARUP","code_information":[{"code":"3118818441","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88184","type":"HCPCS"}],"standard_charges":[{"gross_charge":697.0,"discounted_cash":697.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FLOW CYTOMETRY LEUKEMIA/LYMPHOMA PHENOTYPE 1ST OF 28 MARKERS - ARUP","code_information":[{"code":"3118818442","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88184","type":"HCPCS"}],"standard_charges":[{"gross_charge":697.0,"discounted_cash":697.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FLOW CYTOMETRY LEUKEMIA/LYMPHOMA PHENOTYPE 1ST OF 29 MARKERS - ARUP","code_information":[{"code":"3118818443","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88184","type":"HCPCS"}],"standard_charges":[{"gross_charge":697.0,"discounted_cash":697.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FLOW CYTOMETRY LEUKEMIA/LYMPHOMA PHENOTYPE 1ST OF 30 MARKERS - ARUP","code_information":[{"code":"3118818444","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88184","type":"HCPCS"}],"standard_charges":[{"gross_charge":697.0,"discounted_cash":697.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FLOW CYTOMETRY LEUKEMIA/LYMPHOMA PHENOTYPE 1ST OF 31 MARKERS - ARUP","code_information":[{"code":"3118818445","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88184","type":"HCPCS"}],"standard_charges":[{"gross_charge":697.0,"discounted_cash":697.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FLOW CYTOMETRY LEUKEMIA/LYMPHOMA PHENOTYPE 1ST OF 32 MARKERS - ARUP","code_information":[{"code":"3118818446","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88184","type":"HCPCS"}],"standard_charges":[{"gross_charge":697.0,"discounted_cash":697.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FLOW CYTOMETRY LEUKEMIA/LYMPHOMA PHENOTYPE 1ST OF 33 MARKERS - ARUP","code_information":[{"code":"3118818447","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88184","type":"HCPCS"}],"standard_charges":[{"gross_charge":697.0,"discounted_cash":697.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FLOW CYTOMETRY LEUKEMIA/LYMPHOMA PHENOTYPE 1ST OF 34 MARKERS - ARUP","code_information":[{"code":"3118818448","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88184","type":"HCPCS"}],"standard_charges":[{"gross_charge":697.0,"discounted_cash":697.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FLOW CYTOMETRY LEUKEMIA/LYMPHOMA PHENOTYPE 1ST OF 5 MARKERS - ARUP","code_information":[{"code":"3118818449","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88184","type":"HCPCS"}],"standard_charges":[{"gross_charge":697.0,"discounted_cash":697.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FLOW CYTOMETRY LEUKEMIA/LYMPHOMA PHENOTYPE 1ST OF 6 MARKERS - ARUP","code_information":[{"code":"3118818450","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88184","type":"HCPCS"}],"standard_charges":[{"gross_charge":697.0,"discounted_cash":697.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FLOW CYTOMETRY LEUKEMIA/LYMPHOMA PHENOTYPE 1ST OF 7 MARKERS - ARUP","code_information":[{"code":"3118818451","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88184","type":"HCPCS"}],"standard_charges":[{"gross_charge":697.0,"discounted_cash":697.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FLOW CYTOMETRY LEUKEMIA/LYMPHOMA PHENOTYPE 1ST OF 8 MARKERS - ARUP","code_information":[{"code":"3118818452","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88184","type":"HCPCS"}],"standard_charges":[{"gross_charge":697.0,"discounted_cash":697.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FLOW CYTOMETRY LEUKEMIA/LYMPHOMA PHENOTYPE 1ST OF 9 MARKERS - ARUP","code_information":[{"code":"3118818453","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88184","type":"HCPCS"}],"standard_charges":[{"gross_charge":697.0,"discounted_cash":697.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FLOWCYTOMETRY/TECH COMPONENT, ADD-ON - LAB FLOWCYTOMETRY/TECH CMP","code_information":[{"code":"3118818501","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":526.0,"discounted_cash":526.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FLOWCYTOMETRY/TECH COMPONENT, ADD-ON - BUNDLED CHARGE","code_information":[{"code":"3118818502","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":563.0,"discounted_cash":563.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FLOW CYTOMETRY  EACH ADDITIONAL MARKER","code_information":[{"code":"3118818505","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":62.0,"discounted_cash":62.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FLOW CYTOMETRY LEUKEMIA/LYMPHOMA PHENOTYPE 34 ADDITIONAL MARKERS - ARUP","code_information":[{"code":"3118818510","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":563.0,"discounted_cash":563.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FLOW CYTOMETRY LEUKEMIA/LYMPHOMA PHENOTYPE 9 ADDITIONAL MARKERS - ARUP","code_information":[{"code":"3118818511","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":563.0,"discounted_cash":563.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FLOW CYTOMETRY LEUKEMIA/LYMPHOMA PHENOTYPE 10 ADDITIONAL MARKERS - ARUP","code_information":[{"code":"3118818512","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":563.0,"discounted_cash":563.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FLOW CYTOMETRY LEUKEMIA/LYMPHOMA PHENOTYPE 11 ADDITIONAL MARKERS - ARUP","code_information":[{"code":"3118818513","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":563.0,"discounted_cash":563.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FLOW CYTOMETRY LEUKEMIA/LYMPHOMA PHENOTYPE 12 ADDITIONAL MARKERS - ARUP","code_information":[{"code":"3118818514","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":563.0,"discounted_cash":563.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FLOW CYTOMETRY LEUKEMIA/LYMPHOMA PHENOTYPE 13 ADDITIONAL MARKERS - ARUP","code_information":[{"code":"3118818515","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":563.0,"discounted_cash":563.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FLOW CYTOMETRY LEUKEMIA/LYMPHOMA PHENOTYPE 14 ADDITIONAL MARKERS - ARUP","code_information":[{"code":"3118818516","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":563.0,"discounted_cash":563.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FLOW CYTOMETRY LEUKEMIA/LYMPHOMA PHENOTYPE 15 ADDITIONAL MARKERS - ARUP","code_information":[{"code":"3118818517","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":563.0,"discounted_cash":563.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FLOW CYTOMETRY LEUKEMIA/LYMPHOMA PHENOTYPE 16 ADDITIONAL MARKERS - ARUP","code_information":[{"code":"3118818518","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":563.0,"discounted_cash":563.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FLOW CYTOMETRY LEUKEMIA/LYMPHOMA PHENOTYPE 17 ADDITIONAL MARKERS - ARUP","code_information":[{"code":"3118818519","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":563.0,"discounted_cash":563.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FLOW CYTOMETRY LEUKEMIA/LYMPHOMA PHENOTYPE 18 ADDITIONAL MARKERS - ARUP","code_information":[{"code":"3118818520","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":563.0,"discounted_cash":563.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FLOW CYTOMETRY LEUKEMIA/LYMPHOMA PHENOTYPE 19 ADDITIONAL MARKERS - ARUP","code_information":[{"code":"3118818521","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":563.0,"discounted_cash":563.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FLOW CYTOMETRY LEUKEMIA/LYMPHOMA PHENOTYPE 20 ADDITIONAL MARKERS - ARUP","code_information":[{"code":"3118818522","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":563.0,"discounted_cash":563.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FLOW CYTOMETRY LEUKEMIA/LYMPHOMA PHENOTYPE 21 ADDITIONAL MARKERS - ARUP","code_information":[{"code":"3118818523","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":563.0,"discounted_cash":563.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FLOW CYTOMETRY LEUKEMIA/LYMPHOMA PHENOTYPE 22 ADDITIONAL MARKERS - ARUP","code_information":[{"code":"3118818524","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":563.0,"discounted_cash":563.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FLOW CYTOMETRY LEUKEMIA/LYMPHOMA PHENOTYPE 23 ADDITIONAL MARKERS - ARUP","code_information":[{"code":"3118818525","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":563.0,"discounted_cash":563.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FLOW CYTOMETRY LEUKEMIA/LYMPHOMA PHENOTYPE 24 ADDITIONAL MARKERS - ARUP","code_information":[{"code":"3118818526","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":563.0,"discounted_cash":563.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FLOW CYTOMETRY LEUKEMIA/LYMPHOMA PHENOTYPE 25 ADDITIONAL MARKERS - ARUP","code_information":[{"code":"3118818527","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":563.0,"discounted_cash":563.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FLOW CYTOMETRY LEUKEMIA/LYMPHOMA PHENOTYPE 26 ADDITIONAL MARKERS - ARUP","code_information":[{"code":"3118818528","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":563.0,"discounted_cash":563.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FLOW CYTOMETRY LEUKEMIA/LYMPHOMA PHENOTYPE 27 ADDITIONAL MARKERS - ARUP","code_information":[{"code":"3118818529","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":563.0,"discounted_cash":563.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FLOW CYTOMETRY LEUKEMIA/LYMPHOMA PHENOTYPE 28 ADDITIONAL MARKERS - ARUP","code_information":[{"code":"3118818530","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":563.0,"discounted_cash":563.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FLOW CYTOMETRY LEUKEMIA/LYMPHOMA PHENOTYPE 29 ADDITIONAL MARKERS - ARUP","code_information":[{"code":"3118818531","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":563.0,"discounted_cash":563.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FLOW CYTOMETRY LEUKEMIA/LYMPHOMA PHENOTYPE 30 ADDITIONAL MARKERS - ARUP","code_information":[{"code":"3118818532","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":563.0,"discounted_cash":563.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FLOW CYTOMETRY LEUKEMIA/LYMPHOMA PHENOTYPE 31 ADDITIONAL MARKERS - ARUP","code_information":[{"code":"3118818533","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":563.0,"discounted_cash":563.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FLOW CYTOMETRY LEUKEMIA/LYMPHOMA PHENOTYPE 32 ADDITIONAL MARKERS - ARUP","code_information":[{"code":"3118818534","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":563.0,"discounted_cash":563.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FLOW CYTOMETRY LEUKEMIA/LYMPHOMA PHENOTYPE 33 ADDITIONAL MARKERS - ARUP","code_information":[{"code":"3118818535","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":563.0,"discounted_cash":563.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FLOW CYTOMETRY LEUKEMIA/LYMPHOMA PHENOTYPE 4 ADDITIONAL MARKERS - ARUP","code_information":[{"code":"3118818536","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":563.0,"discounted_cash":563.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FLOW CYTOMETRY LEUKEMIA/LYMPHOMA PHENOTYPE 5 ADDITIONAL MARKERS - ARUP","code_information":[{"code":"3118818537","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":563.0,"discounted_cash":563.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FLOW CYTOMETRY LEUKEMIA/LYMPHOMA PHENOTYPE 6 ADDITIONAL MARKERS - ARUP","code_information":[{"code":"3118818538","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":563.0,"discounted_cash":563.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FLOW CYTOMETRY LEUKEMIA/LYMPHOMA PHENOTYPE 7 ADDITIONAL MARKERS - ARUP","code_information":[{"code":"3118818539","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":563.0,"discounted_cash":563.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FLOW CYTOMETRY LEUKEMIA/LYMPHOMA PHENOTYPE 8 ADDITIONAL MARKERS - ARUP","code_information":[{"code":"3118818540","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":563.0,"discounted_cash":563.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FLOW CYTOMETRY LEUK/LYMPH PHENO 9-15 MARKERS - ARUP","code_information":[{"code":"3118818801","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88188","type":"HCPCS"}],"standard_charges":[{"gross_charge":27.0,"discounted_cash":27.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FLOW CYTOMETRY INTERPRETATION 9-15 MARKERS","code_information":[{"code":"3118818802","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88188","type":"HCPCS"}],"standard_charges":[{"gross_charge":27.0,"discounted_cash":27.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CHROMOSOME COUNT - CHROMOSOME ANALYSIS PRODUCTS OF CONCEPTION - ARUP","code_information":[{"code":"3118826202","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88262","type":"HCPCS"}],"standard_charges":[{"gross_charge":1726.0,"discounted_cash":1726.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PATHOLOGY - CHROM ANALYSIS 20 - 25 CELL","code_information":[{"code":"3118826401","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88264","type":"HCPCS"}],"standard_charges":[{"gross_charge":1082.0,"discounted_cash":1082.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SURGICAL PATHOLOGY LEVEL I GROSS ONLY","code_information":[{"code":"3128830001","type":"CDM"},{"code":"0312","type":"RC"},{"code":"88300","type":"HCPCS"}],"standard_charges":[{"gross_charge":214.0,"discounted_cash":214.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SURGICAL PATHOLOGY LEVEL II","code_information":[{"code":"3128830201","type":"CDM"},{"code":"0312","type":"RC"},{"code":"88302","type":"HCPCS"}],"standard_charges":[{"gross_charge":330.0,"discounted_cash":330.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SURG PATH,LEVEL III - LAB SURG PATH,LEVEL III","code_information":[{"code":"3128830401","type":"CDM"},{"code":"0312","type":"RC"},{"code":"88304","type":"HCPCS"}],"standard_charges":[{"gross_charge":469.0,"discounted_cash":469.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SURGICAL PATHOLOGY LEVEL IV","code_information":[{"code":"3128830501","type":"CDM"},{"code":"0312","type":"RC"},{"code":"88305","type":"HCPCS"}],"standard_charges":[{"gross_charge":581.0,"discounted_cash":581.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SURGICAL PATHOLOGY LEVEL V","code_information":[{"code":"3128830701","type":"CDM"},{"code":"0312","type":"RC"},{"code":"88307","type":"HCPCS"}],"standard_charges":[{"gross_charge":893.0,"discounted_cash":893.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SURGICAL PATHOLOGY LEVEL VI","code_information":[{"code":"3128830901","type":"CDM"},{"code":"0312","type":"RC"},{"code":"88309","type":"HCPCS"}],"standard_charges":[{"gross_charge":1028.0,"discounted_cash":1028.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SURGICAL PATHOLOGY DECALCIFY TISSUE","code_information":[{"code":"3128831105","type":"CDM"},{"code":"0312","type":"RC"},{"code":"88311","type":"HCPCS"}],"standard_charges":[{"gross_charge":266.0,"discounted_cash":266.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SPECIAL STAINS,GROUP I - LAB SPECIAL STAINS,GROUP I","code_information":[{"code":"3128831201","type":"CDM"},{"code":"0312","type":"RC"},{"code":"88312","type":"HCPCS"}],"standard_charges":[{"gross_charge":399.0,"discounted_cash":399.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SURGICAL PATHOLOGY SPECIAL STAIN GROUP I MICROORGANISMS","code_information":[{"code":"3128831202","type":"CDM"},{"code":"0312","type":"RC"},{"code":"88312","type":"HCPCS"}],"standard_charges":[{"gross_charge":266.0,"discounted_cash":266.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SURGICAL PATHOLOGY SPECIAL STAIN GROUP II EXCEPT MICROORGANISMS","code_information":[{"code":"3128831302","type":"CDM"},{"code":"0312","type":"RC"},{"code":"88313","type":"HCPCS"}],"standard_charges":[{"gross_charge":424.0,"discounted_cash":424.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MICROSLIDE CONSULT W SLIDE PREP - LAB MICROSLIDE CONSULT W SLD PREP","code_information":[{"code":"3128832301","type":"CDM"},{"code":"0312","type":"RC"},{"code":"88323","type":"HCPCS"}],"standard_charges":[{"gross_charge":1013.0,"discounted_cash":1013.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PATHOLOGY CONSULT IN SURGERY, FROZEN SECTION BLOCK","code_information":[{"code":"3128833101","type":"CDM"},{"code":"0312","type":"RC"},{"code":"88331","type":"HCPCS"}],"standard_charges":[{"gross_charge":563.0,"discounted_cash":563.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PATHOLOGY CONSULT IN SURGERY, EACH ADDITIONAL FROZEN SECTION BLOCK","code_information":[{"code":"3128833201","type":"CDM"},{"code":"0312","type":"RC"},{"code":"88332","type":"HCPCS"}],"standard_charges":[{"gross_charge":480.0,"discounted_cash":480.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PATHOLOGY CONSULT IN SURGERY, EACH ADDITIONAL CYTOLOGIC EXAMINATION","code_information":[{"code":"3128833401","type":"CDM"},{"code":"0312","type":"RC"},{"code":"88334","type":"HCPCS"}],"standard_charges":[{"gross_charge":197.0,"discounted_cash":197.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IMMUNOHISTOCHEMISTRY (IHC) EACH ADDITIONAL ANTIBODY","code_information":[{"code":"3128834101","type":"CDM"},{"code":"0312","type":"RC"},{"code":"88341","type":"HCPCS"}],"standard_charges":[{"gross_charge":798.0,"discounted_cash":798.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IMMUNOHISTOCHEMISTRY (IHC) FIRST ANTIBODY","code_information":[{"code":"3128834201","type":"CDM"},{"code":"0312","type":"RC"},{"code":"88342","type":"HCPCS"}],"standard_charges":[{"gross_charge":798.0,"discounted_cash":798.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IMMUNOHISTOCHEMISTRY - INITIAL SINGLE ANTIBODY STAIN PROCEDURE - ARKANA","code_information":[{"code":"3128834202","type":"CDM"},{"code":"0312","type":"RC"},{"code":"88342","type":"HCPCS"}],"standard_charges":[{"gross_charge":945.0,"discounted_cash":945.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IMHISTOCHEM/CYTCHM INIT ANTIBODY STAIN PROCEDURE - SINGLE ABY","code_information":[{"code":"3128834203","type":"CDM"},{"code":"0312","type":"RC"},{"code":"88342","type":"HCPCS"}],"standard_charges":[{"gross_charge":945.0,"discounted_cash":945.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SKIN ANTIBODY","code_information":[{"code":"3128834603","type":"CDM"},{"code":"0312","type":"RC"},{"code":"88346","type":"HCPCS"}],"standard_charges":[{"gross_charge":1668.0,"discounted_cash":1668.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IMMUNOFLUORESCENT STUDY,INDIRECT ADDITIONAL SINGLE ABY STAIN","code_information":[{"code":"3128835001","type":"CDM"},{"code":"0312","type":"RC"},{"code":"88350","type":"HCPCS"}],"standard_charges":[{"gross_charge":266.0,"discounted_cash":266.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PDL1 22C3 IMMUNOHISTOCHEMISTRY (IHC) WITH TUMOR PROPORTION SCORE - ARUP","code_information":[{"code":"3128836005","type":"CDM"},{"code":"0312","type":"RC"},{"code":"88360","type":"HCPCS"}],"standard_charges":[{"gross_charge":584.0,"discounted_cash":584.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PD-L1 22C3 IHC WITH TUMOR PROPORTION SCORE - ARUP","code_information":[{"code":"3128836006","type":"CDM"},{"code":"0312","type":"RC"},{"code":"88360","type":"HCPCS"}],"standard_charges":[{"gross_charge":584.0,"discounted_cash":584.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PD-L1 22C3 IHC WITH COMBINED POSITIVE SCORE - ARUP","code_information":[{"code":"3128836007","type":"CDM"},{"code":"0312","type":"RC"},{"code":"88360","type":"HCPCS"}],"standard_charges":[{"gross_charge":584.0,"discounted_cash":584.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HER2NEU FISH, BREAST TISSUE","code_information":[{"code":"3128837701","type":"CDM"},{"code":"0312","type":"RC"},{"code":"88377","type":"HCPCS"}],"standard_charges":[{"gross_charge":1836.0,"discounted_cash":1836.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SURGICAL PATHOLOGY PROSTATE NEEDLE BIOPSY, ANY NUMBER OF SPECIMENS","code_information":[{"code":"312G041601","type":"CDM"},{"code":"0312","type":"RC"},{"code":"G0416","type":"HCPCS"}],"standard_charges":[{"gross_charge":798.0,"discounted_cash":798.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC X-RAY EYE FOR FOREIGN BODY","code_information":[{"code":"3207003001","type":"CDM"},{"code":"0320","type":"RC"},{"code":"70030","type":"HCPCS"}],"standard_charges":[{"gross_charge":244.0,"discounted_cash":244.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC X-RAY JAW <4 VW","code_information":[{"code":"3207010001","type":"CDM"},{"code":"0320","type":"RC"},{"code":"70100","type":"HCPCS"}],"standard_charges":[{"gross_charge":383.0,"discounted_cash":383.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC X-RAY JAW 4+ VW","code_information":[{"code":"3207011001","type":"CDM"},{"code":"0320","type":"RC"},{"code":"70110","type":"HCPCS"}],"standard_charges":[{"gross_charge":772.0,"discounted_cash":772.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC X-RAY FACIAL BONES <3 VW","code_information":[{"code":"3207014001","type":"CDM"},{"code":"0320","type":"RC"},{"code":"70140","type":"HCPCS"}],"standard_charges":[{"gross_charge":348.0,"discounted_cash":348.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC X-RAY FACIAL BONES 3+ VW","code_information":[{"code":"3207015001","type":"CDM"},{"code":"0320","type":"RC"},{"code":"70150","type":"HCPCS"}],"standard_charges":[{"gross_charge":731.0,"discounted_cash":731.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC X-RAY NASAL BONES","code_information":[{"code":"3207016001","type":"CDM"},{"code":"0320","type":"RC"},{"code":"70160","type":"HCPCS"}],"standard_charges":[{"gross_charge":488.0,"discounted_cash":488.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC X-RAY ORBITS","code_information":[{"code":"3207020001","type":"CDM"},{"code":"0320","type":"RC"},{"code":"70200","type":"HCPCS"}],"standard_charges":[{"gross_charge":518.0,"discounted_cash":518.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC X-RAY SINUSES <3 VW - XR PARANASAL SINUSES 1-2 VIEWS","code_information":[{"code":"3207021002","type":"CDM"},{"code":"0320","type":"RC"},{"code":"70210","type":"HCPCS"}],"standard_charges":[{"gross_charge":791.0,"discounted_cash":791.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC X-RAY SINUSES 3+ VW","code_information":[{"code":"3207022001","type":"CDM"},{"code":"0320","type":"RC"},{"code":"70220","type":"HCPCS"}],"standard_charges":[{"gross_charge":825.0,"discounted_cash":825.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC X-RAY SKULL <4 VW","code_information":[{"code":"3207025001","type":"CDM"},{"code":"0320","type":"RC"},{"code":"70250","type":"HCPCS"}],"standard_charges":[{"gross_charge":538.0,"discounted_cash":538.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC X-RAY SKULL 4+ VW","code_information":[{"code":"3207026001","type":"CDM"},{"code":"0320","type":"RC"},{"code":"70260","type":"HCPCS"}],"standard_charges":[{"gross_charge":807.0,"discounted_cash":807.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC X-RAY TMJ UNILAT","code_information":[{"code":"3207032802","type":"CDM"},{"code":"0320","type":"RC"},{"code":"70328","type":"HCPCS"}],"standard_charges":[{"gross_charge":987.0,"discounted_cash":987.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC X-RAY TMJ BILAT","code_information":[{"code":"3207033001","type":"CDM"},{"code":"0320","type":"RC"},{"code":"70330","type":"HCPCS"}],"standard_charges":[{"gross_charge":1200.0,"discounted_cash":1200.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC X-RAY NECK SOFT TISSUE","code_information":[{"code":"3207036001","type":"CDM"},{"code":"0320","type":"RC"},{"code":"70360","type":"HCPCS"}],"standard_charges":[{"gross_charge":276.0,"discounted_cash":276.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC X-RAY RIBS 2 VW UNILAT","code_information":[{"code":"3207110001","type":"CDM"},{"code":"0320","type":"RC"},{"code":"71100","type":"HCPCS"}],"standard_charges":[{"gross_charge":491.0,"discounted_cash":491.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC X-RAY RIBS 3 VW BILAT","code_information":[{"code":"3207111001","type":"CDM"},{"code":"0320","type":"RC"},{"code":"71110","type":"HCPCS"}],"standard_charges":[{"gross_charge":532.0,"discounted_cash":532.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC X-RAY STERNUM 2+ VW","code_information":[{"code":"3207112001","type":"CDM"},{"code":"0320","type":"RC"},{"code":"71120","type":"HCPCS"}],"standard_charges":[{"gross_charge":500.0,"discounted_cash":500.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC X-RAY STERNO-CLAVICLUAR JT","code_information":[{"code":"3207113001","type":"CDM"},{"code":"0320","type":"RC"},{"code":"71130","type":"HCPCS"}],"standard_charges":[{"gross_charge":509.0,"discounted_cash":509.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC X-RAY SPINE ONE VIEW","code_information":[{"code":"3207202001","type":"CDM"},{"code":"0320","type":"RC"},{"code":"72020","type":"HCPCS"}],"standard_charges":[{"gross_charge":325.0,"discounted_cash":325.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RADEX SPINE CERVICAL 2 OR 3 VIEWS","code_information":[{"code":"3207204002","type":"CDM"},{"code":"0320","type":"RC"},{"code":"72040","type":"HCPCS"}],"standard_charges":[{"gross_charge":442.0,"discounted_cash":442.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RADEX SPINE CERVICAL 4 OR 5 VIEWS","code_information":[{"code":"3207205001","type":"CDM"},{"code":"0320","type":"RC"},{"code":"72050","type":"HCPCS"}],"standard_charges":[{"gross_charge":717.0,"discounted_cash":717.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RADEX SPINE CERVICAL 6 OR MORE VIEWS","code_information":[{"code":"3207205201","type":"CDM"},{"code":"0320","type":"RC"},{"code":"72052","type":"HCPCS"}],"standard_charges":[{"gross_charge":842.0,"discounted_cash":842.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC X-RAY THORACIC SPINE 2 VW","code_information":[{"code":"3207207001","type":"CDM"},{"code":"0320","type":"RC"},{"code":"72070","type":"HCPCS"}],"standard_charges":[{"gross_charge":477.0,"discounted_cash":477.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC X-RAY THORACIC SPINE+SWIM 3 VW","code_information":[{"code":"3207207201","type":"CDM"},{"code":"0320","type":"RC"},{"code":"72072","type":"HCPCS"}],"standard_charges":[{"gross_charge":667.0,"discounted_cash":667.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC X-RAY THORACIC SPINE 4 VW","code_information":[{"code":"3207207401","type":"CDM"},{"code":"0320","type":"RC"},{"code":"72074","type":"HCPCS"}],"standard_charges":[{"gross_charge":1079.0,"discounted_cash":1079.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RADEX SPINE THORACOLUMBAR JUNCTION MIN 2 VIEWS","code_information":[{"code":"3207208001","type":"CDM"},{"code":"0320","type":"RC"},{"code":"72080","type":"HCPCS"}],"standard_charges":[{"gross_charge":483.0,"discounted_cash":483.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RADEX ENTIR THRC LMBR CRV SAC SPI W/SKULL 1 VW","code_information":[{"code":"3207208101","type":"CDM"},{"code":"0320","type":"RC"},{"code":"72081","type":"HCPCS"}],"standard_charges":[{"gross_charge":431.0,"discounted_cash":431.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RADEX ENTIR THRC LMBR CRV SAC SPI W/SKULL 6/> VW","code_information":[{"code":"3207208401","type":"CDM"},{"code":"0320","type":"RC"},{"code":"72084","type":"HCPCS"}],"standard_charges":[{"gross_charge":1099.0,"discounted_cash":1099.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC X-RAY LUMBAR SPINE 2/3 VW","code_information":[{"code":"3207210001","type":"CDM"},{"code":"0320","type":"RC"},{"code":"72100","type":"HCPCS"}],"standard_charges":[{"gross_charge":342.0,"discounted_cash":342.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC X-RAY LUMBAR SPINE 4 VW","code_information":[{"code":"3207211001","type":"CDM"},{"code":"0320","type":"RC"},{"code":"72110","type":"HCPCS"}],"standard_charges":[{"gross_charge":749.0,"discounted_cash":749.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC X-RAY LUMBAR SPINE 6+ VW","code_information":[{"code":"3207211401","type":"CDM"},{"code":"0320","type":"RC"},{"code":"72114","type":"HCPCS"}],"standard_charges":[{"gross_charge":845.0,"discounted_cash":845.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC X-RAY LUMBAR SPINE FLEX/EXTEN","code_information":[{"code":"3207212001","type":"CDM"},{"code":"0320","type":"RC"},{"code":"72120","type":"HCPCS"}],"standard_charges":[{"gross_charge":652.0,"discounted_cash":652.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC X-RAY PELVIS 1/2 VW","code_information":[{"code":"3207217001","type":"CDM"},{"code":"0320","type":"RC"},{"code":"72170","type":"HCPCS"}],"standard_charges":[{"gross_charge":380.0,"discounted_cash":380.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC X-RAY PELVIS 3+ VW","code_information":[{"code":"3207219001","type":"CDM"},{"code":"0320","type":"RC"},{"code":"72190","type":"HCPCS"}],"standard_charges":[{"gross_charge":664.0,"discounted_cash":664.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC X-RAY SACROILIAC JTS <3 VW","code_information":[{"code":"3207220001","type":"CDM"},{"code":"0320","type":"RC"},{"code":"72200","type":"HCPCS"}],"standard_charges":[{"gross_charge":585.0,"discounted_cash":585.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC X-RAY SACROILIAC JTS 3+ VW","code_information":[{"code":"3207220201","type":"CDM"},{"code":"0320","type":"RC"},{"code":"72202","type":"HCPCS"}],"standard_charges":[{"gross_charge":644.0,"discounted_cash":644.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC X-RAY SACRUM/COCCYX 2+ VW","code_information":[{"code":"3207222001","type":"CDM"},{"code":"0320","type":"RC"},{"code":"72220","type":"HCPCS"}],"standard_charges":[{"gross_charge":354.0,"discounted_cash":354.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MYELOGRAPHY CERV SPINE","code_information":[{"code":"3207224001","type":"CDM"},{"code":"0320","type":"RC"},{"code":"72240","type":"HCPCS"}],"standard_charges":[{"gross_charge":253.0,"discounted_cash":253.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MYELOGRAPHY THORAX SPINE - FL THORACIC SPINE MYELOGRAM","code_information":[{"code":"3207225501","type":"CDM"},{"code":"0320","type":"RC"},{"code":"72255","type":"HCPCS"}],"standard_charges":[{"gross_charge":8388.0,"discounted_cash":8388.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MYELOGRAPHY LUMBAR SPINE","code_information":[{"code":"3207226501","type":"CDM"},{"code":"0320","type":"RC"},{"code":"72265","type":"HCPCS"}],"standard_charges":[{"gross_charge":1872.0,"discounted_cash":1872.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MYELOGRAPHY OF ENTIRE SPINE","code_information":[{"code":"3207227004","type":"CDM"},{"code":"0320","type":"RC"},{"code":"72270","type":"HCPCS"}],"standard_charges":[{"gross_charge":1776.0,"discounted_cash":1776.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC X-RAY CLAVICLE","code_information":[{"code":"3207300001","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73000","type":"HCPCS"}],"standard_charges":[{"gross_charge":316.0,"discounted_cash":316.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC X-RAY SCAPULA","code_information":[{"code":"3207301001","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73010","type":"HCPCS"}],"standard_charges":[{"gross_charge":442.0,"discounted_cash":442.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC X-RAY SHOULDER 1 VW","code_information":[{"code":"3207302002","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73020","type":"HCPCS"}],"standard_charges":[{"gross_charge":284.0,"discounted_cash":284.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC X-RAY SHOULDER 2+ VW","code_information":[{"code":"3207303002","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73030","type":"HCPCS"}],"standard_charges":[{"gross_charge":532.0,"discounted_cash":532.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC X-RAY AC JTS","code_information":[{"code":"3207305001","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73050","type":"HCPCS"}],"standard_charges":[{"gross_charge":524.0,"discounted_cash":524.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC X-RAY HUMERUS","code_information":[{"code":"3207306002","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73060","type":"HCPCS"}],"standard_charges":[{"gross_charge":398.0,"discounted_cash":398.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC X-RAY ELBOW 2 VW","code_information":[{"code":"3207307002","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73070","type":"HCPCS"}],"standard_charges":[{"gross_charge":488.0,"discounted_cash":488.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC X-RAY ELBOW 3+ VW","code_information":[{"code":"3207308002","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73080","type":"HCPCS"}],"standard_charges":[{"gross_charge":500.0,"discounted_cash":500.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC X-RAY FOREARM 2 VW","code_information":[{"code":"3207309001","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73090","type":"HCPCS"}],"standard_charges":[{"gross_charge":328.0,"discounted_cash":328.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC X-RAY ARM, INFANT","code_information":[{"code":"3207309201","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73092","type":"HCPCS"}],"standard_charges":[{"gross_charge":290.0,"discounted_cash":290.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC X-RAY WRIST 2 VW","code_information":[{"code":"3207310001","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73100","type":"HCPCS"}],"standard_charges":[{"gross_charge":328.0,"discounted_cash":328.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC X-RAY WRIST 3+ VW","code_information":[{"code":"3207311001","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73110","type":"HCPCS"}],"standard_charges":[{"gross_charge":421.0,"discounted_cash":421.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC X-RAY HAND 2 VW","code_information":[{"code":"3207312001","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73120","type":"HCPCS"}],"standard_charges":[{"gross_charge":328.0,"discounted_cash":328.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC X-RAY HAND 3+ VW","code_information":[{"code":"3207313001","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73130","type":"HCPCS"}],"standard_charges":[{"gross_charge":427.0,"discounted_cash":427.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC X-RAY EXAM OF FINGER(S)","code_information":[{"code":"3207314002","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73140","type":"HCPCS"}],"standard_charges":[{"gross_charge":407.0,"discounted_cash":407.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RADEX HIP UNILATERAL WITH PELVIS 1 VIEW","code_information":[{"code":"3207350101","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73501","type":"HCPCS"}],"standard_charges":[{"gross_charge":307.0,"discounted_cash":307.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RADEX HIP UNILATERAL WITH PELVIS 2-3 VIEWS","code_information":[{"code":"3207350201","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73502","type":"HCPCS"}],"standard_charges":[{"gross_charge":430.0,"discounted_cash":430.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RADEX HIP UNILATERAL WITH PELVIS MINIMUM 4 VIEWS","code_information":[{"code":"3207350301","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73503","type":"HCPCS"}],"standard_charges":[{"gross_charge":467.0,"discounted_cash":467.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RADEX HIPS BILATERAL WITH PELVIS 2 VIEWS","code_information":[{"code":"3207352101","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73521","type":"HCPCS"}],"standard_charges":[{"gross_charge":641.0,"discounted_cash":641.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC X-RAY EXAM HIPS BI 3-4 VWS - XR HIPS BILAT 3-4 VW W/ OR W/O PELVIS","code_information":[{"code":"3207352201","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73522","type":"HCPCS"}],"standard_charges":[{"gross_charge":900.0,"discounted_cash":900.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RADEX HIPS BILATERAL WITH PELVIS MINIMUM 5 VIEWS","code_information":[{"code":"3207352301","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73523","type":"HCPCS"}],"standard_charges":[{"gross_charge":1345.0,"discounted_cash":1345.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RADIOLOGIC EXAMINATION FEMUR 1 VIEW","code_information":[{"code":"3207355101","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73551","type":"HCPCS"}],"standard_charges":[{"gross_charge":456.0,"discounted_cash":456.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RADIOLOGIC EXAMINATION FEMUR MINIMUM 2 VIEWS","code_information":[{"code":"3207355201","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73552","type":"HCPCS"}],"standard_charges":[{"gross_charge":477.0,"discounted_cash":477.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC X-RAY KNEE 1 OR 2 VIEW","code_information":[{"code":"3207356001","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73560","type":"HCPCS"}],"standard_charges":[{"gross_charge":316.0,"discounted_cash":316.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC X-RAY KNEE 3 VIEW","code_information":[{"code":"3207356201","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73562","type":"HCPCS"}],"standard_charges":[{"gross_charge":439.0,"discounted_cash":439.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC X-RAY KNEE 4+ VIEW","code_information":[{"code":"3207356401","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73564","type":"HCPCS"}],"standard_charges":[{"gross_charge":623.0,"discounted_cash":623.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC X-RAY KNEE BILAT STANDING","code_information":[{"code":"3207356501","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73565","type":"HCPCS"}],"standard_charges":[{"gross_charge":837.0,"discounted_cash":837.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC X-RAY TIB + FIB, 2VW","code_information":[{"code":"3207359001","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73590","type":"HCPCS"}],"standard_charges":[{"gross_charge":421.0,"discounted_cash":421.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC X-RAY LEG, INFANT","code_information":[{"code":"3207359201","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73592","type":"HCPCS"}],"standard_charges":[{"gross_charge":1308.0,"discounted_cash":1308.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC X-RAY ANKLE 2 VW","code_information":[{"code":"3207360001","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73600","type":"HCPCS"}],"standard_charges":[{"gross_charge":404.0,"discounted_cash":404.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC X-RAY ANKLE 3+ VW","code_information":[{"code":"3207361001","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73610","type":"HCPCS"}],"standard_charges":[{"gross_charge":491.0,"discounted_cash":491.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC X-RAY FOOT 2 VW","code_information":[{"code":"3207362001","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73620","type":"HCPCS"}],"standard_charges":[{"gross_charge":351.0,"discounted_cash":351.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC X-RAY FOOT 3+ VW","code_information":[{"code":"3207363001","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73630","type":"HCPCS"}],"standard_charges":[{"gross_charge":430.0,"discounted_cash":430.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC X-RAY HEEL","code_information":[{"code":"3207365001","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73650","type":"HCPCS"}],"standard_charges":[{"gross_charge":333.0,"discounted_cash":333.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC X-RAY TOE(S)","code_information":[{"code":"3207366001","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73660","type":"HCPCS"}],"standard_charges":[{"gross_charge":629.0,"discounted_cash":629.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RADIOLOGIC EXAM ABDOMEN 1 VIEW","code_information":[{"code":"3207401802","type":"CDM"},{"code":"0320","type":"RC"},{"code":"74018","type":"HCPCS"}],"standard_charges":[{"gross_charge":346.0,"discounted_cash":346.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RADIOLOGIC EXAM ABDOMEN 2 VIEWS","code_information":[{"code":"3207401901","type":"CDM"},{"code":"0320","type":"RC"},{"code":"74019","type":"HCPCS"}],"standard_charges":[{"gross_charge":407.0,"discounted_cash":407.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RADIOLOGIC EXAM ABDOMEN 3+ VIEWS","code_information":[{"code":"3207402101","type":"CDM"},{"code":"0320","type":"RC"},{"code":"74021","type":"HCPCS"}],"standard_charges":[{"gross_charge":580.0,"discounted_cash":580.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RADIOLOGIC EXAM COMPLETE ACUTE ABD SERIES W/CHEST","code_information":[{"code":"3207402201","type":"CDM"},{"code":"0320","type":"RC"},{"code":"74022","type":"HCPCS"}],"standard_charges":[{"gross_charge":644.0,"discounted_cash":644.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RADIOLOGIC EXAM ESOPHAGUS SINGLE CONTRAST STUDY","code_information":[{"code":"3207422001","type":"CDM"},{"code":"0320","type":"RC"},{"code":"74220","type":"HCPCS"}],"standard_charges":[{"gross_charge":939.0,"discounted_cash":939.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RADIOLOGIC EXAM SWALLOW FUNCTION CONTRAST STUDY","code_information":[{"code":"3207423001","type":"CDM"},{"code":"0320","type":"RC"},{"code":"74230","type":"HCPCS"}],"standard_charges":[{"gross_charge":738.0,"discounted_cash":738.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RADIOLOGIC EXAM UPR GI TRC SINGLE CONTRAST STUDY","code_information":[{"code":"3207424001","type":"CDM"},{"code":"0320","type":"RC"},{"code":"74240","type":"HCPCS"}],"standard_charges":[{"gross_charge":682.0,"discounted_cash":682.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RADIOLOGIC EXAM UPR GI TRC DOUBLE CONTRAST STUDY","code_information":[{"code":"3207424601","type":"CDM"},{"code":"0320","type":"RC"},{"code":"74246","type":"HCPCS"}],"standard_charges":[{"gross_charge":1948.0,"discounted_cash":1948.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CXR SM BOWEL W/MLT IMG","code_information":[{"code":"3207424801","type":"CDM"},{"code":"0320","type":"RC"},{"code":"74248","type":"HCPCS"}],"standard_charges":[{"gross_charge":978.0,"discounted_cash":978.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RADIOLOGIC EXAM SMALL INT SINGLE CONTRAST STUDY","code_information":[{"code":"3207425001","type":"CDM"},{"code":"0320","type":"RC"},{"code":"74250","type":"HCPCS"}],"standard_charges":[{"gross_charge":364.0,"discounted_cash":364.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RADIOLOGIC EXAM COLON SINGLE CONTRAST STUDY","code_information":[{"code":"3207427001","type":"CDM"},{"code":"0320","type":"RC"},{"code":"74270","type":"HCPCS"}],"standard_charges":[{"gross_charge":1392.0,"discounted_cash":1392.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC XR CHOLECYSTOGRAM","code_information":[{"code":"3207429001","type":"CDM"},{"code":"0320","type":"RC"},{"code":"74290","type":"HCPCS"}],"standard_charges":[{"gross_charge":1646.0,"discounted_cash":1646.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC X-RAY OPER CHOLANGIOGRAM","code_information":[{"code":"3207430001","type":"CDM"},{"code":"0320","type":"RC"},{"code":"74300","type":"HCPCS"}],"standard_charges":[{"gross_charge":956.0,"discounted_cash":956.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC X-RAY FOR BILE DUCT ENDOSCOPY","code_information":[{"code":"3207432801","type":"CDM"},{"code":"0320","type":"RC"},{"code":"74328","type":"HCPCS"}],"standard_charges":[{"gross_charge":1825.0,"discounted_cash":1825.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC X-RAY BILE/PANCREAS ENDOSCOPY","code_information":[{"code":"3207433001","type":"CDM"},{"code":"0320","type":"RC"},{"code":"74330","type":"HCPCS"}],"standard_charges":[{"gross_charge":3246.0,"discounted_cash":3246.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INTRO LONG GI TUBE W/MULT FLUORO & IMAGES RS&I","code_information":[{"code":"3207434002","type":"CDM"},{"code":"0320","type":"RC"},{"code":"74340","type":"HCPCS"}],"standard_charges":[{"gross_charge":772.0,"discounted_cash":772.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC X-RAY IV PYELOGRAM (IVP)","code_information":[{"code":"3207440001","type":"CDM"},{"code":"0320","type":"RC"},{"code":"74400","type":"HCPCS"}],"standard_charges":[{"gross_charge":1363.0,"discounted_cash":1363.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC X-RAY CYSTOGRAM, MIN 3 VIEW","code_information":[{"code":"3207443001","type":"CDM"},{"code":"0320","type":"RC"},{"code":"74430","type":"HCPCS"}],"standard_charges":[{"gross_charge":794.0,"discounted_cash":794.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC X-RAY URETHROCYSTOGRAM","code_information":[{"code":"3207445001","type":"CDM"},{"code":"0320","type":"RC"},{"code":"74450","type":"HCPCS"}],"standard_charges":[{"gross_charge":1009.0,"discounted_cash":1009.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC X-RAY URETHROCYSTOGRAM+VOIDING","code_information":[{"code":"3207445501","type":"CDM"},{"code":"0320","type":"RC"},{"code":"74455","type":"HCPCS"}],"standard_charges":[{"gross_charge":823.0,"discounted_cash":823.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC X-RAY HYSTEROSALPINGOGRAM","code_information":[{"code":"3207474001","type":"CDM"},{"code":"0320","type":"RC"},{"code":"74740","type":"HCPCS"}],"standard_charges":[{"gross_charge":968.0,"discounted_cash":968.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FLUOROSCOPY UP TO 1 HOUR PHYSICIAN/QHP TIME","code_information":[{"code":"3207600004","type":"CDM"},{"code":"0320","type":"RC"},{"code":"76000","type":"HCPCS"}],"standard_charges":[{"gross_charge":625.0,"discounted_cash":625.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC X-RAY NOSE-RECTUM CHILD F.B.","code_information":[{"code":"3207601002","type":"CDM"},{"code":"0320","type":"RC"},{"code":"76010","type":"HCPCS"}],"standard_charges":[{"gross_charge":760.0,"discounted_cash":760.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC XR EXAM  BREAST SPECIMEN","code_information":[{"code":"3207609801","type":"CDM"},{"code":"0320","type":"RC"},{"code":"76098","type":"HCPCS"}],"standard_charges":[{"gross_charge":273.0,"discounted_cash":273.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FLUOROGUIDE CNTRL VEN ACCESS,PLACE,REPLACE,REMOVE","code_information":[{"code":"3207700101","type":"CDM"},{"code":"0320","type":"RC"},{"code":"77001","type":"HCPCS"}],"standard_charges":[{"gross_charge":568.0,"discounted_cash":568.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC NEEDLE LOCALIZATION BY XRAY - FL GUIDED BIOPSY/ASP/INJ","code_information":[{"code":"3207700293","type":"CDM"},{"code":"0320","type":"RC"},{"code":"77002","type":"HCPCS"}],"standard_charges":[{"gross_charge":968.0,"discounted_cash":968.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC X-RAYS FOR BONE AGE","code_information":[{"code":"3207707201","type":"CDM"},{"code":"0320","type":"RC"},{"code":"77072","type":"HCPCS"}],"standard_charges":[{"gross_charge":284.0,"discounted_cash":284.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC X-RAYS, BONE LENGTH STUDIES","code_information":[{"code":"3207707301","type":"CDM"},{"code":"0320","type":"RC"},{"code":"77073","type":"HCPCS"}],"standard_charges":[{"gross_charge":804.0,"discounted_cash":804.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC X-RAYS, BONE SURVEY COMPLETE","code_information":[{"code":"3207707501","type":"CDM"},{"code":"0320","type":"RC"},{"code":"77075","type":"HCPCS"}],"standard_charges":[{"gross_charge":1243.0,"discounted_cash":1243.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DEXA,BONE DENSITY, 1 + SITE, AXIAL SKELETON","code_information":[{"code":"3207708002","type":"CDM"},{"code":"0320","type":"RC"},{"code":"77080","type":"HCPCS"}],"standard_charges":[{"gross_charge":936.0,"discounted_cash":936.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DEXA,BONE DENSITY, 1 + SITE, APPENDICULR SKELTN","code_information":[{"code":"3207708101","type":"CDM"},{"code":"0320","type":"RC"},{"code":"77081","type":"HCPCS"}],"standard_charges":[{"gross_charge":1088.0,"discounted_cash":1088.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DXA BONE DENSITY STUDY AXIAL SKELETON","code_information":[{"code":"3207708501","type":"CDM"},{"code":"0320","type":"RC"},{"code":"77085","type":"HCPCS"}],"standard_charges":[{"gross_charge":606.0,"discounted_cash":606.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ARTHROGRAM OF SHOULDER","code_information":[{"code":"3227304001","type":"CDM"},{"code":"0322","type":"RC"},{"code":"73040","type":"HCPCS"}],"standard_charges":[{"gross_charge":1117.0,"discounted_cash":1117.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ARTHROGRAM OF ELBOW","code_information":[{"code":"3227308501","type":"CDM"},{"code":"0322","type":"RC"},{"code":"73085","type":"HCPCS"}],"standard_charges":[{"gross_charge":1117.0,"discounted_cash":1117.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ARTHROGRAM OF WRIST","code_information":[{"code":"3227311502","type":"CDM"},{"code":"0322","type":"RC"},{"code":"73115","type":"HCPCS"}],"standard_charges":[{"gross_charge":1079.0,"discounted_cash":1079.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ARTHROGRAM OF HIP","code_information":[{"code":"3227352501","type":"CDM"},{"code":"0322","type":"RC"},{"code":"73525","type":"HCPCS"}],"standard_charges":[{"gross_charge":1117.0,"discounted_cash":1117.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ARTHROGRAM OF KNEE JOINT","code_information":[{"code":"3227358001","type":"CDM"},{"code":"0322","type":"RC"},{"code":"73580","type":"HCPCS"}],"standard_charges":[{"gross_charge":1079.0,"discounted_cash":1079.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC X-RAY ANTEGRADE PYELOGRAM TUBE","code_information":[{"code":"3237442504","type":"CDM"},{"code":"0323","type":"RC"},{"code":"74425","type":"HCPCS"}],"standard_charges":[{"gross_charge":878.0,"discounted_cash":878.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CHANGE PERCUT TUBE/DRAIN CATH W CONTRAST MONIT","code_information":[{"code":"3237598401","type":"CDM"},{"code":"0323","type":"RC"},{"code":"75984","type":"HCPCS"}],"standard_charges":[{"gross_charge":1394.1,"discounted_cash":1394.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RADIOLOGIC EXAM CHEST SINGLE VIEW","code_information":[{"code":"3247104502","type":"CDM"},{"code":"0324","type":"RC"},{"code":"71045","type":"HCPCS"}],"standard_charges":[{"gross_charge":232.0,"discounted_cash":232.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RADIOLOGIC EXAM CHEST 2 VIEWS","code_information":[{"code":"3247104606","type":"CDM"},{"code":"0324","type":"RC"},{"code":"71046","type":"HCPCS"}],"standard_charges":[{"gross_charge":462.0,"discounted_cash":462.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC XR CHEST 2V W AP LORDOTIC","code_information":[{"code":"3247104701","type":"CDM"},{"code":"0324","type":"RC"},{"code":"71047","type":"HCPCS"}],"standard_charges":[{"gross_charge":491.0,"discounted_cash":491.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC X-RAY RIBS, CHEST 3+ VW","code_information":[{"code":"3247110101","type":"CDM"},{"code":"0324","type":"RC"},{"code":"71101","type":"HCPCS"}],"standard_charges":[{"gross_charge":570.0,"discounted_cash":570.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC X-RAY RIBS, CHEST 4+ VW","code_information":[{"code":"3247111101","type":"CDM"},{"code":"0324","type":"RC"},{"code":"71111","type":"HCPCS"}],"standard_charges":[{"gross_charge":717.0,"discounted_cash":717.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INJ CHEMO, NON-HORMONAL ANTI-NEOPL, SUBQ/IM","code_information":[{"code":"3319640101","type":"CDM"},{"code":"0331","type":"RC"},{"code":"96401","type":"HCPCS"}],"standard_charges":[{"gross_charge":344.0,"discounted_cash":344.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INJ CHEMO, HORMONAL ANTI-NEOPL, SUBQ/IM","code_information":[{"code":"3319640201","type":"CDM"},{"code":"0331","type":"RC"},{"code":"96402","type":"HCPCS"}],"standard_charges":[{"gross_charge":344.0,"discounted_cash":344.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INJ CHEMO, IV PUSH, SGL/INITIAL DRUG","code_information":[{"code":"3319640901","type":"CDM"},{"code":"0331","type":"RC"},{"code":"96409","type":"HCPCS"}],"standard_charges":[{"gross_charge":1378.0,"discounted_cash":1378.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INJ CHEMO, IV PUSH, EA ADDL DRUG","code_information":[{"code":"3319641101","type":"CDM"},{"code":"0331","type":"RC"},{"code":"96411","type":"HCPCS"}],"standard_charges":[{"gross_charge":1781.0,"discounted_cash":1781.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CHEMOTHERAPY, UNSPECIFIED PROCEDURE","code_information":[{"code":"3319654901","type":"CDM"},{"code":"0331","type":"RC"},{"code":"96549","type":"HCPCS"}],"standard_charges":[{"gross_charge":421.0,"discounted_cash":421.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RADIATION THERAPY INTENSITY MODULATED THERAPY PLAN - IMRT","code_information":[{"code":"3337730101","type":"CDM"},{"code":"0333","type":"RC"},{"code":"77301","type":"HCPCS"}],"standard_charges":[{"gross_charge":16579.0,"discounted_cash":16579.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RADIATION THERAPY - TELETHERAPY ISODOSE PLAN SIMPLE","code_information":[{"code":"3337730601","type":"CDM"},{"code":"0333","type":"RC"},{"code":"77306","type":"HCPCS"}],"standard_charges":[{"gross_charge":3489.0,"discounted_cash":3489.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RADIATION THERAPY - TELETHERAPY ISODOSE PLAN COMPLEX","code_information":[{"code":"3337730701","type":"CDM"},{"code":"0333","type":"RC"},{"code":"77307","type":"HCPCS"}],"standard_charges":[{"gross_charge":4200.0,"discounted_cash":4200.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RADIATION THERAPY - BRACHYTHERAPY ISODOSE PLAN SIMPLE","code_information":[{"code":"3337731601","type":"CDM"},{"code":"0333","type":"RC"},{"code":"77316","type":"HCPCS"}],"standard_charges":[{"gross_charge":3965.0,"discounted_cash":3965.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RADIATION THERAPY - BRACHYTHERAPY ISODOSE PLAN INTERMEDIATE","code_information":[{"code":"3337731701","type":"CDM"},{"code":"0333","type":"RC"},{"code":"77317","type":"HCPCS"}],"standard_charges":[{"gross_charge":4172.0,"discounted_cash":4172.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RADIATION THERAPY - BRACHYTHERAPY ISODOSE PLAN COMPLEX","code_information":[{"code":"3337731801","type":"CDM"},{"code":"0333","type":"RC"},{"code":"77318","type":"HCPCS"}],"standard_charges":[{"gross_charge":5400.0,"discounted_cash":5400.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TR SRS 1 SESSION MULTI COBALT 60","code_information":[{"code":"3337737101","type":"CDM"},{"code":"0333","type":"RC"},{"code":"77371","type":"HCPCS"}],"standard_charges":[{"gross_charge":93660.0,"discounted_cash":93660.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RADIATION TREATMENT DELIVERY SUPERFICIAL PER DAY","code_information":[{"code":"3337740101","type":"CDM"},{"code":"0333","type":"RC"},{"code":"77401","type":"HCPCS"}],"standard_charges":[{"gross_charge":1210.0,"discounted_cash":1210.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TR DELIVERY >=1 MEV SIMPLE","code_information":[{"code":"3337740201","type":"CDM"},{"code":"0333","type":"RC"},{"code":"77402","type":"HCPCS"}],"standard_charges":[{"gross_charge":1243.0,"discounted_cash":1243.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RAD TX DELIVERY INTERMEDIATE","code_information":[{"code":"3337740701","type":"CDM"},{"code":"0333","type":"RC"},{"code":"77407","type":"HCPCS"}],"standard_charges":[{"gross_charge":1823.0,"discounted_cash":1823.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RAD TX DELIVERY INTERMEDIATE BID","code_information":[{"code":"3337740702","type":"CDM"},{"code":"0333","type":"RC"},{"code":"77407","type":"HCPCS"}],"standard_charges":[{"gross_charge":1823.0,"discounted_cash":1823.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TR THERAPEUTIC RADIOLOGY PORT IMAGES(S) ADDL","code_information":[{"code":"3337741702","type":"CDM"},{"code":"0333","type":"RC"},{"code":"77417","type":"HCPCS"}],"standard_charges":[{"gross_charge":396.0,"discounted_cash":396.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BRACHYTHERAPY INTRACAVITARY SIMPLE","code_information":[{"code":"3337776101","type":"CDM"},{"code":"0333","type":"RC"},{"code":"77761","type":"HCPCS"}],"standard_charges":[{"gross_charge":6679.0,"discounted_cash":6679.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BRACHYTHERAPY INTRACAVITARY INTERMEDIATE","code_information":[{"code":"3337776201","type":"CDM"},{"code":"0333","type":"RC"},{"code":"77762","type":"HCPCS"}],"standard_charges":[{"gross_charge":6679.0,"discounted_cash":6679.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BRACHYTHERAPY INTRACAVITARY COMPLEX","code_information":[{"code":"3337776301","type":"CDM"},{"code":"0333","type":"RC"},{"code":"77763","type":"HCPCS"}],"standard_charges":[{"gross_charge":8779.0,"discounted_cash":8779.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IV INF, CHEMO, SGL/INITIAL DRUG, TO 1 HR","code_information":[{"code":"3359641301","type":"CDM"},{"code":"0335","type":"RC"},{"code":"96413","type":"HCPCS"}],"standard_charges":[{"gross_charge":967.0,"discounted_cash":967.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IV INF, CHEMO, SGL/INITIAL DRUG, EA ADDL HR","code_information":[{"code":"3359641501","type":"CDM"},{"code":"0335","type":"RC"},{"code":"96415","type":"HCPCS"}],"standard_charges":[{"gross_charge":343.0,"discounted_cash":343.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IV INF BY PUMP, CHEMO, 8+ HOURS W/O FOLLOW-UP","code_information":[{"code":"3359641601","type":"CDM"},{"code":"0335","type":"RC"},{"code":"96416","type":"HCPCS"}],"standard_charges":[{"gross_charge":1462.0,"discounted_cash":1462.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IV INF, CHEMO, EA SEQUENTIAL, TO 1 HR","code_information":[{"code":"3359641701","type":"CDM"},{"code":"0335","type":"RC"},{"code":"96417","type":"HCPCS"}],"standard_charges":[{"gross_charge":294.0,"discounted_cash":294.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IV INF BY EXT PUMP, CHEMO, 8+ HOURS W/FOLLOW-UP","code_information":[{"code":"335G049801","type":"CDM"},{"code":"0335","type":"RC"},{"code":"G0498","type":"HCPCS"}],"standard_charges":[{"gross_charge":1462.0,"discounted_cash":1462.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC THYROID UPTAKE SINGLE/MULTIPLE QUANT MEASUREMENT","code_information":[{"code":"3417801201","type":"CDM"},{"code":"0341","type":"RC"},{"code":"78012","type":"HCPCS"}],"standard_charges":[{"gross_charge":863.0,"discounted_cash":863.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC THYROID UPTAKE W/BLOOD FLOW SNGLE/MULT QUAN MEAS","code_information":[{"code":"3417801401","type":"CDM"},{"code":"0341","type":"RC"},{"code":"78014","type":"HCPCS"}],"standard_charges":[{"gross_charge":1618.0,"discounted_cash":1618.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC THYROID MET IMAGING BODY","code_information":[{"code":"3417801801","type":"CDM"},{"code":"0341","type":"RC"},{"code":"78018","type":"HCPCS"}],"standard_charges":[{"gross_charge":2195.0,"discounted_cash":2195.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PARATHYROID PLANAR IMAGING","code_information":[{"code":"3417807001","type":"CDM"},{"code":"0341","type":"RC"},{"code":"78070","type":"HCPCS"}],"standard_charges":[{"gross_charge":1598.0,"discounted_cash":1598.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PARATHYROID PLANAR IMAGING W/WO SUBTRACTION","code_information":[{"code":"3417807101","type":"CDM"},{"code":"0341","type":"RC"},{"code":"78071","type":"HCPCS"}],"standard_charges":[{"gross_charge":2452.0,"discounted_cash":2452.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC LYMPHATICS & LYMPH GLANDS IMAGING","code_information":[{"code":"3417819502","type":"CDM"},{"code":"0341","type":"RC"},{"code":"78195","type":"HCPCS"}],"standard_charges":[{"gross_charge":2052.0,"discounted_cash":2052.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HEPATOBILIARY SYST IMAGING INCLUDING GALLBLADDER","code_information":[{"code":"3417822601","type":"CDM"},{"code":"0341","type":"RC"},{"code":"78226","type":"HCPCS"}],"standard_charges":[{"gross_charge":2177.0,"discounted_cash":2177.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HEPATOBIL SYST IMAG INC GB W/PHARMA INTERVENJ","code_information":[{"code":"3417822702","type":"CDM"},{"code":"0341","type":"RC"},{"code":"78227","type":"HCPCS"}],"standard_charges":[{"gross_charge":2177.0,"discounted_cash":2177.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GASTRIC EMPTYING IMAGING STUDY","code_information":[{"code":"3417826401","type":"CDM"},{"code":"0341","type":"RC"},{"code":"78264","type":"HCPCS"}],"standard_charges":[{"gross_charge":2242.0,"discounted_cash":2242.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ACUTE GI BLOOD LOSS IMAGING","code_information":[{"code":"3417827801","type":"CDM"},{"code":"0341","type":"RC"},{"code":"78278","type":"HCPCS"}],"standard_charges":[{"gross_charge":1928.0,"discounted_cash":1928.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BONE IMAGING, LIMITED AREA","code_information":[{"code":"3417830001","type":"CDM"},{"code":"0341","type":"RC"},{"code":"78300","type":"HCPCS"}],"standard_charges":[{"gross_charge":2174.0,"discounted_cash":2174.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BONE IMAGING, MULTIPLE AREAS","code_information":[{"code":"3417830501","type":"CDM"},{"code":"0341","type":"RC"},{"code":"78305","type":"HCPCS"}],"standard_charges":[{"gross_charge":2200.0,"discounted_cash":2200.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BONE IMAGING, WHOLE BODY","code_information":[{"code":"3417830601","type":"CDM"},{"code":"0341","type":"RC"},{"code":"78306","type":"HCPCS"}],"standard_charges":[{"gross_charge":2400.0,"discounted_cash":2400.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BONE IMAGING, 3 PHASE","code_information":[{"code":"3417831501","type":"CDM"},{"code":"0341","type":"RC"},{"code":"78315","type":"HCPCS"}],"standard_charges":[{"gross_charge":2892.0,"discounted_cash":2892.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HT MUSCLE IMAGE SPECT SING - NM HEART PERFUSION SPECT STRESS","code_information":[{"code":"3417845108","type":"CDM"},{"code":"0341","type":"RC"},{"code":"78451","type":"HCPCS"}],"standard_charges":[{"gross_charge":5768.0,"discounted_cash":5768.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MYOCARDIAL SPECT MULTIPLE STUDIES","code_information":[{"code":"3417845201","type":"CDM"},{"code":"0341","type":"RC"},{"code":"78452","type":"HCPCS"}],"standard_charges":[{"gross_charge":6729.0,"discounted_cash":6729.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GATED HEART, PLANAR SINGLE","code_information":[{"code":"3417847201","type":"CDM"},{"code":"0341","type":"RC"},{"code":"78472","type":"HCPCS"}],"standard_charges":[{"gross_charge":2398.0,"discounted_cash":2398.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC LUNG PERFUSION IMAGING","code_information":[{"code":"3417858001","type":"CDM"},{"code":"0341","type":"RC"},{"code":"78580","type":"HCPCS"}],"standard_charges":[{"gross_charge":1551.0,"discounted_cash":1551.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PULMONARY VENTILATION & PERFUSION IMAGING","code_information":[{"code":"3417858201","type":"CDM"},{"code":"0341","type":"RC"},{"code":"78582","type":"HCPCS"}],"standard_charges":[{"gross_charge":2390.0,"discounted_cash":2390.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC QUANT DIFFERENTIAL PULM PERFUSION W/WO IMAGING","code_information":[{"code":"3417859701","type":"CDM"},{"code":"0341","type":"RC"},{"code":"78597","type":"HCPCS"}],"standard_charges":[{"gross_charge":2390.0,"discounted_cash":2390.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC QUANT DIFF PULM PRFUSION & VENTLAJ W/WO IMAGING","code_information":[{"code":"3417859801","type":"CDM"},{"code":"0341","type":"RC"},{"code":"78598","type":"HCPCS"}],"standard_charges":[{"gross_charge":4661.0,"discounted_cash":4661.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RENAL FLOW/FUNCT IMAGE,PHARM RX","code_information":[{"code":"3417870803","type":"CDM"},{"code":"0341","type":"RC"},{"code":"78708","type":"HCPCS"}],"standard_charges":[{"gross_charge":2395.0,"discounted_cash":2395.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RENAL FLOW/FUNCT IMAGE,COMBO,PHARM","code_information":[{"code":"3417870901","type":"CDM"},{"code":"0341","type":"RC"},{"code":"78709","type":"HCPCS"}],"standard_charges":[{"gross_charge":2634.0,"discounted_cash":2634.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RP LOCLZJ TUM PLNR 1 AREA SINGLE DAY IMAGING","code_information":[{"code":"3417880001","type":"CDM"},{"code":"0341","type":"RC"},{"code":"78800","type":"HCPCS"}],"standard_charges":[{"gross_charge":3047.0,"discounted_cash":3047.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RP LOCLZJ TUM SPECT 1 AREA SINGLE DAY IMAGING","code_information":[{"code":"3417880301","type":"CDM"},{"code":"0341","type":"RC"},{"code":"78803","type":"HCPCS"}],"standard_charges":[{"gross_charge":5200.0,"discounted_cash":5200.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC NUCLEAR THERAPY, ORAL","code_information":[{"code":"3427900503","type":"CDM"},{"code":"0342","type":"RC"},{"code":"79005","type":"HCPCS"}],"standard_charges":[{"gross_charge":2829.0,"discounted_cash":2829.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CERBRAL PERFUSION STUDY, CT W/ CONTRAST","code_information":[{"code":"3500042T01","type":"CDM"},{"code":"0350","type":"RC"},{"code":"0042T","type":"HCPCS"}],"standard_charges":[{"gross_charge":4590.0,"discounted_cash":4590.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CT GUIDANCE NEEDLE PLACEMENT","code_information":[{"code":"3507701243","type":"CDM"},{"code":"0350","type":"RC"},{"code":"77012","type":"HCPCS"}],"standard_charges":[{"gross_charge":3221.0,"discounted_cash":3221.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CT GUIDANCE TISSUE ABLATION","code_information":[{"code":"3507701310","type":"CDM"},{"code":"0350","type":"RC"},{"code":"77013","type":"HCPCS"}],"standard_charges":[{"gross_charge":2282.0,"discounted_cash":2282.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CT SCAN,HEAD/BRAIN,W/O CONTRAST MATL","code_information":[{"code":"3517045001","type":"CDM"},{"code":"0351","type":"RC"},{"code":"70450","type":"HCPCS"}],"standard_charges":[{"gross_charge":2848.0,"discounted_cash":2848.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CT SCAN HEAD CONTRAST","code_information":[{"code":"3517046001","type":"CDM"},{"code":"0351","type":"RC"},{"code":"70460","type":"HCPCS"}],"standard_charges":[{"gross_charge":4673.0,"discounted_cash":4673.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CT SCAN HEAD COMBO","code_information":[{"code":"3517047001","type":"CDM"},{"code":"0351","type":"RC"},{"code":"70470","type":"HCPCS"}],"standard_charges":[{"gross_charge":5394.0,"discounted_cash":5394.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CT SCAN,ORBIT/SELLA/POST FOSSA/EAR,W/O","code_information":[{"code":"3517048001","type":"CDM"},{"code":"0351","type":"RC"},{"code":"70480","type":"HCPCS"}],"standard_charges":[{"gross_charge":3015.0,"discounted_cash":3015.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CT SCAN ORBIT/SELLA/POST FOSSA/EAR CONTRAST","code_information":[{"code":"3517048101","type":"CDM"},{"code":"0351","type":"RC"},{"code":"70481","type":"HCPCS"}],"standard_charges":[{"gross_charge":4909.0,"discounted_cash":4909.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CT SCAN SKULL COMBO","code_information":[{"code":"3517048201","type":"CDM"},{"code":"0351","type":"RC"},{"code":"70482","type":"HCPCS"}],"standard_charges":[{"gross_charge":5463.0,"discounted_cash":5463.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CT SCAN,MAXILLOFACIAL AREA,W/O CONTRAST","code_information":[{"code":"3517048602","type":"CDM"},{"code":"0351","type":"RC"},{"code":"70486","type":"HCPCS"}],"standard_charges":[{"gross_charge":2721.0,"discounted_cash":2721.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CT SCAN, FACE/JAW CONTRAST","code_information":[{"code":"3517048702","type":"CDM"},{"code":"0351","type":"RC"},{"code":"70487","type":"HCPCS"}],"standard_charges":[{"gross_charge":5311.0,"discounted_cash":5311.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CT SCANS FACE/JAW COMBO","code_information":[{"code":"3517048802","type":"CDM"},{"code":"0351","type":"RC"},{"code":"70488","type":"HCPCS"}],"standard_charges":[{"gross_charge":5827.0,"discounted_cash":5827.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CT SCAN,SOFT TISSUE NECK,W/O CONTRAST","code_information":[{"code":"3517049001","type":"CDM"},{"code":"0351","type":"RC"},{"code":"70490","type":"HCPCS"}],"standard_charges":[{"gross_charge":3102.0,"discounted_cash":3102.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CT NECK TISSUE CONTRAST","code_information":[{"code":"3517049101","type":"CDM"},{"code":"0351","type":"RC"},{"code":"70491","type":"HCPCS"}],"standard_charges":[{"gross_charge":5025.0,"discounted_cash":5025.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CT NECK TISSUE COMBO","code_information":[{"code":"3517049201","type":"CDM"},{"code":"0351","type":"RC"},{"code":"70492","type":"HCPCS"}],"standard_charges":[{"gross_charge":5813.0,"discounted_cash":5813.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CT ANGIO,HEAD COMBO,INCL IMAGE PROCESS","code_information":[{"code":"3517049602","type":"CDM"},{"code":"0351","type":"RC"},{"code":"70496","type":"HCPCS"}],"standard_charges":[{"gross_charge":6134.0,"discounted_cash":6134.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CT ANGIO,NECK COMBO,INCL IMAGE PROCESS","code_information":[{"code":"3517049802","type":"CDM"},{"code":"0351","type":"RC"},{"code":"70498","type":"HCPCS"}],"standard_charges":[{"gross_charge":5635.0,"discounted_cash":5635.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CT SCAN,THORAX,W/O CONTRAST","code_information":[{"code":"3527125001","type":"CDM"},{"code":"0352","type":"RC"},{"code":"71250","type":"HCPCS"}],"standard_charges":[{"gross_charge":2855.0,"discounted_cash":2855.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CAT SCAN OF CHEST CONTRAST","code_information":[{"code":"3527126002","type":"CDM"},{"code":"0352","type":"RC"},{"code":"71260","type":"HCPCS"}],"standard_charges":[{"gross_charge":4327.0,"discounted_cash":4327.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CAT SCAN OF CHEST COMBO","code_information":[{"code":"3527127001","type":"CDM"},{"code":"0352","type":"RC"},{"code":"71270","type":"HCPCS"}],"standard_charges":[{"gross_charge":5430.0,"discounted_cash":5430.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC LDCT FOR LUNG CA SCREEN","code_information":[{"code":"3527127101","type":"CDM"},{"code":"0352","type":"RC"},{"code":"71271","type":"HCPCS"}],"standard_charges":[{"gross_charge":387.0,"discounted_cash":387.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CT ANGIO, CHEST, COMBO, INCL IMAGE PROC","code_information":[{"code":"3527127501","type":"CDM"},{"code":"0352","type":"RC"},{"code":"71275","type":"HCPCS"}],"standard_charges":[{"gross_charge":5430.0,"discounted_cash":5430.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CT SCAN,CERVICAL SPINE,W/O CONTRAST","code_information":[{"code":"3527212501","type":"CDM"},{"code":"0352","type":"RC"},{"code":"72125","type":"HCPCS"}],"standard_charges":[{"gross_charge":2494.0,"discounted_cash":2494.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CT SCAN CERV SPINE CONTRAST","code_information":[{"code":"3527212601","type":"CDM"},{"code":"0352","type":"RC"},{"code":"72126","type":"HCPCS"}],"standard_charges":[{"gross_charge":4183.0,"discounted_cash":4183.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CT SCAN CERV SP COMBO","code_information":[{"code":"3527212701","type":"CDM"},{"code":"0352","type":"RC"},{"code":"72127","type":"HCPCS"}],"standard_charges":[{"gross_charge":7609.0,"discounted_cash":7609.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CT SCAN,THORACIC SPINE,W/O CONTRAST","code_information":[{"code":"3527212801","type":"CDM"},{"code":"0352","type":"RC"},{"code":"72128","type":"HCPCS"}],"standard_charges":[{"gross_charge":2753.0,"discounted_cash":2753.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CT SCAN DORSAL SP CONTRAST","code_information":[{"code":"3527212901","type":"CDM"},{"code":"0352","type":"RC"},{"code":"72129","type":"HCPCS"}],"standard_charges":[{"gross_charge":4562.0,"discounted_cash":4562.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CT SCAN DORSAL SP COMBO","code_information":[{"code":"3527213001","type":"CDM"},{"code":"0352","type":"RC"},{"code":"72130","type":"HCPCS"}],"standard_charges":[{"gross_charge":5257.0,"discounted_cash":5257.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CT SCAN,LUMBAR SPINE,W/O CONTRAST","code_information":[{"code":"3527213101","type":"CDM"},{"code":"0352","type":"RC"},{"code":"72131","type":"HCPCS"}],"standard_charges":[{"gross_charge":2775.0,"discounted_cash":2775.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CT SCAN LUMBAR SP CONTRAST","code_information":[{"code":"3527213201","type":"CDM"},{"code":"0352","type":"RC"},{"code":"72132","type":"HCPCS"}],"standard_charges":[{"gross_charge":4598.0,"discounted_cash":4598.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CT SCAN LUMBAR SP COMBO","code_information":[{"code":"3527213301","type":"CDM"},{"code":"0352","type":"RC"},{"code":"72133","type":"HCPCS"}],"standard_charges":[{"gross_charge":5299.0,"discounted_cash":5299.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CT SCAN,PELVIS,W/O CONTRAST","code_information":[{"code":"3527219201","type":"CDM"},{"code":"0352","type":"RC"},{"code":"72192","type":"HCPCS"}],"standard_charges":[{"gross_charge":2775.0,"discounted_cash":2775.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CT SCAN OF PELVIS CONTRAST","code_information":[{"code":"3527219301","type":"CDM"},{"code":"0352","type":"RC"},{"code":"72193","type":"HCPCS"}],"standard_charges":[{"gross_charge":4288.0,"discounted_cash":4288.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CT SCAN OF PELVIS COMBO","code_information":[{"code":"3527219401","type":"CDM"},{"code":"0352","type":"RC"},{"code":"72194","type":"HCPCS"}],"standard_charges":[{"gross_charge":5301.0,"discounted_cash":5301.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CT SCAN,UPPER EXTREMITY,W/O CONTRAST","code_information":[{"code":"3527320010","type":"CDM"},{"code":"0352","type":"RC"},{"code":"73200","type":"HCPCS"}],"standard_charges":[{"gross_charge":2985.0,"discounted_cash":2985.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CT SCAN OF ARM CONTRAST","code_information":[{"code":"3527320112","type":"CDM"},{"code":"0352","type":"RC"},{"code":"73201","type":"HCPCS"}],"standard_charges":[{"gross_charge":4562.0,"discounted_cash":4562.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CT SCAN OF ARM COMBO","code_information":[{"code":"3527320209","type":"CDM"},{"code":"0352","type":"RC"},{"code":"73202","type":"HCPCS"}],"standard_charges":[{"gross_charge":5260.0,"discounted_cash":5260.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CT ANGIO,UPPER EXTREM,COMBO","code_information":[{"code":"3527320601","type":"CDM"},{"code":"0352","type":"RC"},{"code":"73206","type":"HCPCS"}],"standard_charges":[{"gross_charge":5267.0,"discounted_cash":5267.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CT SCAN,LOWER EXTREMITY,W/O CONTRAST - LOWER EXTREMITY WO IV CONTRAST","code_information":[{"code":"3527370013","type":"CDM"},{"code":"0352","type":"RC"},{"code":"73700","type":"HCPCS"}],"standard_charges":[{"gross_charge":2753.0,"discounted_cash":2753.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CT SCAN OF LEG CONTRAST","code_information":[{"code":"3527370107","type":"CDM"},{"code":"0352","type":"RC"},{"code":"73701","type":"HCPCS"}],"standard_charges":[{"gross_charge":4562.0,"discounted_cash":4562.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CT SCAN OF LEG COMBO","code_information":[{"code":"3527370205","type":"CDM"},{"code":"0352","type":"RC"},{"code":"73702","type":"HCPCS"}],"standard_charges":[{"gross_charge":5260.0,"discounted_cash":5260.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CT ANGIO,LOWER EXTREM,COMBO,IMAGE PRC","code_information":[{"code":"3527370601","type":"CDM"},{"code":"0352","type":"RC"},{"code":"73706","type":"HCPCS"}],"standard_charges":[{"gross_charge":6287.0,"discounted_cash":6287.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CT SCAN,ABDOMEN,W/O CONTRAST","code_information":[{"code":"3527415001","type":"CDM"},{"code":"0352","type":"RC"},{"code":"74150","type":"HCPCS"}],"standard_charges":[{"gross_charge":2775.0,"discounted_cash":2775.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CT SCAN OF ABDOMEN CONTRAST","code_information":[{"code":"3527416001","type":"CDM"},{"code":"0352","type":"RC"},{"code":"74160","type":"HCPCS"}],"standard_charges":[{"gross_charge":4598.0,"discounted_cash":4598.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CT SCAN OF ABDOMEN W/WO CONT","code_information":[{"code":"3527417001","type":"CDM"},{"code":"0352","type":"RC"},{"code":"74170","type":"HCPCS"}],"standard_charges":[{"gross_charge":5301.0,"discounted_cash":5301.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CT ANGIO ABD&PLVIS CNTRST MTRL W/WO CNTRST IMGES","code_information":[{"code":"3527417401","type":"CDM"},{"code":"0352","type":"RC"},{"code":"74174","type":"HCPCS"}],"standard_charges":[{"gross_charge":8043.0,"discounted_cash":8043.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CT ANGIO, ABD, COMBO,INCL IMAGE PROC","code_information":[{"code":"3527417501","type":"CDM"},{"code":"0352","type":"RC"},{"code":"74175","type":"HCPCS"}],"standard_charges":[{"gross_charge":5438.0,"discounted_cash":5438.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CT SCAN,ABDOMEN AND PELVIS,W/O CONTRAST","code_information":[{"code":"3527417601","type":"CDM"},{"code":"0352","type":"RC"},{"code":"74176","type":"HCPCS"}],"standard_charges":[{"gross_charge":5549.0,"discounted_cash":5549.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CT SCAN,ABDOMEN AND PELVIS,W CONTRAST","code_information":[{"code":"3527417701","type":"CDM"},{"code":"0352","type":"RC"},{"code":"74177","type":"HCPCS"}],"standard_charges":[{"gross_charge":8130.0,"discounted_cash":8130.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CT SCAN,ABDOMEN AND PELVIS,COMBO","code_information":[{"code":"3527417801","type":"CDM"},{"code":"0352","type":"RC"},{"code":"74178","type":"HCPCS"}],"standard_charges":[{"gross_charge":9845.0,"discounted_cash":9845.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CT HEART W/O CONTRAST QUANT EVAL CORONARY CALCIUM","code_information":[{"code":"3527557101","type":"CDM"},{"code":"0352","type":"RC"},{"code":"75571","type":"HCPCS"}],"standard_charges":[{"gross_charge":392.0,"discounted_cash":392.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CT ANGIO HRT CORNRY ART/BYPASS GRFTS CONTRST 3D POST","code_information":[{"code":"3527557401","type":"CDM"},{"code":"0352","type":"RC"},{"code":"75574","type":"HCPCS"}],"standard_charges":[{"gross_charge":4032.0,"discounted_cash":4032.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CT ANGIO AORTOBIFEMORAL, COMBO","code_information":[{"code":"3527563501","type":"CDM"},{"code":"0352","type":"RC"},{"code":"75635","type":"HCPCS"}],"standard_charges":[{"gross_charge":5438.0,"discounted_cash":5438.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OR CARD - LEVEL 1 FIRST 30 MINUTES","code_information":[{"code":"3600000020","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"gross_charge":9519.0,"discounted_cash":9519.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OR CARD - LEVEL 1 EACH ADDL MINUTE","code_information":[{"code":"3600000021","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"gross_charge":89.0,"discounted_cash":89.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OR CARD - LEVEL 2 FIRST 30 MINUTES","code_information":[{"code":"3600000022","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"gross_charge":9922.0,"discounted_cash":9922.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OR CARD - LEVEL 2 EACH ADDL MINUTE","code_information":[{"code":"3600000023","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"gross_charge":60.0,"discounted_cash":60.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OR CARD - LEVEL 3 FIRST 30 MINUTES","code_information":[{"code":"3600000024","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"gross_charge":10810.0,"discounted_cash":10810.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OR CARD - LEVEL 3 EACH ADDL MINUTE","code_information":[{"code":"3600000025","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"gross_charge":99.0,"discounted_cash":99.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OR CARD - LEVEL 4 FIRST 30 MINUTES","code_information":[{"code":"3600000026","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"gross_charge":11500.0,"discounted_cash":11500.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OR CARD - LEVEL 4 EACH ADDL MINUTE","code_information":[{"code":"3600000027","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"gross_charge":126.0,"discounted_cash":126.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OR CARD - LEVEL 5 FIRST 30 MINUTES","code_information":[{"code":"3600000028","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"gross_charge":12691.0,"discounted_cash":12691.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OR CARD - LEVEL 5 EACH ADDL MINUTE","code_information":[{"code":"3600000029","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"gross_charge":118.0,"discounted_cash":118.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OR ENT - LEVEL 1 FIRST 30 MINUTES","code_information":[{"code":"3600000030","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"gross_charge":5604.0,"discounted_cash":5604.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OR ENT - LEVEL 1 EACH ADDL MINUTE","code_information":[{"code":"3600000031","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"gross_charge":31.0,"discounted_cash":31.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OR ENT - LEVEL 2 FIRST 30 MINUTES","code_information":[{"code":"3600000032","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"gross_charge":6451.0,"discounted_cash":6451.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OR ENT - LEVEL 2 EACH ADDL MINUTE","code_information":[{"code":"3600000033","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"gross_charge":66.0,"discounted_cash":66.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OR ENT - LEVEL 3 FIRST 30 MINUTES","code_information":[{"code":"3600000034","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"gross_charge":7295.0,"discounted_cash":7295.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OR ENT - LEVEL 3 EACH ADDL MINUTE","code_information":[{"code":"3600000035","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"gross_charge":74.0,"discounted_cash":74.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OR ENT - LEVEL 4 FIRST 30 MINUTES","code_information":[{"code":"3600000036","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"gross_charge":8131.0,"discounted_cash":8131.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OR ENT - LEVEL 4 EACH ADDL MINUTE","code_information":[{"code":"3600000037","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"gross_charge":101.0,"discounted_cash":101.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OR ENT - LEVEL 5 FIRST 30 MINUTES","code_information":[{"code":"3600000038","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"gross_charge":10772.0,"discounted_cash":10772.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OR ENT - LEVEL 5 EACH ADDL MINUTE","code_information":[{"code":"3600000039","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"gross_charge":100.0,"discounted_cash":100.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OR GENERAL - LEVEL 1 FIRST 30 MINUTES","code_information":[{"code":"3600000040","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"gross_charge":8877.0,"discounted_cash":8877.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OR GENERAL - LEVEL 1 EACH ADDL MINUTE","code_information":[{"code":"3600000041","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"gross_charge":83.0,"discounted_cash":83.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OR GENERAL - LEVEL 2 FIRST 30 MINUTES","code_information":[{"code":"3600000042","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"gross_charge":9243.0,"discounted_cash":9243.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OR GENERAL - LEVEL 2 EACH ADDL MINUTE","code_information":[{"code":"3600000043","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"gross_charge":73.0,"discounted_cash":73.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OR GENERAL - LEVEL 3 FIRST 30 MINUTES","code_information":[{"code":"3600000044","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"gross_charge":9615.0,"discounted_cash":9615.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OR GENERAL - LEVEL 3 EACH ADDL MINUTE","code_information":[{"code":"3600000045","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"gross_charge":92.0,"discounted_cash":92.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OR GENERAL - LEVEL 4 FIRST 30 MINUTES","code_information":[{"code":"3600000046","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"gross_charge":10724.0,"discounted_cash":10724.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OR GENERAL - LEVEL 4 EACH ADDL MINUTE","code_information":[{"code":"3600000047","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"gross_charge":88.0,"discounted_cash":88.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OR GENERAL - LEVEL 5 FIRST 30 MINUTES","code_information":[{"code":"3600000048","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"gross_charge":11834.0,"discounted_cash":11834.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OR GENERAL - LEVEL 5 EACH ADDL MINUTE","code_information":[{"code":"3600000049","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"gross_charge":132.0,"discounted_cash":132.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OR GYN - LEVEL 1 FIRST 30 MINUTES","code_information":[{"code":"3600000050","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"gross_charge":6628.0,"discounted_cash":6628.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OR GYN - LEVEL 1 EACH ADDL MINUTE","code_information":[{"code":"3600000051","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"gross_charge":62.0,"discounted_cash":62.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OR GYN - LEVEL 2 FIRST 30 MINUTES","code_information":[{"code":"3600000052","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"gross_charge":7616.0,"discounted_cash":7616.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OR GYN - LEVEL 2 EACH ADDL MINUTE","code_information":[{"code":"3600000053","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"gross_charge":60.0,"discounted_cash":60.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OR GYN - LEVEL 3 FIRST 30 MINUTES","code_information":[{"code":"3600000054","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"gross_charge":8615.0,"discounted_cash":8615.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OR GYN - LEVEL 3 EACH ADDL MINUTE","code_information":[{"code":"3600000055","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"gross_charge":103.0,"discounted_cash":103.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OR GYN - LEVEL 4 FIRST 30 MINUTES","code_information":[{"code":"3600000056","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"gross_charge":11533.0,"discounted_cash":11533.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OR GYN - LEVEL 4 EACH ADDL MINUTE","code_information":[{"code":"3600000057","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"gross_charge":108.0,"discounted_cash":108.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OR GYN - LEVEL 5 FIRST 30 MINUTES","code_information":[{"code":"3600000058","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"gross_charge":12720.0,"discounted_cash":12720.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OR GYN - LEVEL 5 EACH ADDL MINUTE","code_information":[{"code":"3600000059","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"gross_charge":140.0,"discounted_cash":140.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OR NEURO - LEVEL 1 FIRST 30 MINUTES","code_information":[{"code":"3600000060","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"gross_charge":14533.0,"discounted_cash":14533.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OR NEURO - LEVEL 1 EACH ADDL MINUTE","code_information":[{"code":"3600000061","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"gross_charge":135.0,"discounted_cash":135.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OR NEURO - LEVEL 2 FIRST 30 MINUTES","code_information":[{"code":"3600000062","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"gross_charge":16017.0,"discounted_cash":16017.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OR NEURO - LEVEL 2 EACH ADDL MINUTE","code_information":[{"code":"3600000063","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"gross_charge":126.0,"discounted_cash":126.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OR NEURO - LEVEL 3 FIRST 30 MINUTES","code_information":[{"code":"3600000064","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"gross_charge":18890.0,"discounted_cash":18890.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OR NEURO - LEVEL 3 EACH ADDL MINUTE","code_information":[{"code":"3600000065","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"gross_charge":184.0,"discounted_cash":184.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OR NEURO - LEVEL 4 FIRST 30 MINUTES","code_information":[{"code":"3600000066","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"gross_charge":20828.0,"discounted_cash":20828.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OR NEURO - LEVEL 4 EACH ADDL MINUTE","code_information":[{"code":"3600000067","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"gross_charge":115.0,"discounted_cash":115.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OR NEURO - LEVEL 5 FIRST 30 MINUTES","code_information":[{"code":"3600000068","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"gross_charge":22911.0,"discounted_cash":22911.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OR NEURO - LEVEL 5 EACH ADDL MINUTE","code_information":[{"code":"3600000069","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"gross_charge":209.0,"discounted_cash":209.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OR OPTH - LEVEL 1 FIRST 30 MINUTES","code_information":[{"code":"3600000070","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"gross_charge":5549.0,"discounted_cash":5549.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OR OPTH - LEVEL 1 EACH ADDL MINUTE","code_information":[{"code":"3600000071","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"gross_charge":52.0,"discounted_cash":52.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OR OPTH - LEVEL 2 FIRST 30 MINUTES","code_information":[{"code":"3600000072","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"gross_charge":6386.0,"discounted_cash":6386.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OR OPTH - LEVEL 2 EACH ADDL MINUTE","code_information":[{"code":"3600000073","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"gross_charge":48.0,"discounted_cash":48.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OR OPTH - LEVEL 3 FIRST 30 MINUTES","code_information":[{"code":"3600000074","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"gross_charge":7221.0,"discounted_cash":7221.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OR OPTH - LEVEL 3 EACH ADDL MINUTE","code_information":[{"code":"3600000075","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"gross_charge":67.0,"discounted_cash":67.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OR OPTH - LEVEL 4 FIRST 30 MINUTES","code_information":[{"code":"3600000076","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"gross_charge":8049.0,"discounted_cash":8049.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OR OPTH - LEVEL 4 EACH ADDL MINUTE","code_information":[{"code":"3600000077","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":75.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OR OPTH - LEVEL 5 FIRST 30 MINUTES","code_information":[{"code":"3600000078","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"gross_charge":8885.0,"discounted_cash":8885.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OR OPTH - LEVEL 5 EACH ADDL MINUTE","code_information":[{"code":"3600000079","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"gross_charge":83.0,"discounted_cash":83.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OR ORTHO - LEVEL 1 FIRST 30 MINUTES","code_information":[{"code":"3600000080","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"gross_charge":9178.0,"discounted_cash":9178.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OR ORTHO - LEVEL 1 EACH ADDL MINUTE","code_information":[{"code":"3600000081","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"gross_charge":85.0,"discounted_cash":85.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OR ORTHO - LEVEL 2 FIRST 30 MINUTES","code_information":[{"code":"3600000082","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"gross_charge":10557.0,"discounted_cash":10557.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OR ORTHO - LEVEL 2 EACH ADDL MINUTE","code_information":[{"code":"3600000083","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"gross_charge":88.0,"discounted_cash":88.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OR ORTHO - LEVEL 3 FIRST 30 MINUTES","code_information":[{"code":"3600000084","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"gross_charge":11930.0,"discounted_cash":11930.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OR ORTHO - LEVEL 3 EACH ADDL MINUTE","code_information":[{"code":"3600000085","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"gross_charge":106.0,"discounted_cash":106.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OR ORTHO - LEVEL 4 FIRST 30 MINUTES","code_information":[{"code":"3600000086","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"gross_charge":13308.0,"discounted_cash":13308.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OR ORTHO - LEVEL 4 EACH ADDL MINUTE","code_information":[{"code":"3600000087","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"gross_charge":121.0,"discounted_cash":121.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OR ORTHO - LEVEL 5 FIRST 30 MINUTES","code_information":[{"code":"3600000088","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"gross_charge":14691.0,"discounted_cash":14691.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OR ORTHO - LEVEL 5 EACH ADDL MINUTE","code_information":[{"code":"3600000089","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"gross_charge":150.0,"discounted_cash":150.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OR ROBOT - LEVEL 1 FIRST 30 MINUTES","code_information":[{"code":"3600000090","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"gross_charge":16906.0,"discounted_cash":16906.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OR ROBOT - LEVEL 1 EACH ADDL MINUTE","code_information":[{"code":"3600000091","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"gross_charge":156.0,"discounted_cash":156.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OR ROBOT - LEVEL 2 FIRST 30 MINUTES","code_information":[{"code":"3600000092","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"gross_charge":18390.0,"discounted_cash":18390.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OR ROBOT - LEVEL 2 EACH ADDL MINUTE","code_information":[{"code":"3600000093","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"gross_charge":145.0,"discounted_cash":145.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OR ROBOT - LEVEL 3 FIRST 30 MINUTES","code_information":[{"code":"3600000094","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"gross_charge":21263.0,"discounted_cash":21263.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OR ROBOT - LEVEL 3 EACH ADDL MINUTE","code_information":[{"code":"3600000095","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"gross_charge":211.0,"discounted_cash":211.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OR ROBOT - LEVEL 4 FIRST 30 MINUTES","code_information":[{"code":"3600000096","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"gross_charge":23201.0,"discounted_cash":23201.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OR ROBOT - LEVEL 4 EACH ADDL MINUTE","code_information":[{"code":"3600000097","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"gross_charge":132.0,"discounted_cash":132.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OR ROBOT - LEVEL 5 FIRST 30 MINUTES","code_information":[{"code":"3600000098","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"gross_charge":25284.0,"discounted_cash":25284.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OR ROBOT - LEVEL 5 EACH ADDL MINUTE","code_information":[{"code":"3600000099","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"gross_charge":241.0,"discounted_cash":241.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OR UROL - LEVEL 1 FIRST 30 MINUTES","code_information":[{"code":"36000000A1","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"gross_charge":6125.0,"discounted_cash":6125.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OR UROL - LEVEL 1 EACH ADDL MINUTE","code_information":[{"code":"36000000A2","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"gross_charge":57.0,"discounted_cash":57.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OR UROL - LEVEL 2 FIRST 30 MINUTES","code_information":[{"code":"36000000A3","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"gross_charge":6673.0,"discounted_cash":6673.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OR UROL - LEVEL 2 EACH ADDL MINUTE","code_information":[{"code":"36000000A4","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"gross_charge":52.0,"discounted_cash":52.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OR UROL - LEVEL 3 FIRST 30 MINUTES","code_information":[{"code":"36000000A5","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"gross_charge":6636.0,"discounted_cash":6636.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OR UROL - LEVEL 3 EACH ADDL MINUTE","code_information":[{"code":"36000000A6","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"gross_charge":68.0,"discounted_cash":68.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OR UROL - LEVEL 4 FIRST 30 MINUTES","code_information":[{"code":"36000000A7","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"gross_charge":7399.0,"discounted_cash":7399.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OR UROL - LEVEL 4 EACH ADDL MINUTE","code_information":[{"code":"36000000A8","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"gross_charge":67.0,"discounted_cash":67.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OR UROL - LEVEL 5 FIRST 30 MINUTES","code_information":[{"code":"36000000A9","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"gross_charge":8502.0,"discounted_cash":8502.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OR UROL - LEVEL 5 EACH ADDL MINUTE","code_information":[{"code":"36000000B1","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"gross_charge":98.0,"discounted_cash":98.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OR OB - LEVEL 1 FIRST 30 MINUTES","code_information":[{"code":"36000000C3","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"gross_charge":1531.0,"discounted_cash":1531.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OR OB - LEVEL 1 EACH ADDL MINUTE","code_information":[{"code":"36000000C4","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"gross_charge":14.0,"discounted_cash":14.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OR OB - LEVEL 2 FIRST 30 MINUTES","code_information":[{"code":"36000000C5","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"gross_charge":2002.0,"discounted_cash":2002.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OR OB - LEVEL 2 EACH ADDL MINUTE","code_information":[{"code":"36000000C6","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"gross_charge":19.0,"discounted_cash":19.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OR OB - LEVEL 3 FIRST 30 MINUTES","code_information":[{"code":"36000000C7","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"gross_charge":11215.0,"discounted_cash":11215.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OR OB - LEVEL 3 EACH ADDL MINUTE","code_information":[{"code":"36000000C8","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"gross_charge":104.0,"discounted_cash":104.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OR OB - LEVEL 4 FIRST 30 MINUTES","code_information":[{"code":"36000000C9","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"gross_charge":11293.0,"discounted_cash":11293.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OR OB - LEVEL 4 EACH ADDL MINUTE","code_information":[{"code":"36000000D1","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"gross_charge":105.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OR OB - LEVEL 5 FIRST 30 MINUTES","code_information":[{"code":"36000000D2","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"gross_charge":10081.0,"discounted_cash":10081.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OR OB - LEVEL 5 EACH ADDL MINUTE","code_information":[{"code":"36000000D3","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"gross_charge":94.0,"discounted_cash":94.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BEDSIDE BRONCHOSCOPY","code_information":[{"code":"36100000002","type":"CDM"},{"code":"0361","type":"RC"}],"standard_charges":[{"gross_charge":3450.83,"discounted_cash":3450.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MINOR SURGICAL PROCEDURE OTHER","code_information":[{"code":"3610000001","type":"CDM"},{"code":"0361","type":"RC"}],"standard_charges":[{"gross_charge":1212.0,"discounted_cash":1212.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FINE NEEDLE ASPIRATION BX W/US GDN 1ST LESION","code_information":[{"code":"3611000501","type":"CDM"},{"code":"0361","type":"RC"},{"code":"10005","type":"HCPCS"}],"standard_charges":[{"gross_charge":2682.0,"discounted_cash":2682.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FINE NEEDLE ASPIRATION BX W/FLUOR GDN 1ST LESION","code_information":[{"code":"3611000701","type":"CDM"},{"code":"0361","type":"RC"},{"code":"10007","type":"HCPCS"}],"standard_charges":[{"gross_charge":2682.0,"discounted_cash":2682.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FINE NEEDLE ASPIRATION BX W/CT GDN 1ST LESION","code_information":[{"code":"3611000901","type":"CDM"},{"code":"0361","type":"RC"},{"code":"10009","type":"HCPCS"}],"standard_charges":[{"gross_charge":7877.0,"discounted_cash":7877.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FINE NEEDLE ASPIRATION BX W/O IMG GDN 1ST LESION","code_information":[{"code":"3611002101","type":"CDM"},{"code":"0361","type":"RC"},{"code":"10021","type":"HCPCS"}],"standard_charges":[{"gross_charge":705.0,"discounted_cash":705.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IMAGE-GUIDED CATHETER FLUID COLLECTION DRAINAGE","code_information":[{"code":"3611003001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"10030","type":"HCPCS"}],"standard_charges":[{"gross_charge":6653.0,"discounted_cash":6653.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PERQ SFT TISS LOC DEVICE PLMT 1ST LES W/GDNCE","code_information":[{"code":"3611003501","type":"CDM"},{"code":"0361","type":"RC"},{"code":"10035","type":"HCPCS"}],"standard_charges":[{"gross_charge":2730.0,"discounted_cash":2730.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DRAIN SKIN ABSCESS SIMPLE","code_information":[{"code":"3611006001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"10060","type":"HCPCS"}],"standard_charges":[{"gross_charge":701.0,"discounted_cash":701.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DRAIN SKIN ABSCESS COMPLIC","code_information":[{"code":"3611006101","type":"CDM"},{"code":"0361","type":"RC"},{"code":"10061","type":"HCPCS"}],"standard_charges":[{"gross_charge":736.0,"discounted_cash":736.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DRAIN PILONIDAL CYST SIMPL","code_information":[{"code":"3611008001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"10080","type":"HCPCS"}],"standard_charges":[{"gross_charge":4631.0,"discounted_cash":4631.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DRAIN PILONIDAL CYST COMPLIC","code_information":[{"code":"3611008101","type":"CDM"},{"code":"0361","type":"RC"},{"code":"10081","type":"HCPCS"}],"standard_charges":[{"gross_charge":9490.0,"discounted_cash":9490.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC REMOVE FOREIGN BODY SIMPLE","code_information":[{"code":"3611012001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"10120","type":"HCPCS"}],"standard_charges":[{"gross_charge":2317.0,"discounted_cash":2317.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC REMOVE FOREIGN BODY COMPLIC","code_information":[{"code":"3611012101","type":"CDM"},{"code":"0361","type":"RC"},{"code":"10121","type":"HCPCS"}],"standard_charges":[{"gross_charge":15149.0,"discounted_cash":15149.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DRAINAGE OF HEMATOMA/FLUID","code_information":[{"code":"3611014001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"10140","type":"HCPCS"}],"standard_charges":[{"gross_charge":3717.0,"discounted_cash":3717.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PUNCTURE DRAINAGE OF LESION","code_information":[{"code":"3611016001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"10160","type":"HCPCS"}],"standard_charges":[{"gross_charge":471.0,"discounted_cash":471.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DEBRIDEMENT, INFECTED SKIN, UP TO 10% BSA","code_information":[{"code":"3611100001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"11000","type":"HCPCS"}],"standard_charges":[{"gross_charge":2631.0,"discounted_cash":2631.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DEBRIDEMENT, SKIN, SUB-Q TISSUE,=<20 SQ CM","code_information":[{"code":"3611104201","type":"CDM"},{"code":"0361","type":"RC"},{"code":"11042","type":"HCPCS"}],"standard_charges":[{"gross_charge":966.0,"discounted_cash":966.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DEBRIDEMENT, SKIN, SUB-Q TISSUE,MUSCLE,=<20 SQ CM","code_information":[{"code":"3611104301","type":"CDM"},{"code":"0361","type":"RC"},{"code":"11043","type":"HCPCS"}],"standard_charges":[{"gross_charge":1093.0,"discounted_cash":1093.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DEBRIDEMENT, SKIN, SUB-Q TISSUE,MUSCLE,BONE,=<20 SQ CM","code_information":[{"code":"3611104401","type":"CDM"},{"code":"0361","type":"RC"},{"code":"11044","type":"HCPCS"}],"standard_charges":[{"gross_charge":2500.0,"discounted_cash":2500.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DEBRIDEMENT, SKIN, SUB-Q TISSUE,EACH ADD 20 SQ CM","code_information":[{"code":"3611104501","type":"CDM"},{"code":"0361","type":"RC"},{"code":"11045","type":"HCPCS"}],"standard_charges":[{"gross_charge":1063.0,"discounted_cash":1063.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TRIM HYPERKERATOTIC SKIN LESION, ONE","code_information":[{"code":"3611105501","type":"CDM"},{"code":"0361","type":"RC"},{"code":"11055","type":"HCPCS"}],"standard_charges":[{"gross_charge":317.0,"discounted_cash":317.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TRIM BENIGN HYPERKERATOTIC SKIN LESION,2-4","code_information":[{"code":"3611105601","type":"CDM"},{"code":"0361","type":"RC"},{"code":"11056","type":"HCPCS"}],"standard_charges":[{"gross_charge":336.0,"discounted_cash":336.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TRIM BENIGN HYPERKERATOTIC SKIN LESION,>4","code_information":[{"code":"3611105701","type":"CDM"},{"code":"0361","type":"RC"},{"code":"11057","type":"HCPCS"}],"standard_charges":[{"gross_charge":358.0,"discounted_cash":358.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TANGENTIAL BIOPSY SKIN SINGLE LESION","code_information":[{"code":"3611110201","type":"CDM"},{"code":"0361","type":"RC"},{"code":"11102","type":"HCPCS"}],"standard_charges":[{"gross_charge":476.0,"discounted_cash":476.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TANGENTIAL BIOPSY SKIN EA SEP/ADDITIONAL LESION","code_information":[{"code":"3611110301","type":"CDM"},{"code":"0361","type":"RC"},{"code":"11103","type":"HCPCS"}],"standard_charges":[{"gross_charge":483.0,"discounted_cash":483.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PUNCH BIOPSY SKIN SINGLE LESION","code_information":[{"code":"3611110401","type":"CDM"},{"code":"0361","type":"RC"},{"code":"11104","type":"HCPCS"}],"standard_charges":[{"gross_charge":826.0,"discounted_cash":826.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PUNCH BIOPSY SKIN EA SEP/ADDITIONAL LESION","code_information":[{"code":"3611110501","type":"CDM"},{"code":"0361","type":"RC"},{"code":"11105","type":"HCPCS"}],"standard_charges":[{"gross_charge":563.0,"discounted_cash":563.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INCISIONAL BIOPSY SKIN SINGLE LESION","code_information":[{"code":"3611110601","type":"CDM"},{"code":"0361","type":"RC"},{"code":"11106","type":"HCPCS"}],"standard_charges":[{"gross_charge":1843.0,"discounted_cash":1843.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC REMOVAL OF SKIN TAGS, UP TO 15","code_information":[{"code":"3611120001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"11200","type":"HCPCS"}],"standard_charges":[{"gross_charge":376.0,"discounted_cash":376.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SHAV SKIN LES < 0.5 CM TRUNK,ARM,LEG","code_information":[{"code":"3611130001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"11300","type":"HCPCS"}],"standard_charges":[{"gross_charge":513.0,"discounted_cash":513.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SHAV SKIN LES 0.6 TO 1.0 CM TRUNK,ARM,LEG","code_information":[{"code":"3611130101","type":"CDM"},{"code":"0361","type":"RC"},{"code":"11301","type":"HCPCS"}],"standard_charges":[{"gross_charge":610.0,"discounted_cash":610.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SHAV SKIN LES 1.1 TO 2.0 CM TRUNK,ARM,LEG","code_information":[{"code":"3611130201","type":"CDM"},{"code":"0361","type":"RC"},{"code":"11302","type":"HCPCS"}],"standard_charges":[{"gross_charge":720.0,"discounted_cash":720.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SHAVE SKIN LESION TRUNK,ARM,LEG>2.1 CM","code_information":[{"code":"3611130301","type":"CDM"},{"code":"0361","type":"RC"},{"code":"11303","type":"HCPCS"}],"standard_charges":[{"gross_charge":1298.0,"discounted_cash":1298.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SHAVE SKIN LES SNHF.6-1CM","code_information":[{"code":"3611130601","type":"CDM"},{"code":"0361","type":"RC"},{"code":"11306","type":"HCPCS"}],"standard_charges":[{"gross_charge":974.0,"discounted_cash":974.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SHAVE SKIN LESION SNHF 1.1-2 CM","code_information":[{"code":"3611130701","type":"CDM"},{"code":"0361","type":"RC"},{"code":"11307","type":"HCPCS"}],"standard_charges":[{"gross_charge":1217.0,"discounted_cash":1217.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SHAV SKIN LES <0.5 CM FACE,FACIAL","code_information":[{"code":"3611131001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"11310","type":"HCPCS"}],"standard_charges":[{"gross_charge":811.0,"discounted_cash":811.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SHAVE SKIN LES 0.6-1.0 CM","code_information":[{"code":"3611131101","type":"CDM"},{"code":"0361","type":"RC"},{"code":"11311","type":"HCPCS"}],"standard_charges":[{"gross_charge":1116.0,"discounted_cash":1116.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SHAV SKIN LES 1.1 TO 2.0 CM FACE,FACIAL","code_information":[{"code":"3611131201","type":"CDM"},{"code":"0361","type":"RC"},{"code":"11312","type":"HCPCS"}],"standard_charges":[{"gross_charge":1318.0,"discounted_cash":1318.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC EXC SKIN BENIG 0.6-1 CM TRUNK,ARM,LEG","code_information":[{"code":"3611140101","type":"CDM"},{"code":"0361","type":"RC"},{"code":"11401","type":"HCPCS"}],"standard_charges":[{"gross_charge":1298.0,"discounted_cash":1298.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC EXC SKIN BENIG 1.1-2 CM TRUNK,ARM,LEG","code_information":[{"code":"3611140201","type":"CDM"},{"code":"0361","type":"RC"},{"code":"11402","type":"HCPCS"}],"standard_charges":[{"gross_charge":1470.0,"discounted_cash":1470.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC EXC SKIN BENIG 2.1-3 CM TRUNK,ARM,LEG","code_information":[{"code":"3611140301","type":"CDM"},{"code":"0361","type":"RC"},{"code":"11403","type":"HCPCS"}],"standard_charges":[{"gross_charge":1866.0,"discounted_cash":1866.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC EXC SKIN BENIG 3.1-4 CM TRUNK,ARM,LEG","code_information":[{"code":"3611140401","type":"CDM"},{"code":"0361","type":"RC"},{"code":"11404","type":"HCPCS"}],"standard_charges":[{"gross_charge":2140.0,"discounted_cash":2140.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC EXC SKIN BENIG 0.6-1 CM REMAINDR BODY","code_information":[{"code":"3611142101","type":"CDM"},{"code":"0361","type":"RC"},{"code":"11421","type":"HCPCS"}],"standard_charges":[{"gross_charge":1491.0,"discounted_cash":1491.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC EXC BENIGN LESION FACE/FACIAL 1.1-2.0 CM","code_information":[{"code":"3611144202","type":"CDM"},{"code":"0361","type":"RC"},{"code":"11442","type":"HCPCS"}],"standard_charges":[{"gross_charge":1795.0,"discounted_cash":1795.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC EXCISION MALIGNANT LES W/ MARG  TAL 1.1-2.0 CM","code_information":[{"code":"3611160201","type":"CDM"},{"code":"0361","type":"RC"},{"code":"11602","type":"HCPCS"}],"standard_charges":[{"gross_charge":2302.0,"discounted_cash":2302.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC EXC SKIN MALIG 2.1-3 CM TRUNK,ARM,LEG","code_information":[{"code":"3611160301","type":"CDM"},{"code":"0361","type":"RC"},{"code":"11603","type":"HCPCS"}],"standard_charges":[{"gross_charge":2860.0,"discounted_cash":2860.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC EXC SKIN MALIG 3.1-4 CM TRUNK,ARM,LEG","code_information":[{"code":"3611160401","type":"CDM"},{"code":"0361","type":"RC"},{"code":"11604","type":"HCPCS"}],"standard_charges":[{"gross_charge":3215.0,"discounted_cash":3215.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC EXC SKIN MALIG >4 CM TRUNK,ARM,LEG","code_information":[{"code":"3611160601","type":"CDM"},{"code":"0361","type":"RC"},{"code":"11606","type":"HCPCS"}],"standard_charges":[{"gross_charge":5091.0,"discounted_cash":5091.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC EXC MALIG LESION REMAINDER BODY 2.1-3.0 CM","code_information":[{"code":"3611162301","type":"CDM"},{"code":"0361","type":"RC"},{"code":"11623","type":"HCPCS"}],"standard_charges":[{"gross_charge":3154.0,"discounted_cash":3154.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TRIM NAIL(S)","code_information":[{"code":"3611171901","type":"CDM"},{"code":"0361","type":"RC"},{"code":"11719","type":"HCPCS"}],"standard_charges":[{"gross_charge":221.0,"discounted_cash":221.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DEBRIDEMENT OF NAIL(S), 1-5","code_information":[{"code":"3611172001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"11720","type":"HCPCS"}],"standard_charges":[{"gross_charge":268.0,"discounted_cash":268.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DEBRIDEMENT OF NAILS, 6 OR MORE","code_information":[{"code":"3611172101","type":"CDM"},{"code":"0361","type":"RC"},{"code":"11721","type":"HCPCS"}],"standard_charges":[{"gross_charge":452.0,"discounted_cash":452.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC REMOVAL OF NAIL PLATE","code_information":[{"code":"3611173001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"11730","type":"HCPCS"}],"standard_charges":[{"gross_charge":397.0,"discounted_cash":397.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DRAIN BLOOD FROM UNDER NAIL","code_information":[{"code":"3611174001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"11740","type":"HCPCS"}],"standard_charges":[{"gross_charge":316.0,"discounted_cash":316.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC REMOVAL OF NAIL BED","code_information":[{"code":"3611175001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"11750","type":"HCPCS"}],"standard_charges":[{"gross_charge":1411.0,"discounted_cash":1411.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RECONSTRUC OF NAIL BED","code_information":[{"code":"3611176001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"11760","type":"HCPCS"}],"standard_charges":[{"gross_charge":1363.0,"discounted_cash":1363.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC EXCISION OF NAIL FOLD, TOE","code_information":[{"code":"3611176501","type":"CDM"},{"code":"0361","type":"RC"},{"code":"11765","type":"HCPCS"}],"standard_charges":[{"gross_charge":1240.0,"discounted_cash":1240.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INJ INTRALESIONAL UP TO 7","code_information":[{"code":"3611190001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"11900","type":"HCPCS"}],"standard_charges":[{"gross_charge":2663.0,"discounted_cash":2663.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INSERT DRUG DELIVERY IMPLANT","code_information":[{"code":"3611198101","type":"CDM"},{"code":"0361","type":"RC"},{"code":"11981","type":"HCPCS"}],"standard_charges":[{"gross_charge":1565.0,"discounted_cash":1565.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC REMOVE DRUG DELIVERY IMPLANT","code_information":[{"code":"3611198201","type":"CDM"},{"code":"0361","type":"RC"},{"code":"11982","type":"HCPCS"}],"standard_charges":[{"gross_charge":3442.0,"discounted_cash":3442.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC REPLACE DRUG DELIVERY IMPLANT","code_information":[{"code":"3611198301","type":"CDM"},{"code":"0361","type":"RC"},{"code":"11983","type":"HCPCS"}],"standard_charges":[{"gross_charge":4906.0,"discounted_cash":4906.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RESUPERF WND BODY <2.5CM","code_information":[{"code":"3611200101","type":"CDM"},{"code":"0361","type":"RC"},{"code":"12001","type":"HCPCS"}],"standard_charges":[{"gross_charge":929.0,"discounted_cash":929.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RESUP NPTERF WND BODY 2.6-7.5 CM","code_information":[{"code":"3611200201","type":"CDM"},{"code":"0361","type":"RC"},{"code":"12002","type":"HCPCS"}],"standard_charges":[{"gross_charge":1260.0,"discounted_cash":1260.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RESUPERF WND BODY 7.6-12.5 CM","code_information":[{"code":"3611200401","type":"CDM"},{"code":"0361","type":"RC"},{"code":"12004","type":"HCPCS"}],"standard_charges":[{"gross_charge":1592.0,"discounted_cash":1592.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RESUPERF WND BODY 12.6-20 CM","code_information":[{"code":"3611200501","type":"CDM"},{"code":"0361","type":"RC"},{"code":"12005","type":"HCPCS"}],"standard_charges":[{"gross_charge":2178.0,"discounted_cash":2178.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RESUPERF WND BODY 20.1-30 CM","code_information":[{"code":"3611200601","type":"CDM"},{"code":"0361","type":"RC"},{"code":"12006","type":"HCPCS"}],"standard_charges":[{"gross_charge":2642.0,"discounted_cash":2642.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RESUPERF WND FACE <2.5 CM","code_information":[{"code":"3611201101","type":"CDM"},{"code":"0361","type":"RC"},{"code":"12011","type":"HCPCS"}],"standard_charges":[{"gross_charge":1321.0,"discounted_cash":1321.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RESUPERF WND FACE 2.6-5 CM","code_information":[{"code":"3611201301","type":"CDM"},{"code":"0361","type":"RC"},{"code":"12013","type":"HCPCS"}],"standard_charges":[{"gross_charge":1506.0,"discounted_cash":1506.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RESUPERF WND FACE 5.1-7.5 CM","code_information":[{"code":"3611201401","type":"CDM"},{"code":"0361","type":"RC"},{"code":"12014","type":"HCPCS"}],"standard_charges":[{"gross_charge":1938.0,"discounted_cash":1938.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RESUPERF WND FACE 7.6-12.5 CM","code_information":[{"code":"3611201501","type":"CDM"},{"code":"0361","type":"RC"},{"code":"12015","type":"HCPCS"}],"standard_charges":[{"gross_charge":2444.0,"discounted_cash":2444.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RESUPERF WND FACE 12.6-20 CM","code_information":[{"code":"3611201601","type":"CDM"},{"code":"0361","type":"RC"},{"code":"12016","type":"HCPCS"}],"standard_charges":[{"gross_charge":2642.0,"discounted_cash":2642.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC LAYR CLOS WND TRUNK,ARM,LEG <2.5 CM","code_information":[{"code":"3611203101","type":"CDM"},{"code":"0361","type":"RC"},{"code":"12031","type":"HCPCS"}],"standard_charges":[{"gross_charge":2160.0,"discounted_cash":2160.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC LAYR CLOS WND TRUNK,ARM,LEG 2.6-7.5 CM","code_information":[{"code":"3611203201","type":"CDM"},{"code":"0361","type":"RC"},{"code":"12032","type":"HCPCS"}],"standard_charges":[{"gross_charge":2721.0,"discounted_cash":2721.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC LAYR CLOS WND TRUNK,ARM,LEG 2.6-7.5 CM","code_information":[{"code":"36112032PB","type":"CDM"},{"code":"0361","type":"RC"},{"code":"12032","type":"HCPCS"}],"standard_charges":[{"gross_charge":2721.0,"discounted_cash":2721.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC LAYR CLOS WND TRUNK,ARM,LEG 7.6-12.5 CM","code_information":[{"code":"3611203401","type":"CDM"},{"code":"0361","type":"RC"},{"code":"12034","type":"HCPCS"}],"standard_charges":[{"gross_charge":3207.0,"discounted_cash":3207.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC LAYR CLOS WND TRUNK,ARM,LEG 12.6-20 CM","code_information":[{"code":"3611203501","type":"CDM"},{"code":"0361","type":"RC"},{"code":"12035","type":"HCPCS"}],"standard_charges":[{"gross_charge":3780.0,"discounted_cash":3780.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC LAYR CLOS WND TRUNK,ARM,LEG 20.1-30 CM","code_information":[{"code":"3611203601","type":"CDM"},{"code":"0361","type":"RC"},{"code":"12036","type":"HCPCS"}],"standard_charges":[{"gross_charge":4568.0,"discounted_cash":4568.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC LAYR CLOS WND TRUNK,ARM,LEG >30 CM","code_information":[{"code":"3611203701","type":"CDM"},{"code":"0361","type":"RC"},{"code":"12037","type":"HCPCS"}],"standard_charges":[{"gross_charge":5399.0,"discounted_cash":5399.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC LAYR CLOS WND REST BODY <2.5 CM","code_information":[{"code":"3611204101","type":"CDM"},{"code":"0361","type":"RC"},{"code":"12041","type":"HCPCS"}],"standard_charges":[{"gross_charge":2205.0,"discounted_cash":2205.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC LAYR CLOS WND REST BODY 2.6-7.5 CM","code_information":[{"code":"3611204201","type":"CDM"},{"code":"0361","type":"RC"},{"code":"12042","type":"HCPCS"}],"standard_charges":[{"gross_charge":2930.0,"discounted_cash":2930.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC LAYR CLOS WND REST BODY 7.6-12.5 CM","code_information":[{"code":"3611204401","type":"CDM"},{"code":"0361","type":"RC"},{"code":"12044","type":"HCPCS"}],"standard_charges":[{"gross_charge":3350.0,"discounted_cash":3350.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC LAYR CLOS WND FACE,FACIAL <2.5 CM","code_information":[{"code":"3611205101","type":"CDM"},{"code":"0361","type":"RC"},{"code":"12051","type":"HCPCS"}],"standard_charges":[{"gross_charge":2229.0,"discounted_cash":2229.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC LAYR CLOS WND FACE,FACIAL 2.5-5 CM","code_information":[{"code":"3611205201","type":"CDM"},{"code":"0361","type":"RC"},{"code":"12052","type":"HCPCS"}],"standard_charges":[{"gross_charge":2745.0,"discounted_cash":2745.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC LAYR CLOS WND FACE,FACIAL 5.1-7.5 CM","code_information":[{"code":"3611205301","type":"CDM"},{"code":"0361","type":"RC"},{"code":"12053","type":"HCPCS"}],"standard_charges":[{"gross_charge":3032.0,"discounted_cash":3032.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC LAYR CLOS WND FACE,FACIAL 7.6-12.5 CM","code_information":[{"code":"3611205401","type":"CDM"},{"code":"0361","type":"RC"},{"code":"12054","type":"HCPCS"}],"standard_charges":[{"gross_charge":3348.0,"discounted_cash":3348.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RECMPL WND SCALP,EXTR 1.1-2.5 CM","code_information":[{"code":"3611312001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"13120","type":"HCPCS"}],"standard_charges":[{"gross_charge":3477.0,"discounted_cash":3477.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RECMPL WND SCALP,EXTR 2.6-7.5 CM","code_information":[{"code":"3611312101","type":"CDM"},{"code":"0361","type":"RC"},{"code":"13121","type":"HCPCS"}],"standard_charges":[{"gross_charge":4306.0,"discounted_cash":4306.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC REP,SKIN,SCALP/EXTREM+5 CM/<","code_information":[{"code":"3611312201","type":"CDM"},{"code":"0361","type":"RC"},{"code":"13122","type":"HCPCS"}],"standard_charges":[{"gross_charge":2530.0,"discounted_cash":2530.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RECMPL WND HEAD,FAC,HAND 1.1-2.5 CM","code_information":[{"code":"3611313101","type":"CDM"},{"code":"0361","type":"RC"},{"code":"13131","type":"HCPCS"}],"standard_charges":[{"gross_charge":1999.0,"discounted_cash":1999.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RECMPL WND HEAD,FAC,HAND 2.6-7.5 CM","code_information":[{"code":"3611313201","type":"CDM"},{"code":"0361","type":"RC"},{"code":"13132","type":"HCPCS"}],"standard_charges":[{"gross_charge":2562.0,"discounted_cash":2562.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC REPR,FACE,GENITAL,HAND,FT+5 CMCM/<","code_information":[{"code":"3611313301","type":"CDM"},{"code":"0361","type":"RC"},{"code":"13133","type":"HCPCS"}],"standard_charges":[{"gross_charge":2172.0,"discounted_cash":2172.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RECMPL WND LID,NOS,EAR 1.1-2.5 CM","code_information":[{"code":"3611315101","type":"CDM"},{"code":"0361","type":"RC"},{"code":"13151","type":"HCPCS"}],"standard_charges":[{"gross_charge":4229.0,"discounted_cash":4229.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RECMPL WND LID,NOS,EAR 2.5-7.5 CM","code_information":[{"code":"3611315201","type":"CDM"},{"code":"0361","type":"RC"},{"code":"13152","type":"HCPCS"}],"standard_charges":[{"gross_charge":4229.0,"discounted_cash":4229.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC WOUND PREP,TRUNK/ARM/LG 1ST 100 CM OR 1% PEDS","code_information":[{"code":"3611500201","type":"CDM"},{"code":"0361","type":"RC"},{"code":"15002","type":"HCPCS"}],"standard_charges":[{"gross_charge":2172.0,"discounted_cash":2172.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC WOUND PREP FACE/NECK/HAND/FOOT/GEN 1ST 100 CM OR 1% PEDS","code_information":[{"code":"3611500401","type":"CDM"},{"code":"0361","type":"RC"},{"code":"15004","type":"HCPCS"}],"standard_charges":[{"gross_charge":2172.0,"discounted_cash":2172.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC APP SKN SUB GRFT T/A/L AREA/<100SCM /<1ST 25 SCM","code_information":[{"code":"3611527101","type":"CDM"},{"code":"0361","type":"RC"},{"code":"15271","type":"HCPCS"}],"standard_charges":[{"gross_charge":6219.0,"discounted_cash":6219.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC APP SKN SUB GRFT T/A/L AREA/<100SCM EA ADL 25SCM","code_information":[{"code":"3611527201","type":"CDM"},{"code":"0361","type":"RC"},{"code":"15272","type":"HCPCS"}],"standard_charges":[{"gross_charge":710.0,"discounted_cash":710.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC APP SKN SUB GRFT T/A/L AREA/>100SCM 1ST 100SCM","code_information":[{"code":"3611527301","type":"CDM"},{"code":"0361","type":"RC"},{"code":"15273","type":"HCPCS"}],"standard_charges":[{"gross_charge":2919.0,"discounted_cash":2919.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC APP SKN SUB GRFT T/A/L AREA/>100SCM ADL 100SCM","code_information":[{"code":"3611527401","type":"CDM"},{"code":"0361","type":"RC"},{"code":"15274","type":"HCPCS"}],"standard_charges":[{"gross_charge":1182.0,"discounted_cash":1182.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SUB GRFT F/S/N/H/F/G/M/D /<100SCM /<1ST 25 SCM","code_information":[{"code":"3611527501","type":"CDM"},{"code":"0361","type":"RC"},{"code":"15275","type":"HCPCS"}],"standard_charges":[{"gross_charge":2256.0,"discounted_cash":2256.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SUB GRFT F/S/N/H/F/G/M/D /<100SCM EA ADL 25SCM","code_information":[{"code":"3611527601","type":"CDM"},{"code":"0361","type":"RC"},{"code":"15276","type":"HCPCS"}],"standard_charges":[{"gross_charge":1431.0,"discounted_cash":1431.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INITIAL RX BURN(S) 1ST DEGREE","code_information":[{"code":"3611600001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"16000","type":"HCPCS"}],"standard_charges":[{"gross_charge":629.0,"discounted_cash":629.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DRESS/DEBRID SMALL BURN NO ANES","code_information":[{"code":"3611602001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"16020","type":"HCPCS"}],"standard_charges":[{"gross_charge":555.0,"discounted_cash":555.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DRESS/DEBRID MED BURN NO ANESTH","code_information":[{"code":"3611602501","type":"CDM"},{"code":"0361","type":"RC"},{"code":"16025","type":"HCPCS"}],"standard_charges":[{"gross_charge":1359.0,"discounted_cash":1359.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DESTRUC BENIGN/PREMAL,FIRST LESION","code_information":[{"code":"3611700001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"17000","type":"HCPCS"}],"standard_charges":[{"gross_charge":373.0,"discounted_cash":373.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DESTRUC BENIGN/PREMAL,2-14 LESIONS","code_information":[{"code":"3611700301","type":"CDM"},{"code":"0361","type":"RC"},{"code":"17003","type":"HCPCS"}],"standard_charges":[{"gross_charge":56.0,"discounted_cash":56.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DESTRUC BENIGN/HCEMAL,15+ LESIONS","code_information":[{"code":"3611700401","type":"CDM"},{"code":"0361","type":"RC"},{"code":"17004","type":"HCPCS"}],"standard_charges":[{"gross_charge":2659.0,"discounted_cash":2659.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DESTRUCTION BENIGN LESIONS UP TO 14","code_information":[{"code":"3611711001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"17110","type":"HCPCS"}],"standard_charges":[{"gross_charge":524.0,"discounted_cash":524.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CHEM CAUTERY GRANULATN TISSUE","code_information":[{"code":"3611725001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"17250","type":"HCPCS"}],"standard_charges":[{"gross_charge":546.0,"discounted_cash":546.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DST DKN LES T/A/L 0.6-1 CM","code_information":[{"code":"3611726101","type":"CDM"},{"code":"0361","type":"RC"},{"code":"17261","type":"HCPCS"}],"standard_charges":[{"gross_charge":1505.0,"discounted_cash":1505.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PUNC/ASPIR BREAST CYST","code_information":[{"code":"3611900001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"19000","type":"HCPCS"}],"standard_charges":[{"gross_charge":728.0,"discounted_cash":728.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BX BREAST W DEVICE 1ST LESION STEREOTACTIC GUIDE","code_information":[{"code":"3611908101","type":"CDM"},{"code":"0361","type":"RC"},{"code":"19081","type":"HCPCS"}],"standard_charges":[{"gross_charge":3896.0,"discounted_cash":3896.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BX BREAST W DEVICE 1ST LESION ULTRASOUND GUIDE","code_information":[{"code":"3611908301","type":"CDM"},{"code":"0361","type":"RC"},{"code":"19083","type":"HCPCS"}],"standard_charges":[{"gross_charge":3211.0,"discounted_cash":3211.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BX BREAST W DEVICE ADDL LESION ULTRASOUND GUIDE","code_information":[{"code":"3611908401","type":"CDM"},{"code":"0361","type":"RC"},{"code":"19084","type":"HCPCS"}],"standard_charges":[{"gross_charge":1372.0,"discounted_cash":1372.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BX BREAST W DEVICE 1ST LESION MAGNETIC RES GUIDE","code_information":[{"code":"3611908501","type":"CDM"},{"code":"0361","type":"RC"},{"code":"19085","type":"HCPCS"}],"standard_charges":[{"gross_charge":2792.15,"discounted_cash":2792.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PERQ DEVICE PLACEMT BREAST LOC 1ST LES W GUIDNCE","code_information":[{"code":"3611928101","type":"CDM"},{"code":"0361","type":"RC"},{"code":"19281","type":"HCPCS"}],"standard_charges":[{"gross_charge":3211.0,"discounted_cash":3211.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PERQ DEVICE PLACEMT BREAST LOC EA LES W GUIDNCE","code_information":[{"code":"3611928201","type":"CDM"},{"code":"0361","type":"RC"},{"code":"19282","type":"HCPCS"}],"standard_charges":[{"gross_charge":2190.0,"discounted_cash":2190.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PERQ BREAST LOC DEVICE PLACEMT 1ST LESIO US IMAG","code_information":[{"code":"3611928501","type":"CDM"},{"code":"0361","type":"RC"},{"code":"19285","type":"HCPCS"}],"standard_charges":[{"gross_charge":450.0,"discounted_cash":450.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC EXPLORE WOUND,EXTREMITY","code_information":[{"code":"3612010301","type":"CDM"},{"code":"0361","type":"RC"},{"code":"20103","type":"HCPCS"}],"standard_charges":[{"gross_charge":8733.0,"discounted_cash":8733.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC NEEDLE BIOPSY,MUSCLE","code_information":[{"code":"3612020601","type":"CDM"},{"code":"0361","type":"RC"},{"code":"20206","type":"HCPCS"}],"standard_charges":[{"gross_charge":1821.0,"discounted_cash":1821.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BONE BIOPSY,TROCAR/NEEDLE SUPERF","code_information":[{"code":"3612022001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"20220","type":"HCPCS"}],"standard_charges":[{"gross_charge":1998.0,"discounted_cash":1998.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BONE BIOPSY,TROCAR/NEEDLE DEEP","code_information":[{"code":"3612022501","type":"CDM"},{"code":"0361","type":"RC"},{"code":"20225","type":"HCPCS"}],"standard_charges":[{"gross_charge":2220.0,"discounted_cash":2220.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BX BONE BIOPSY,EXCISIONAL SUPERF","code_information":[{"code":"3612024001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"20240","type":"HCPCS"}],"standard_charges":[{"gross_charge":2647.0,"discounted_cash":2647.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC REMOVAL OF FOREIGN BODY","code_information":[{"code":"3612052001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"20520","type":"HCPCS"}],"standard_charges":[{"gross_charge":11315.0,"discounted_cash":11315.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INJECT CARPAL TUNNEL","code_information":[{"code":"3612052601","type":"CDM"},{"code":"0361","type":"RC"},{"code":"20526","type":"HCPCS"}],"standard_charges":[{"gross_charge":2346.0,"discounted_cash":2346.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INJECT TENDON SHEATH/LIGAMENT","code_information":[{"code":"3612055001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"20550","type":"HCPCS"}],"standard_charges":[{"gross_charge":1699.0,"discounted_cash":1699.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INJECT TENDON ORIGIN/INSERT","code_information":[{"code":"3612055101","type":"CDM"},{"code":"0361","type":"RC"},{"code":"20551","type":"HCPCS"}],"standard_charges":[{"gross_charge":1555.0,"discounted_cash":1555.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INJECT TRIGGER POINT, 1 OR 2","code_information":[{"code":"3612055201","type":"CDM"},{"code":"0361","type":"RC"},{"code":"20552","type":"HCPCS"}],"standard_charges":[{"gross_charge":359.0,"discounted_cash":359.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INJECT TRIGGER POINTS, > 3","code_information":[{"code":"3612055301","type":"CDM"},{"code":"0361","type":"RC"},{"code":"20553","type":"HCPCS"}],"standard_charges":[{"gross_charge":1239.0,"discounted_cash":1239.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ARTHROCENTESIS ASPIR&/INJ SMALL JT/BURSA W/O US","code_information":[{"code":"3612060001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"20600","type":"HCPCS"}],"standard_charges":[{"gross_charge":1302.0,"discounted_cash":1302.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ARTHROCNT ASPIR&/INJ SMALL JT/BURSAW/US REC RPRT","code_information":[{"code":"3612060401","type":"CDM"},{"code":"0361","type":"RC"},{"code":"20604","type":"HCPCS"}],"standard_charges":[{"gross_charge":1756.0,"discounted_cash":1756.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ARTHROCENTESIS ASPIR&/INJ INTERM JT/BURS W/O US","code_information":[{"code":"3612060501","type":"CDM"},{"code":"0361","type":"RC"},{"code":"20605","type":"HCPCS"}],"standard_charges":[{"gross_charge":1342.0,"discounted_cash":1342.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ARTHROCENTESIS ASPIR&/INJ INTERM JT/BURS W/US","code_information":[{"code":"3612060601","type":"CDM"},{"code":"0361","type":"RC"},{"code":"20606","type":"HCPCS"}],"standard_charges":[{"gross_charge":1973.0,"discounted_cash":1973.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/O US","code_information":[{"code":"3612061001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"20610","type":"HCPCS"}],"standard_charges":[{"gross_charge":1559.0,"discounted_cash":1559.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US","code_information":[{"code":"3612061101","type":"CDM"},{"code":"0361","type":"RC"},{"code":"20611","type":"HCPCS"}],"standard_charges":[{"gross_charge":2170.0,"discounted_cash":2170.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASPIRAT/INJECTION GANGLION CYST(S)","code_information":[{"code":"3612061201","type":"CDM"},{"code":"0361","type":"RC"},{"code":"20612","type":"HCPCS"}],"standard_charges":[{"gross_charge":1187.0,"discounted_cash":1187.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC REDUCE TEMPOROMANDIBL DISLOC","code_information":[{"code":"3612148001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"21480","type":"HCPCS"}],"standard_charges":[{"gross_charge":4240.0,"discounted_cash":4240.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC REMOVE FB DEEP SUBFASCIAL/INTRAMUSCULAR SHOULDER","code_information":[{"code":"3612333301","type":"CDM"},{"code":"0361","type":"RC"},{"code":"23333","type":"HCPCS"}],"standard_charges":[{"gross_charge":17700.0,"discounted_cash":17700.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INJ PROC SHOULDER ARTHROGRAPHY/CT/MRI","code_information":[{"code":"3612335001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"23350","type":"HCPCS"}],"standard_charges":[{"gross_charge":564.0,"discounted_cash":564.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CLOSED RX SHLDR DISLOCATION","code_information":[{"code":"3612365001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"23650","type":"HCPCS"}],"standard_charges":[{"gross_charge":2738.0,"discounted_cash":2738.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CLOSED RX SHLDR DISLOC,GR TUB FX","code_information":[{"code":"3612366501","type":"CDM"},{"code":"0361","type":"RC"},{"code":"23665","type":"HCPCS"}],"standard_charges":[{"gross_charge":10371.0,"discounted_cash":10371.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INJECTION FOR ELBOW ARTHROGRAM","code_information":[{"code":"3612422001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"24220","type":"HCPCS"}],"standard_charges":[{"gross_charge":564.0,"discounted_cash":564.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CLOSED RX ELBOW DISLOCATION","code_information":[{"code":"3612460001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"24600","type":"HCPCS"}],"standard_charges":[{"gross_charge":2202.0,"discounted_cash":2202.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CLOSED RX RADIAL HEAD DISLOC,CHILD","code_information":[{"code":"3612464001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"24640","type":"HCPCS"}],"standard_charges":[{"gross_charge":2202.0,"discounted_cash":2202.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CLOSED RX RADIAL HEAD/NECK FX,MANIP","code_information":[{"code":"3612465501","type":"CDM"},{"code":"0361","type":"RC"},{"code":"24655","type":"HCPCS"}],"standard_charges":[{"gross_charge":10371.0,"discounted_cash":10371.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INJECTION FOR WRIST ARTHROGRAM","code_information":[{"code":"3612524601","type":"CDM"},{"code":"0361","type":"RC"},{"code":"25246","type":"HCPCS"}],"standard_charges":[{"gross_charge":583.0,"discounted_cash":583.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC REMOVE FOREARM/WRIST FOREIGN BODY","code_information":[{"code":"3612524801","type":"CDM"},{"code":"0361","type":"RC"},{"code":"25248","type":"HCPCS"}],"standard_charges":[{"gross_charge":20434.0,"discounted_cash":20434.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CLOSED RX RAD/ULNA SHAFT FX,MANIP","code_information":[{"code":"3612556501","type":"CDM"},{"code":"0361","type":"RC"},{"code":"25565","type":"HCPCS"}],"standard_charges":[{"gross_charge":10469.0,"discounted_cash":10469.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CLOSED RX DIST RAD/ULNA FX","code_information":[{"code":"3612560001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"25600","type":"HCPCS"}],"standard_charges":[{"gross_charge":3171.0,"discounted_cash":3171.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CLOSED RX DIST RAD/ULNA FX","code_information":[{"code":"36125600PB","type":"CDM"},{"code":"0361","type":"RC"},{"code":"25600","type":"HCPCS"}],"standard_charges":[{"gross_charge":1720.0,"discounted_cash":1720.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CLOSED RX DIST RAD/ULNA FX,MANIPUL","code_information":[{"code":"3612560501","type":"CDM"},{"code":"0361","type":"RC"},{"code":"25605","type":"HCPCS"}],"standard_charges":[{"gross_charge":10371.0,"discounted_cash":10371.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CLOSED RX CARPAL SCAPH FX W/ MANIP","code_information":[{"code":"3612562401","type":"CDM"},{"code":"0361","type":"RC"},{"code":"25624","type":"HCPCS"}],"standard_charges":[{"gross_charge":10469.0,"discounted_cash":10469.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CLOSED RX ULNA STYLOID FX","code_information":[{"code":"3612565001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"25650","type":"HCPCS"}],"standard_charges":[{"gross_charge":1603.0,"discounted_cash":1603.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CLOSED TREAT WRIST DISLOCATION","code_information":[{"code":"3612566001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"25660","type":"HCPCS"}],"standard_charges":[{"gross_charge":1603.0,"discounted_cash":1603.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CLOSED RX RADIO-ULNA DISLOCATION","code_information":[{"code":"3612567501","type":"CDM"},{"code":"0361","type":"RC"},{"code":"25675","type":"HCPCS"}],"standard_charges":[{"gross_charge":2202.0,"discounted_cash":2202.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DRAIN FINGER ABSCESS,SIMPLE","code_information":[{"code":"3612601001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"26010","type":"HCPCS"}],"standard_charges":[{"gross_charge":1542.0,"discounted_cash":1542.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DRAIN FINGER ABSCESS,COMPLICATED","code_information":[{"code":"3612601101","type":"CDM"},{"code":"0361","type":"RC"},{"code":"26011","type":"HCPCS"}],"standard_charges":[{"gross_charge":10544.0,"discounted_cash":10544.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CLOSED RX METACARPAL FX","code_information":[{"code":"3612660001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"26600","type":"HCPCS"}],"standard_charges":[{"gross_charge":1720.0,"discounted_cash":1720.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CLOSED RX METACARPAL FX,MANIP","code_information":[{"code":"3612660501","type":"CDM"},{"code":"0361","type":"RC"},{"code":"26605","type":"HCPCS"}],"standard_charges":[{"gross_charge":1720.0,"discounted_cash":1720.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CLOSED RX MC-P DISLOC","code_information":[{"code":"3612670001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"26700","type":"HCPCS"}],"standard_charges":[{"gross_charge":2004.0,"discounted_cash":2004.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CLOSE RX PROX/MID FING SHFT FX,MANIP","code_information":[{"code":"3612672501","type":"CDM"},{"code":"0361","type":"RC"},{"code":"26725","type":"HCPCS"}],"standard_charges":[{"gross_charge":2069.0,"discounted_cash":2069.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CLOSE RX DIST FINGR FX,MANIPULATN","code_information":[{"code":"3612675501","type":"CDM"},{"code":"0361","type":"RC"},{"code":"26755","type":"HCPCS"}],"standard_charges":[{"gross_charge":1720.0,"discounted_cash":1720.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OPEN TX DISTAL PHALANGEAL FX, EA","code_information":[{"code":"3612676501","type":"CDM"},{"code":"0361","type":"RC"},{"code":"26765","type":"HCPCS"}],"standard_charges":[{"gross_charge":24461.0,"discounted_cash":24461.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CLOSED RX IP JT DISLOCATION","code_information":[{"code":"3612677001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"26770","type":"HCPCS"}],"standard_charges":[{"gross_charge":2004.0,"discounted_cash":2004.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INCIS/DRAIN PELVIS/HIP,DEEP ABSCESS","code_information":[{"code":"3612699001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"26990","type":"HCPCS"}],"standard_charges":[{"gross_charge":25037.0,"discounted_cash":25037.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INJECTION HIP ARTHROGRAM","code_information":[{"code":"3612709301","type":"CDM"},{"code":"0361","type":"RC"},{"code":"27093","type":"HCPCS"}],"standard_charges":[{"gross_charge":1488.0,"discounted_cash":1488.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INJECTION,SACROILIAC JOINT","code_information":[{"code":"3612709601","type":"CDM"},{"code":"0361","type":"RC"},{"code":"27096","type":"HCPCS"}],"standard_charges":[{"gross_charge":1931.0,"discounted_cash":1931.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CLOSED RX POST HIP ARTHRPLAS DISLOC","code_information":[{"code":"3612726501","type":"CDM"},{"code":"0361","type":"RC"},{"code":"27265","type":"HCPCS"}],"standard_charges":[{"gross_charge":2738.0,"discounted_cash":2738.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC NJX PX CNTRST KNE ARTHG CNTRST ENHNCD CT/MRI KNE","code_information":[{"code":"3612736901","type":"CDM"},{"code":"0361","type":"RC"},{"code":"27369","type":"HCPCS"}],"standard_charges":[{"gross_charge":1840.0,"discounted_cash":1840.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CLOSED RX KNEE DISLOCATN","code_information":[{"code":"3612755001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"27550","type":"HCPCS"}],"standard_charges":[{"gross_charge":4006.0,"discounted_cash":4006.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CLOSED RX KNEECAP DISLOCATN","code_information":[{"code":"3612756001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"27560","type":"HCPCS"}],"standard_charges":[{"gross_charge":2202.0,"discounted_cash":2202.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DRAIN LOWER LEG DEEP ABSC/HEMATOMA","code_information":[{"code":"3612760301","type":"CDM"},{"code":"0361","type":"RC"},{"code":"27603","type":"HCPCS"}],"standard_charges":[{"gross_charge":17700.0,"discounted_cash":17700.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CLOSED RX TIBIA SHAFT FX","code_information":[{"code":"3612775001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"27750","type":"HCPCS"}],"standard_charges":[{"gross_charge":1658.0,"discounted_cash":1658.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CLOSED RX PROX FIB/SHAFT FX W/O MANIP","code_information":[{"code":"3612778001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"27780","type":"HCPCS"}],"standard_charges":[{"gross_charge":1603.0,"discounted_cash":1603.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CLOSED RX DIST FIBULA FX,MANIP","code_information":[{"code":"3612778801","type":"CDM"},{"code":"0361","type":"RC"},{"code":"27788","type":"HCPCS"}],"standard_charges":[{"gross_charge":3171.0,"discounted_cash":3171.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CLOSED TX BIMALLEOLAR ANKLE FRACTURE W/O MANIP","code_information":[{"code":"3612780801","type":"CDM"},{"code":"0361","type":"RC"},{"code":"27808","type":"HCPCS"}],"standard_charges":[{"gross_charge":1603.0,"discounted_cash":1603.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CLOSED TX BIMALLEOLAR ANKLE FRACTURE W MANIP","code_information":[{"code":"3612781001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"27810","type":"HCPCS"}],"standard_charges":[{"gross_charge":10469.0,"discounted_cash":10469.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CLOSED RX TRIMALLEOLAR FX","code_information":[{"code":"3612781601","type":"CDM"},{"code":"0361","type":"RC"},{"code":"27816","type":"HCPCS"}],"standard_charges":[{"gross_charge":1603.0,"discounted_cash":1603.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CLOSED RX TRIMALLEOLAR FX,MANIP","code_information":[{"code":"3612781801","type":"CDM"},{"code":"0361","type":"RC"},{"code":"27818","type":"HCPCS"}],"standard_charges":[{"gross_charge":10469.0,"discounted_cash":10469.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CLOSED RX ANKLE DISLOCATN","code_information":[{"code":"3612784001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"27840","type":"HCPCS"}],"standard_charges":[{"gross_charge":2202.0,"discounted_cash":2202.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC REMV FOOT FOREIGN BODY,SUBCUTANEOUS","code_information":[{"code":"3612819001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"28190","type":"HCPCS"}],"standard_charges":[{"gross_charge":3269.0,"discounted_cash":3269.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PBB REMV FOOT FOREIGN BODY,DEEP","code_information":[{"code":"3612819201","type":"CDM"},{"code":"0361","type":"RC"},{"code":"28192","type":"HCPCS"}],"standard_charges":[{"gross_charge":12719.0,"discounted_cash":12719.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TENOTOMY EXTEN FOOT/TOE EA TENDON, OPEN","code_information":[{"code":"3612823401","type":"CDM"},{"code":"0361","type":"RC"},{"code":"28234","type":"HCPCS"}],"standard_charges":[{"gross_charge":4563.0,"discounted_cash":4563.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CLOSED RX TOE FX,MANIPULATN","code_information":[{"code":"3612851501","type":"CDM"},{"code":"0361","type":"RC"},{"code":"28515","type":"HCPCS"}],"standard_charges":[{"gross_charge":1582.0,"discounted_cash":1582.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CLOSED RX MT-PHAL TOE DISLOCATION","code_information":[{"code":"3612863001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"28630","type":"HCPCS"}],"standard_charges":[{"gross_charge":4006.0,"discounted_cash":4006.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC AMPUTATION TOE, INTERPHAL JNT","code_information":[{"code":"3612882501","type":"CDM"},{"code":"0361","type":"RC"},{"code":"28825","type":"HCPCS"}],"standard_charges":[{"gross_charge":21238.0,"discounted_cash":21238.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC APPLY LONG ARM CAST","code_information":[{"code":"3612906501","type":"CDM"},{"code":"0361","type":"RC"},{"code":"29065","type":"HCPCS"}],"standard_charges":[{"gross_charge":745.0,"discounted_cash":745.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC APPLY FOREARM CAST","code_information":[{"code":"3612907501","type":"CDM"},{"code":"0361","type":"RC"},{"code":"29075","type":"HCPCS"}],"standard_charges":[{"gross_charge":1879.0,"discounted_cash":1879.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC APPLY LONG ARM SPLINT","code_information":[{"code":"3612910501","type":"CDM"},{"code":"0361","type":"RC"},{"code":"29105","type":"HCPCS"}],"standard_charges":[{"gross_charge":1246.0,"discounted_cash":1246.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC APPLY FOREARM SPLINT,STATIC","code_information":[{"code":"3612912501","type":"CDM"},{"code":"0361","type":"RC"},{"code":"29125","type":"HCPCS"}],"standard_charges":[{"gross_charge":1004.0,"discounted_cash":1004.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC APPLY FINGER SPLINT,STATIC","code_information":[{"code":"3612913001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"29130","type":"HCPCS"}],"standard_charges":[{"gross_charge":876.0,"discounted_cash":876.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC STRAPPING ELBOW/WRIST BY PHYSICIAN","code_information":[{"code":"3612926001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"29260","type":"HCPCS"}],"standard_charges":[{"gross_charge":486.0,"discounted_cash":486.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC APPLY LONG LEG CAST","code_information":[{"code":"3612934501","type":"CDM"},{"code":"0361","type":"RC"},{"code":"29345","type":"HCPCS"}],"standard_charges":[{"gross_charge":2484.0,"discounted_cash":2484.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC APPLY LONG LEG CAST,WALKER","code_information":[{"code":"3612935501","type":"CDM"},{"code":"0361","type":"RC"},{"code":"29355","type":"HCPCS"}],"standard_charges":[{"gross_charge":1879.0,"discounted_cash":1879.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC APPLY SHORT LEG CAST","code_information":[{"code":"3612940501","type":"CDM"},{"code":"0361","type":"RC"},{"code":"29405","type":"HCPCS"}],"standard_charges":[{"gross_charge":1142.0,"discounted_cash":1142.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC APPLY LONG LEG SPLINT","code_information":[{"code":"3612950501","type":"CDM"},{"code":"0361","type":"RC"},{"code":"29505","type":"HCPCS"}],"standard_charges":[{"gross_charge":2141.0,"discounted_cash":2141.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC APPLY LOWER LEG SPLINT","code_information":[{"code":"3612951501","type":"CDM"},{"code":"0361","type":"RC"},{"code":"29515","type":"HCPCS"}],"standard_charges":[{"gross_charge":1268.0,"discounted_cash":1268.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC STRAPPING UNNA BOOT","code_information":[{"code":"3612958001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"29580","type":"HCPCS"}],"standard_charges":[{"gross_charge":245.0,"discounted_cash":245.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC APPL MLT-LAYER VENOUS WOUND COMPRESS BELOW KNEE","code_information":[{"code":"3612958101","type":"CDM"},{"code":"0361","type":"RC"},{"code":"29581","type":"HCPCS"}],"standard_charges":[{"gross_charge":873.0,"discounted_cash":873.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC REMV/REVISN BOOT/BODY CAST","code_information":[{"code":"3612970001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"29700","type":"HCPCS"}],"standard_charges":[{"gross_charge":383.0,"discounted_cash":383.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DRN ABSC/HEMTMA NASAL INTERN APRCH","code_information":[{"code":"3613000001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"30000","type":"HCPCS"}],"standard_charges":[{"gross_charge":597.83,"discounted_cash":597.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INTRANASAL BIOPSY","code_information":[{"code":"3613010001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"30100","type":"HCPCS"}],"standard_charges":[{"gross_charge":11990.0,"discounted_cash":11990.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC REMOVE NASAL FOREIGN BODY","code_information":[{"code":"3613030001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"30300","type":"HCPCS"}],"standard_charges":[{"gross_charge":944.0,"discounted_cash":944.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CTRL NOSEBLEED,ANTER,SIMPLE","code_information":[{"code":"3613090101","type":"CDM"},{"code":"0361","type":"RC"},{"code":"30901","type":"HCPCS"}],"standard_charges":[{"gross_charge":1120.0,"discounted_cash":1120.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CTRL NOSEBLEED,ANTER,COMPLEX","code_information":[{"code":"3613090301","type":"CDM"},{"code":"0361","type":"RC"},{"code":"30903","type":"HCPCS"}],"standard_charges":[{"gross_charge":1080.0,"discounted_cash":1080.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CTRL NOSEBLEED,POST,W/PACKS &/OR CAUT","code_information":[{"code":"3613090501","type":"CDM"},{"code":"0361","type":"RC"},{"code":"30905","type":"HCPCS"}],"standard_charges":[{"gross_charge":1079.0,"discounted_cash":1079.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CTRL NOSEBLEED,POST,W/PACKS &/OR CAUT SUBSEQ","code_information":[{"code":"3613090601","type":"CDM"},{"code":"0361","type":"RC"},{"code":"30906","type":"HCPCS"}],"standard_charges":[{"gross_charge":1622.0,"discounted_cash":1622.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC NASAL SURG PROC UNLISTED","code_information":[{"code":"3613099901","type":"CDM"},{"code":"0361","type":"RC"},{"code":"30999","type":"HCPCS"}],"standard_charges":[{"gross_charge":860.0,"discounted_cash":860.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC NASAL ENDOSCOPY,DX","code_information":[{"code":"3613123101","type":"CDM"},{"code":"0361","type":"RC"},{"code":"31231","type":"HCPCS"}],"standard_charges":[{"gross_charge":682.0,"discounted_cash":682.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC NASAL/SINUS ENDOSCOPY,BX/RMV POLYP/DEBRID","code_information":[{"code":"3613123701","type":"CDM"},{"code":"0361","type":"RC"},{"code":"31237","type":"HCPCS"}],"standard_charges":[{"gross_charge":3182.0,"discounted_cash":3182.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PBB NASAL/SINUS ENDOSCOPY,W/CONTROL NASAL HEM","code_information":[{"code":"3613123801","type":"CDM"},{"code":"0361","type":"RC"},{"code":"31238","type":"HCPCS"}],"standard_charges":[{"gross_charge":1591.0,"discounted_cash":1591.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INSERT EMERGENCY ENDOTRACH AIRWAY","code_information":[{"code":"3613150001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"31500","type":"HCPCS"}],"standard_charges":[{"gross_charge":1388.0,"discounted_cash":1388.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC LARYNGOSCOPY,FLEX FIBER,DIAGNOSTIC","code_information":[{"code":"3613157501","type":"CDM"},{"code":"0361","type":"RC"},{"code":"31575","type":"HCPCS"}],"standard_charges":[{"gross_charge":321.0,"discounted_cash":321.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC LARYNGOSCOPY,FLEX/RIGID+STROBOSCOPY","code_information":[{"code":"3613157901","type":"CDM"},{"code":"0361","type":"RC"},{"code":"31579","type":"HCPCS"}],"standard_charges":[{"gross_charge":222.0,"discounted_cash":222.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BRONCHOSCOPY,DIAGNOSTIC W LAVAGE","code_information":[{"code":"3613162401","type":"CDM"},{"code":"0361","type":"RC"},{"code":"31624","type":"HCPCS"}],"standard_charges":[{"gross_charge":9570.0,"discounted_cash":9570.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PERCUT BX, LUNG/MEDIASTINUM INCLUDES GUIDANCE","code_information":[{"code":"3613240801","type":"CDM"},{"code":"0361","type":"RC"},{"code":"32408","type":"HCPCS"}],"standard_charges":[{"gross_charge":6271.0,"discounted_cash":6271.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TUBE THORACOSTOMY INCLUDES WATER SEAL","code_information":[{"code":"3613255101","type":"CDM"},{"code":"0361","type":"RC"},{"code":"32551","type":"HCPCS"}],"standard_charges":[{"gross_charge":2766.0,"discounted_cash":2766.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC THORACENTESIS NEEDLE/CATH PLEURA W/O IMAGING","code_information":[{"code":"3613255401","type":"CDM"},{"code":"0361","type":"RC"},{"code":"32554","type":"HCPCS"}],"standard_charges":[{"gross_charge":1296.0,"discounted_cash":1296.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC THORACENTESIS NEEDLE/CATH PLEURA W/IMAGING","code_information":[{"code":"3613255501","type":"CDM"},{"code":"0361","type":"RC"},{"code":"32555","type":"HCPCS"}],"standard_charges":[{"gross_charge":1571.0,"discounted_cash":1571.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PERQ DRAINAGE PLEURA INSERT CATH W/IMAGING","code_information":[{"code":"3613255701","type":"CDM"},{"code":"0361","type":"RC"},{"code":"32557","type":"HCPCS"}],"standard_charges":[{"gross_charge":2252.0,"discounted_cash":2252.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CATH UMBIL VEIN NEWBORN","code_information":[{"code":"3613651001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36510","type":"HCPCS"}],"standard_charges":[{"gross_charge":485.0,"discounted_cash":485.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INSERT NON-TUNNEL CV CATH","code_information":[{"code":"3613655601","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36556","type":"HCPCS"}],"standard_charges":[{"gross_charge":4051.0,"discounted_cash":4051.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INSERT TUNNELED CV CATH W/O PORT OR PUMP","code_information":[{"code":"3613655801","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36558","type":"HCPCS"}],"standard_charges":[{"gross_charge":10744.0,"discounted_cash":10744.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INSERT TUNNELED CV CATH W 2 ACCESS SITES, W/O PUMP OR PORT","code_information":[{"code":"3613656501","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36565","type":"HCPCS"}],"standard_charges":[{"gross_charge":18452.0,"discounted_cash":18452.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INSERT TUNNELED CV CATH W 2 ACCESS SITES, W/ PUMP OR PORT","code_information":[{"code":"3613656601","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36566","type":"HCPCS"}],"standard_charges":[{"gross_charge":31593.0,"discounted_cash":31593.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INSERT PICC W/O SUB-Q PORT <5 Y/O","code_information":[{"code":"3613656801","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36568","type":"HCPCS"}],"standard_charges":[{"gross_charge":8965.0,"discounted_cash":8965.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INSERTION PICC W/O IMG GDN 5 YR/>","code_information":[{"code":"3613656901","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36569","type":"HCPCS"}],"standard_charges":[{"gross_charge":2707.0,"discounted_cash":2707.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INSERT PICC W/ SUB-Q PORT","code_information":[{"code":"3613657101","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36571","type":"HCPCS"}],"standard_charges":[{"gross_charge":10585.0,"discounted_cash":10585.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INSERTION PICC W/RS&I 5 YR/>","code_information":[{"code":"3613657301","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36573","type":"HCPCS"}],"standard_charges":[{"gross_charge":7117.0,"discounted_cash":7117.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC REPLACE NON-TUNNELED CVC COMP W/O SUBQ PORT/PUMP","code_information":[{"code":"3613658001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36580","type":"HCPCS"}],"standard_charges":[{"gross_charge":10861.0,"discounted_cash":10861.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC REMOVAL TUNNELED CV CATH W/O SUBQ PORT OR PUMP","code_information":[{"code":"3613658901","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36589","type":"HCPCS"}],"standard_charges":[{"gross_charge":3998.0,"discounted_cash":3998.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC REMOVAL TUNNELED CV CATH W SUBQ PORT OR PUMP","code_information":[{"code":"3613659001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36590","type":"HCPCS"}],"standard_charges":[{"gross_charge":5765.0,"discounted_cash":5765.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DECLOT BY THROMBOLYTIC AGENT IMPLANT DEVICE/CATH","code_information":[{"code":"3613659301","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36593","type":"HCPCS"}],"standard_charges":[{"gross_charge":826.0,"discounted_cash":826.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CONTRAST INJ CENT VEN CATH, INC FLOURO","code_information":[{"code":"3613659801","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36598","type":"HCPCS"}],"standard_charges":[{"gross_charge":376.0,"discounted_cash":376.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INSERT CATH,ART,PERCUT,SHORTTERM","code_information":[{"code":"3613662001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36620","type":"HCPCS"}],"standard_charges":[{"gross_charge":517.0,"discounted_cash":517.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INSERT NEEDLE,INTRAOSSEOUS INFUSN","code_information":[{"code":"3613668001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36680","type":"HCPCS"}],"standard_charges":[{"gross_charge":421.0,"discounted_cash":421.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC VASCULAR SURGERY PROCEDURE UNLIST","code_information":[{"code":"3613779901","type":"CDM"},{"code":"0361","type":"RC"},{"code":"37799","type":"HCPCS"}],"standard_charges":[{"gross_charge":7265.0,"discounted_cash":7265.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DIAGNOSTIC BONE MARROW BIOPSIES & ASPIRATIONS","code_information":[{"code":"3613822201","type":"CDM"},{"code":"0361","type":"RC"},{"code":"38222","type":"HCPCS"}],"standard_charges":[{"gross_charge":7154.0,"discounted_cash":7154.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC NEEDLE BIOPSY, LYMPH NODE(S)","code_information":[{"code":"3613850501","type":"CDM"},{"code":"0361","type":"RC"},{"code":"38505","type":"HCPCS"}],"standard_charges":[{"gross_charge":3048.0,"discounted_cash":3048.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IDENTIFY SENTINEL NODE","code_information":[{"code":"3613879201","type":"CDM"},{"code":"0361","type":"RC"},{"code":"38792","type":"HCPCS"}],"standard_charges":[{"gross_charge":1539.0,"discounted_cash":1539.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC REPAIR LIP,FULL THICK,VERMILION","code_information":[{"code":"3614065001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"40650","type":"HCPCS"}],"standard_charges":[{"gross_charge":3269.0,"discounted_cash":3269.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC REPAIR LIP,<1/2 VERT HEIGHT","code_information":[{"code":"3614065201","type":"CDM"},{"code":"0361","type":"RC"},{"code":"40652","type":"HCPCS"}],"standard_charges":[{"gross_charge":3495.0,"discounted_cash":3495.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC REPAIR LIP >1/2 VERT HEIGHT/COMPLEX","code_information":[{"code":"3614065401","type":"CDM"},{"code":"0361","type":"RC"},{"code":"40654","type":"HCPCS"}],"standard_charges":[{"gross_charge":4340.0,"discounted_cash":4340.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DRAIN MOUTH ABSC/CYST/HEMATOMA,SIMPL","code_information":[{"code":"3614080001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"40800","type":"HCPCS"}],"standard_charges":[{"gross_charge":1247.0,"discounted_cash":1247.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC REMV FB MOUTH VESTIBULE SIMPL","code_information":[{"code":"3614080401","type":"CDM"},{"code":"0361","type":"RC"},{"code":"40804","type":"HCPCS"}],"standard_charges":[{"gross_charge":5481.0,"discounted_cash":5481.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BIOPSY OF MOUTH LESION","code_information":[{"code":"3614080801","type":"CDM"},{"code":"0361","type":"RC"},{"code":"40808","type":"HCPCS"}],"standard_charges":[{"gross_charge":3495.0,"discounted_cash":3495.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC EXCIS MOUTH MUCOSA/SUB,SIMPL REPAIR","code_information":[{"code":"3614081201","type":"CDM"},{"code":"0361","type":"RC"},{"code":"40812","type":"HCPCS"}],"standard_charges":[{"gross_charge":15950.0,"discounted_cash":15950.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC REPAIR MOUTH VESTIBULE >2.5 CM/COMPLEX","code_information":[{"code":"3614083101","type":"CDM"},{"code":"0361","type":"RC"},{"code":"40831","type":"HCPCS"}],"standard_charges":[{"gross_charge":3495.0,"discounted_cash":3495.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PBB I&D MOUTH/TONG INTRA,MASTICATOR","code_information":[{"code":"3614100901","type":"CDM"},{"code":"0361","type":"RC"},{"code":"41009","type":"HCPCS"}],"standard_charges":[{"gross_charge":3495.0,"discounted_cash":3495.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BIOPSY TONGUE,POSTER 1/3","code_information":[{"code":"3614110501","type":"CDM"},{"code":"0361","type":"RC"},{"code":"41105","type":"HCPCS"}],"standard_charges":[{"gross_charge":19751.0,"discounted_cash":19751.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC EXC TONGUE LESION W/ CLOSURE, ANT 2/3","code_information":[{"code":"3614111201","type":"CDM"},{"code":"0361","type":"RC"},{"code":"41112","type":"HCPCS"}],"standard_charges":[{"gross_charge":21181.0,"discounted_cash":21181.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC REPAIR TONGUE LACER,<2.6 CM","code_information":[{"code":"3614125001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"41250","type":"HCPCS"}],"standard_charges":[{"gross_charge":1333.0,"discounted_cash":1333.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC REPAIR TONGUE LACER,2.6 CM+/COMPLX","code_information":[{"code":"3614125201","type":"CDM"},{"code":"0361","type":"RC"},{"code":"41252","type":"HCPCS"}],"standard_charges":[{"gross_charge":2841.0,"discounted_cash":2841.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DRAINAGE OF GUM LESION","code_information":[{"code":"3614180001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"41800","type":"HCPCS"}],"standard_charges":[{"gross_charge":1186.0,"discounted_cash":1186.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DRAIN ABSC PALATE/UVULA","code_information":[{"code":"3614200001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"42000","type":"HCPCS"}],"standard_charges":[{"gross_charge":1832.0,"discounted_cash":1832.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BIOPSY PALATE/UVULA","code_information":[{"code":"3614210001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"42100","type":"HCPCS"}],"standard_charges":[{"gross_charge":9908.0,"discounted_cash":9908.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INC/DRAIN PERITONSIL ABSCESS","code_information":[{"code":"3614270001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"42700","type":"HCPCS"}],"standard_charges":[{"gross_charge":1960.0,"discounted_cash":1960.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BIOPSY OF OROPHARYNX","code_information":[{"code":"3614280001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"42800","type":"HCPCS"}],"standard_charges":[{"gross_charge":19394.0,"discounted_cash":19394.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC","code_information":[{"code":"3614323501","type":"CDM"},{"code":"0361","type":"RC"},{"code":"43235","type":"HCPCS"}],"standard_charges":[{"gross_charge":1696.0,"discounted_cash":1696.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC EGD TRANSORAL BIOPSY SINGLE/MULTIPLE","code_information":[{"code":"3614323901","type":"CDM"},{"code":"0361","type":"RC"},{"code":"43239","type":"HCPCS"}],"standard_charges":[{"gross_charge":1939.0,"discounted_cash":1939.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC EGD DILATION GASTRIC/DUODENAL STRICTURE - EGD","code_information":[{"code":"3614324502","type":"CDM"},{"code":"0361","type":"RC"},{"code":"43245","type":"HCPCS"}],"standard_charges":[{"gross_charge":2499.0,"discounted_cash":2499.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC EGD TRANSORAL CONTROL BLEEDING ANY METHOD","code_information":[{"code":"3614325501","type":"CDM"},{"code":"0361","type":"RC"},{"code":"43255","type":"HCPCS"}],"standard_charges":[{"gross_charge":2888.0,"discounted_cash":2888.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PLACEMENT NG/OG TUBE BY PHYSICIAN","code_information":[{"code":"3614375201","type":"CDM"},{"code":"0361","type":"RC"},{"code":"43752","type":"HCPCS"}],"standard_charges":[{"gross_charge":525.0,"discounted_cash":525.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PERQ REPLACEMENT GTUBE NOT REQ REVJ GSTRST TRC","code_information":[{"code":"3614376201","type":"CDM"},{"code":"0361","type":"RC"},{"code":"43762","type":"HCPCS"}],"standard_charges":[{"gross_charge":834.0,"discounted_cash":834.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INTRO LONG GI TUBE","code_information":[{"code":"3614450001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"44500","type":"HCPCS"}],"standard_charges":[{"gross_charge":496.0,"discounted_cash":496.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE","code_information":[{"code":"3614538001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"45380","type":"HCPCS"}],"standard_charges":[{"gross_charge":8636.0,"discounted_cash":8636.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RMV FECAL IMPACTION OR FOREIGN BODY W/ ANESTH","code_information":[{"code":"3614591501","type":"CDM"},{"code":"0361","type":"RC"},{"code":"45915","type":"HCPCS"}],"standard_charges":[{"gross_charge":15209.0,"discounted_cash":15209.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC I&D PERIRECTAL ABSCESS","code_information":[{"code":"3614604001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"46040","type":"HCPCS"}],"standard_charges":[{"gross_charge":7793.0,"discounted_cash":7793.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC I&D PERIANAL ABSCESS,SUPERFICIAL","code_information":[{"code":"3614605001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"46050","type":"HCPCS"}],"standard_charges":[{"gross_charge":5972.0,"discounted_cash":5972.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INCISE EXTERNAL HEMORRHOID","code_information":[{"code":"3614608301","type":"CDM"},{"code":"0361","type":"RC"},{"code":"46083","type":"HCPCS"}],"standard_charges":[{"gross_charge":990.0,"discounted_cash":990.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ANOSCOPY DX W/COLLJ SPEC BR/WA SPX WHEN PRFRMD","code_information":[{"code":"3614660001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"46600","type":"HCPCS"}],"standard_charges":[{"gross_charge":2124.0,"discounted_cash":2124.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC NEEDLE BIOPSY LIVER","code_information":[{"code":"3614700001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"47000","type":"HCPCS"}],"standard_charges":[{"gross_charge":1720.0,"discounted_cash":1720.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC NJX CHOLANGIO PRQ W/IMG GID RS&I EXISTING ACCESS","code_information":[{"code":"3614753101","type":"CDM"},{"code":"0361","type":"RC"},{"code":"47531","type":"HCPCS"}],"standard_charges":[{"gross_charge":1276.0,"discounted_cash":1276.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ABDOM PARACENTESIS DX/THER W IMAGING GUIDANCE","code_information":[{"code":"3614908301","type":"CDM"},{"code":"0361","type":"RC"},{"code":"49083","type":"HCPCS"}],"standard_charges":[{"gross_charge":1278.0,"discounted_cash":1278.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PERCUT BIOPSY, ABDOMINAL MASS","code_information":[{"code":"3614918001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"49180","type":"HCPCS"}],"standard_charges":[{"gross_charge":2282.0,"discounted_cash":2282.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IMAGE-GUIDE FLUID COLLXN DRAINAGE CATH VISC PERQ","code_information":[{"code":"3614940501","type":"CDM"},{"code":"0361","type":"RC"},{"code":"49405","type":"HCPCS"}],"standard_charges":[{"gross_charge":5597.0,"discounted_cash":5597.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IMG-GUIDE FLUID COLLXN DRAINAG CATH PERITON PERQ","code_information":[{"code":"3614940601","type":"CDM"},{"code":"0361","type":"RC"},{"code":"49406","type":"HCPCS"}],"standard_charges":[{"gross_charge":5597.0,"discounted_cash":5597.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DRAINAGE CATHETER EXCHANGE","code_information":[{"code":"3614942301","type":"CDM"},{"code":"0361","type":"RC"},{"code":"49423","type":"HCPCS"}],"standard_charges":[{"gross_charge":5506.14,"discounted_cash":5506.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CONTRAST INJECTION PERCUTANEOUOS RADIOLOGIC EVAL GI TUBE","code_information":[{"code":"3614946501","type":"CDM"},{"code":"0361","type":"RC"},{"code":"49465","type":"HCPCS"}],"standard_charges":[{"gross_charge":3250.0,"discounted_cash":3250.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BIOPSY OF KIDNEY,PERCUTANEOUS","code_information":[{"code":"3615020001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"50200","type":"HCPCS"}],"standard_charges":[{"gross_charge":2440.0,"discounted_cash":2440.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC NJX PX ANTEGRDE NFROSGRM &/URTRGRM EXSTNG ACESS","code_information":[{"code":"3615043101","type":"CDM"},{"code":"0361","type":"RC"},{"code":"50431","type":"HCPCS"}],"standard_charges":[{"gross_charge":2539.0,"discounted_cash":2539.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ABLATION RENAL TUMOR UNILATERAL PERQ CRYOTHERAPY","code_information":[{"code":"3615059301","type":"CDM"},{"code":"0361","type":"RC"},{"code":"50593","type":"HCPCS"}],"standard_charges":[{"gross_charge":39700.0,"discounted_cash":39700.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASPIRATION BLADDER INSERT SUPRAPUBIC CATHETER","code_information":[{"code":"3615110201","type":"CDM"},{"code":"0361","type":"RC"},{"code":"51102","type":"HCPCS"}],"standard_charges":[{"gross_charge":7560.0,"discounted_cash":7560.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INJECTION FOR BLADDER X-RAY","code_information":[{"code":"3615160001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"51600","type":"HCPCS"}],"standard_charges":[{"gross_charge":1142.0,"discounted_cash":1142.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INJECT FOR RETROGRADE URETHOCYSTO","code_information":[{"code":"3615161001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"51610","type":"HCPCS"}],"standard_charges":[{"gross_charge":1254.0,"discounted_cash":1254.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IRRIGATION OF BLADDER","code_information":[{"code":"3615170001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"51700","type":"HCPCS"}],"standard_charges":[{"gross_charge":1488.0,"discounted_cash":1488.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INSERT,NON-INDWELLING BLADDER CATHETER","code_information":[{"code":"3615170101","type":"CDM"},{"code":"0361","type":"RC"},{"code":"51701","type":"HCPCS"}],"standard_charges":[{"gross_charge":840.0,"discounted_cash":840.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INSERT,TEMP INDWELLING BLAD CATH,SIMPLE","code_information":[{"code":"3615170201","type":"CDM"},{"code":"0361","type":"RC"},{"code":"51702","type":"HCPCS"}],"standard_charges":[{"gross_charge":516.0,"discounted_cash":516.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INSERT,TEMP INDWELLING BLAD CATH,COMP","code_information":[{"code":"3615170301","type":"CDM"},{"code":"0361","type":"RC"},{"code":"51703","type":"HCPCS"}],"standard_charges":[{"gross_charge":1971.0,"discounted_cash":1971.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CHANGE OF BLADDER TUBE,SIMPLE","code_information":[{"code":"3615170501","type":"CDM"},{"code":"0361","type":"RC"},{"code":"51705","type":"HCPCS"}],"standard_charges":[{"gross_charge":539.0,"discounted_cash":539.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CHANGE OF BLADDER TUBE,COMPLICATED","code_information":[{"code":"3615171001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"51710","type":"HCPCS"}],"standard_charges":[{"gross_charge":4600.0,"discounted_cash":4600.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INSTILL ANTICANCER AGENT IN BLADDER","code_information":[{"code":"3615172001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"51720","type":"HCPCS"}],"standard_charges":[{"gross_charge":1313.0,"discounted_cash":1313.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC COMPLEX CYSTOMETROGRAM VOIDING PRESSURE STUDIES","code_information":[{"code":"3615172801","type":"CDM"},{"code":"0361","type":"RC"},{"code":"51728","type":"HCPCS"}],"standard_charges":[{"gross_charge":1651.0,"discounted_cash":1651.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC COMPLEX CYSTOMETROGRAM  W/VOID PRESS&URETHRAL PROFILE","code_information":[{"code":"3615172901","type":"CDM"},{"code":"0361","type":"RC"},{"code":"51729","type":"HCPCS"}],"standard_charges":[{"gross_charge":4655.0,"discounted_cash":4655.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MEAS,POST-VOID RES,US,NON-IMAGING","code_information":[{"code":"3615179801","type":"CDM"},{"code":"0361","type":"RC"},{"code":"51798","type":"HCPCS"}],"standard_charges":[{"gross_charge":98.0,"discounted_cash":98.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CYSTOURETHROSCOPY","code_information":[{"code":"36152000PB","type":"CDM"},{"code":"0361","type":"RC"},{"code":"52000","type":"HCPCS"}],"standard_charges":[{"gross_charge":1095.0,"discounted_cash":1095.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CYSTOURETHROSCOPY,BIOPSY","code_information":[{"code":"3615220401","type":"CDM"},{"code":"0361","type":"RC"},{"code":"52204","type":"HCPCS"}],"standard_charges":[{"gross_charge":12872.0,"discounted_cash":12872.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CYSTOSCOPY,DIL URETHRAL STRICTURE","code_information":[{"code":"3615228101","type":"CDM"},{"code":"0361","type":"RC"},{"code":"52281","type":"HCPCS"}],"standard_charges":[{"gross_charge":9963.0,"discounted_cash":9963.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CYSTOSCOPY,REMV CALCULUS,SIMPLE","code_information":[{"code":"3615231001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"52310","type":"HCPCS"}],"standard_charges":[{"gross_charge":10297.0,"discounted_cash":10297.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CYSTOSCOPY,REMV CALCULUS,COMPLIC","code_information":[{"code":"3615231501","type":"CDM"},{"code":"0361","type":"RC"},{"code":"52315","type":"HCPCS"}],"standard_charges":[{"gross_charge":12678.0,"discounted_cash":12678.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DILATE URETHRA STRICTURE MALE INIT","code_information":[{"code":"3615360001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"53600","type":"HCPCS"}],"standard_charges":[{"gross_charge":588.0,"discounted_cash":588.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DILATE URETHRA STRICTURE MALE SUBS","code_information":[{"code":"3615360101","type":"CDM"},{"code":"0361","type":"RC"},{"code":"53601","type":"HCPCS"}],"standard_charges":[{"gross_charge":344.0,"discounted_cash":344.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CIRCUMCISION W/ CLAMP OR DEVICE","code_information":[{"code":"3615415001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"54150","type":"HCPCS"}],"standard_charges":[{"gross_charge":12454.0,"discounted_cash":12454.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CIRCUMCISION,OTHR >28 DAYS OLD","code_information":[{"code":"3615416101","type":"CDM"},{"code":"0361","type":"RC"},{"code":"54161","type":"HCPCS"}],"standard_charges":[{"gross_charge":15954.0,"discounted_cash":15954.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IRRIGAT CORPUS CAVERN,PRIAPISM","code_information":[{"code":"3615422001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"54220","type":"HCPCS"}],"standard_charges":[{"gross_charge":1567.0,"discounted_cash":1567.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INJECT CORPORA CAVERN,PHARM AGNT","code_information":[{"code":"3615423501","type":"CDM"},{"code":"0361","type":"RC"},{"code":"54235","type":"HCPCS"}],"standard_charges":[{"gross_charge":1567.0,"discounted_cash":1567.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INCIS/DRAIN SCROTUM/TESTIS,EPIDIDYM","code_information":[{"code":"3615470001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"54700","type":"HCPCS"}],"standard_charges":[{"gross_charge":12454.0,"discounted_cash":12454.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DRAINAGE OF HYDROCELE,TUNICA","code_information":[{"code":"3615500001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"55000","type":"HCPCS"}],"standard_charges":[{"gross_charge":6401.0,"discounted_cash":6401.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DRAINAGE SCROTAL WALL ABSCESS","code_information":[{"code":"3615510001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"55100","type":"HCPCS"}],"standard_charges":[{"gross_charge":11949.0,"discounted_cash":11949.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC VASECTOMY","code_information":[{"code":"3615525001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"55250","type":"HCPCS"}],"standard_charges":[{"gross_charge":11342.0,"discounted_cash":11342.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BIOPSY OF PROSTATE,NEEDLE/PUNCH","code_information":[{"code":"3615570001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"55700","type":"HCPCS"}],"standard_charges":[{"gross_charge":3250.0,"discounted_cash":3250.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PLACE RADIOTHER DEVICE/MARKER, PROSTATE","code_information":[{"code":"3615587602","type":"CDM"},{"code":"0361","type":"RC"},{"code":"55876","type":"HCPCS"}],"standard_charges":[{"gross_charge":10768.0,"discounted_cash":10768.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC I&D OF VULVA/PERINEUM ABSCESS","code_information":[{"code":"3615640501","type":"CDM"},{"code":"0361","type":"RC"},{"code":"56405","type":"HCPCS"}],"standard_charges":[{"gross_charge":2616.0,"discounted_cash":2616.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC I&D BARTHOLIN GLAND ABSCESS","code_information":[{"code":"3615642001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"56420","type":"HCPCS"}],"standard_charges":[{"gross_charge":1594.0,"discounted_cash":1594.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BIOPSY VULVA/PERINEUM,ONE LESION","code_information":[{"code":"3615660501","type":"CDM"},{"code":"0361","type":"RC"},{"code":"56605","type":"HCPCS"}],"standard_charges":[{"gross_charge":6876.0,"discounted_cash":6876.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC COLPOSCOPY,VULVA,W/BIOPSY(S)","code_information":[{"code":"3615682101","type":"CDM"},{"code":"0361","type":"RC"},{"code":"56821","type":"HCPCS"}],"standard_charges":[{"gross_charge":3744.0,"discounted_cash":3744.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FIT/INSERT INTRAVAG SUPPORT DEVICE","code_information":[{"code":"3615716001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"57160","type":"HCPCS"}],"standard_charges":[{"gross_charge":1321.0,"discounted_cash":1321.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC COLPOSCOPY,ENTIRE VAGINA,W/BIOPSY(S)","code_information":[{"code":"3615742101","type":"CDM"},{"code":"0361","type":"RC"},{"code":"57421","type":"HCPCS"}],"standard_charges":[{"gross_charge":4876.0,"discounted_cash":4876.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC COLPOSCOPY,CERVIX W/ADJ VAGINA","code_information":[{"code":"3615745201","type":"CDM"},{"code":"0361","type":"RC"},{"code":"57452","type":"HCPCS"}],"standard_charges":[{"gross_charge":1217.0,"discounted_cash":1217.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC COLPOSC,CERVIX W/ADJ VAG,W/BX & CURRETAG","code_information":[{"code":"3615745401","type":"CDM"},{"code":"0361","type":"RC"},{"code":"57454","type":"HCPCS"}],"standard_charges":[{"gross_charge":1890.0,"discounted_cash":1890.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC COLPOSCOPY,CERVIX W/ADJ VAGINA,W/BX","code_information":[{"code":"3615745501","type":"CDM"},{"code":"0361","type":"RC"},{"code":"57455","type":"HCPCS"}],"standard_charges":[{"gross_charge":1614.0,"discounted_cash":1614.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC COLPOSCOPY,CERVIX W/ADJ VAGINA, CURETTAG","code_information":[{"code":"3615745601","type":"CDM"},{"code":"0361","type":"RC"},{"code":"57456","type":"HCPCS"}],"standard_charges":[{"gross_charge":1501.0,"discounted_cash":1501.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BIOPSY CERVIX, 1 OR MORE, OR EXCISION OF LESION","code_information":[{"code":"3615750001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"57500","type":"HCPCS"}],"standard_charges":[{"gross_charge":5064.0,"discounted_cash":5064.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CONIZATION CERVIX,LOOP ELECTRD","code_information":[{"code":"3615752201","type":"CDM"},{"code":"0361","type":"RC"},{"code":"57522","type":"HCPCS"}],"standard_charges":[{"gross_charge":21949.0,"discounted_cash":21949.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BIOPSY OF UTERUS LINING","code_information":[{"code":"3615810001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"58100","type":"HCPCS"}],"standard_charges":[{"gross_charge":2612.0,"discounted_cash":2612.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INSERT INTRAUTERINE DEVICE","code_information":[{"code":"3615830001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"58300","type":"HCPCS"}],"standard_charges":[{"gross_charge":3052.0,"discounted_cash":3052.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC REMOVE INTRAUTERINE DEVICE","code_information":[{"code":"3615830101","type":"CDM"},{"code":"0361","type":"RC"},{"code":"58301","type":"HCPCS"}],"standard_charges":[{"gross_charge":2192.0,"discounted_cash":2192.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CATH/INJECT HYSTEROSALPINGOGRAM","code_information":[{"code":"3615834001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"58340","type":"HCPCS"}],"standard_charges":[{"gross_charge":93.0,"discounted_cash":93.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HYSTEROSCOPY,W/ENDO BX","code_information":[{"code":"3615855801","type":"CDM"},{"code":"0361","type":"RC"},{"code":"58558","type":"HCPCS"}],"standard_charges":[{"gross_charge":5164.0,"discounted_cash":5164.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INSERT CERVICAL DILATOR","code_information":[{"code":"3615920001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"59200","type":"HCPCS"}],"standard_charges":[{"gross_charge":1364.0,"discounted_cash":1364.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ANTEPARTUM HEAD MANIPULATION","code_information":[{"code":"3615941201","type":"CDM"},{"code":"0361","type":"RC"},{"code":"59412","type":"HCPCS"}],"standard_charges":[{"gross_charge":2343.0,"discounted_cash":2343.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BIOPSY OF THYROID,PERCUT","code_information":[{"code":"3616010001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"60100","type":"HCPCS"}],"standard_charges":[{"gross_charge":1038.0,"discounted_cash":1038.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DIAGNOSTIC LUMBAR SPINAL PUNCTURE","code_information":[{"code":"3616227001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"62270","type":"HCPCS"}],"standard_charges":[{"gross_charge":1530.0,"discounted_cash":1530.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INJ,LUMB EPIDUR,BLOOD/CLOT PATCH","code_information":[{"code":"3616227301","type":"CDM"},{"code":"0361","type":"RC"},{"code":"62273","type":"HCPCS"}],"standard_charges":[{"gross_charge":1963.0,"discounted_cash":1963.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MYELOGRAPHY VIA LUMBAR INJECTION RS&I CERVICAL","code_information":[{"code":"3616230201","type":"CDM"},{"code":"0361","type":"RC"},{"code":"62302","type":"HCPCS"}],"standard_charges":[{"gross_charge":3580.0,"discounted_cash":3580.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MYELOGRAPHY VIA LUMBAR INJECT RS&I LUMBOSACRAL","code_information":[{"code":"3616230401","type":"CDM"},{"code":"0361","type":"RC"},{"code":"62304","type":"HCPCS"}],"standard_charges":[{"gross_charge":3580.0,"discounted_cash":3580.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN","code_information":[{"code":"3616232301","type":"CDM"},{"code":"0361","type":"RC"},{"code":"62323","type":"HCPCS"}],"standard_charges":[{"gross_charge":5615.0,"discounted_cash":5615.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DIAGNOSTIC LUMBAR SPINAL PUNCTURE W/FLUOR OR CT","code_information":[{"code":"3616232801","type":"CDM"},{"code":"0361","type":"RC"},{"code":"62328","type":"HCPCS"}],"standard_charges":[{"gross_charge":2170.0,"discounted_cash":2170.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC THERAPEUTIC SPINAL PNXR DRAINAGE CSF W/FLUOR/CT","code_information":[{"code":"3616232901","type":"CDM"},{"code":"0361","type":"RC"},{"code":"62329","type":"HCPCS"}],"standard_charges":[{"gross_charge":1817.0,"discounted_cash":1817.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PERCUT IMPLNT NEUROELECT,EPIDURAL","code_information":[{"code":"3616365001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"63650","type":"HCPCS"}],"standard_charges":[{"gross_charge":2382.0,"discounted_cash":2382.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IMPLANT SPINAL NEUROSTIM/RECEIVER","code_information":[{"code":"3616368501","type":"CDM"},{"code":"0361","type":"RC"},{"code":"63685","type":"HCPCS"}],"standard_charges":[{"gross_charge":2382.0,"discounted_cash":2382.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INJECTION AA&/STRD TRIGEMINAL NERVE EACH BRANCH","code_information":[{"code":"3616440001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"64400","type":"HCPCS"}],"standard_charges":[{"gross_charge":1699.0,"discounted_cash":1699.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INJECTION AA&/STRD GREATER OCCIPITAL NERVE","code_information":[{"code":"3616440501","type":"CDM"},{"code":"0361","type":"RC"},{"code":"64405","type":"HCPCS"}],"standard_charges":[{"gross_charge":1492.0,"discounted_cash":1492.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INJECTION AA&/STRD OTHER PERIPHERAL NERVE/BRANCH","code_information":[{"code":"3616445001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"64450","type":"HCPCS"}],"standard_charges":[{"gross_charge":1407.0,"discounted_cash":1407.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INJECTION AA&/STRD GENICULAR NERVE BRANCHES INCLUDING GUIDANCE","code_information":[{"code":"3616445401","type":"CDM"},{"code":"0361","type":"RC"},{"code":"64454","type":"HCPCS"}],"standard_charges":[{"gross_charge":3613.0,"discounted_cash":3613.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INJECT ANES/STEROID PLANTAR COMMON DIGITAL NERVE","code_information":[{"code":"3616445501","type":"CDM"},{"code":"0361","type":"RC"},{"code":"64455","type":"HCPCS"}],"standard_charges":[{"gross_charge":1187.0,"discounted_cash":1187.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INJECT ANES/STEROID FORAMEN CERV/THORACIC W IMG GUIDE ,1 LEVEL","code_information":[{"code":"3616447901","type":"CDM"},{"code":"0361","type":"RC"},{"code":"64479","type":"HCPCS"}],"standard_charges":[{"gross_charge":7747.0,"discounted_cash":7747.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL","code_information":[{"code":"3616448301","type":"CDM"},{"code":"0361","type":"RC"},{"code":"64483","type":"HCPCS"}],"standard_charges":[{"gross_charge":3406.0,"discounted_cash":3406.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,EA ADD LEVEL","code_information":[{"code":"3616448401","type":"CDM"},{"code":"0361","type":"RC"},{"code":"64484","type":"HCPCS"}],"standard_charges":[{"gross_charge":852.0,"discounted_cash":852.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INJ DX/THER AGNT PARAVERT FACET JOINT,IMG GUIDE,CERV/THORAC, 1ST LEVEL","code_information":[{"code":"3616449001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"64490","type":"HCPCS"}],"standard_charges":[{"gross_charge":6417.0,"discounted_cash":6417.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INJ DX/THER AGNT PARAVERT FACET JOINT,IMG GUIDE,CERV/THORAC, 2ND LEVEL","code_information":[{"code":"3616449101","type":"CDM"},{"code":"0361","type":"RC"},{"code":"64491","type":"HCPCS"}],"standard_charges":[{"gross_charge":2515.0,"discounted_cash":2515.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INJ DX/THER AGNT PARAVERT FACET JOINT,IMG GUIDE,LUMBAR/SAC, 1ST LEVEL","code_information":[{"code":"3616449301","type":"CDM"},{"code":"0361","type":"RC"},{"code":"64493","type":"HCPCS"}],"standard_charges":[{"gross_charge":3996.0,"discounted_cash":3996.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INJ DX/THER AGNT PARAVERT FACET JOINT,IMG GUIDE,LUMBAR/SAC, 2ND LEVEL","code_information":[{"code":"3616449401","type":"CDM"},{"code":"0361","type":"RC"},{"code":"64494","type":"HCPCS"}],"standard_charges":[{"gross_charge":1972.0,"discounted_cash":1972.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PERC IMPLNT NEUROST PERPH","code_information":[{"code":"3616455501","type":"CDM"},{"code":"0361","type":"RC"},{"code":"64555","type":"HCPCS"}],"standard_charges":[{"gross_charge":29123.0,"discounted_cash":29123.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC POST TIBIAL NEUROSTIMULATION,PERC NEEDLE ELECTRODE","code_information":[{"code":"3616456601","type":"CDM"},{"code":"0361","type":"RC"},{"code":"64566","type":"HCPCS"}],"standard_charges":[{"gross_charge":2583.0,"discounted_cash":2583.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CHEMODENERVATION FACIAL NERVE, UNI","code_information":[{"code":"3616461202","type":"CDM"},{"code":"0361","type":"RC"},{"code":"64612","type":"HCPCS"}],"standard_charges":[{"gross_charge":416.0,"discounted_cash":416.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CHEMODERVATE FACIAL/TRIGEM/CERV MUSC MIGRAINE","code_information":[{"code":"3616461501","type":"CDM"},{"code":"0361","type":"RC"},{"code":"64615","type":"HCPCS"}],"standard_charges":[{"gross_charge":2031.0,"discounted_cash":2031.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CHEMODENERVATION MUSCLE NECK UNILAT FOR DYSTONIA","code_information":[{"code":"3616461601","type":"CDM"},{"code":"0361","type":"RC"},{"code":"64616","type":"HCPCS"}],"standard_charges":[{"gross_charge":1699.0,"discounted_cash":1699.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DESTRUCTION NEUROLYTIC AGT GENICULAR NERVE W/IMG","code_information":[{"code":"3616462401","type":"CDM"},{"code":"0361","type":"RC"},{"code":"64624","type":"HCPCS"}],"standard_charges":[{"gross_charge":8218.0,"discounted_cash":8218.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC THERM DEST INTRAOSSEOUS BVN 1ST 2 LUM/SAC","code_information":[{"code":"3616462801","type":"CDM"},{"code":"0361","type":"RC"},{"code":"64628","type":"HCPCS"}],"standard_charges":[{"gross_charge":18646.0,"discounted_cash":18646.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC THERM DEST INTRAOSSEOUS BVN EA ADD LUM/SAC","code_information":[{"code":"3616462901","type":"CDM"},{"code":"0361","type":"RC"},{"code":"64629","type":"HCPCS"}],"standard_charges":[{"gross_charge":6688.0,"discounted_cash":6688.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DSTR NROLYTC AGNT PARVERTEB FCT SNGL CRVCL/THORA","code_information":[{"code":"3616463301","type":"CDM"},{"code":"0361","type":"RC"},{"code":"64633","type":"HCPCS"}],"standard_charges":[{"gross_charge":12290.0,"discounted_cash":12290.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DSTR NROLYTC AGNT PARVERTEB FCT ADDL CRVCL/THORA","code_information":[{"code":"3616463401","type":"CDM"},{"code":"0361","type":"RC"},{"code":"64634","type":"HCPCS"}],"standard_charges":[{"gross_charge":2804.0,"discounted_cash":2804.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DSTR NROLYTC AGNT PARVERTEB FCT SNGL LMBR/SACRAL","code_information":[{"code":"3616463501","type":"CDM"},{"code":"0361","type":"RC"},{"code":"64635","type":"HCPCS"}],"standard_charges":[{"gross_charge":7833.0,"discounted_cash":7833.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DSTR NROLYTC AGNT PARVERTEB FCT ADDL LMBR/SACRAL","code_information":[{"code":"3616463601","type":"CDM"},{"code":"0361","type":"RC"},{"code":"64636","type":"HCPCS"}],"standard_charges":[{"gross_charge":3126.0,"discounted_cash":3126.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CHEMODENERVATION ONE EXTREMITY 1-4 MUSCLE","code_information":[{"code":"3616464201","type":"CDM"},{"code":"0361","type":"RC"},{"code":"64642","type":"HCPCS"}],"standard_charges":[{"gross_charge":3445.0,"discounted_cash":3445.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CHEMODENERVATION ADDITIONAL EXTREMITY 1-4 MUSCLE","code_information":[{"code":"3616464301","type":"CDM"},{"code":"0361","type":"RC"},{"code":"64643","type":"HCPCS"}],"standard_charges":[{"gross_charge":1067.0,"discounted_cash":1067.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CHEMODENERVATION 1 EXTREMITY 5 OR MORE MUSCLES","code_information":[{"code":"3616464401","type":"CDM"},{"code":"0361","type":"RC"},{"code":"64644","type":"HCPCS"}],"standard_charges":[{"gross_charge":3800.0,"discounted_cash":3800.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CHEMODENERVATION OF TRUNK MUSCLES >5 MUSCLES","code_information":[{"code":"3616464701","type":"CDM"},{"code":"0361","type":"RC"},{"code":"64647","type":"HCPCS"}],"standard_charges":[{"gross_charge":3845.0,"discounted_cash":3845.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC REMV F.B.,EYE,SUPERF CONJUNC","code_information":[{"code":"3616520501","type":"CDM"},{"code":"0361","type":"RC"},{"code":"65205","type":"HCPCS"}],"standard_charges":[{"gross_charge":848.0,"discounted_cash":848.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC EYE RMV FOREIGN BODY CONJ/SUBCONJ/SCLER NONPERFORATING","code_information":[{"code":"3616521001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"65210","type":"HCPCS"}],"standard_charges":[{"gross_charge":1696.0,"discounted_cash":1696.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC REMV F.B.,EYE,CORNEA,NO SLIT","code_information":[{"code":"3616522001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"65220","type":"HCPCS"}],"standard_charges":[{"gross_charge":1448.0,"discounted_cash":1448.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC REMV F.B.,EYE,CORNEA,SLIT LAMP","code_information":[{"code":"3616522201","type":"CDM"},{"code":"0361","type":"RC"},{"code":"65222","type":"HCPCS"}],"standard_charges":[{"gross_charge":1713.0,"discounted_cash":1713.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC I&D EYELID BLEPHAROTOMY","code_information":[{"code":"3616770001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"67700","type":"HCPCS"}],"standard_charges":[{"gross_charge":1991.0,"discounted_cash":1991.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DRAIN EXT EAR ABSC/BLOOD,SIMPLE","code_information":[{"code":"3616900001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"69000","type":"HCPCS"}],"standard_charges":[{"gross_charge":815.0,"discounted_cash":815.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DRAIN EXT EAR ABSC/BLOOD,COMPLIC","code_information":[{"code":"3616900501","type":"CDM"},{"code":"0361","type":"RC"},{"code":"69005","type":"HCPCS"}],"standard_charges":[{"gross_charge":10544.0,"discounted_cash":10544.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BX BIOPSY OF EXT AUDITORY CANAL","code_information":[{"code":"3616910501","type":"CDM"},{"code":"0361","type":"RC"},{"code":"69105","type":"HCPCS"}],"standard_charges":[{"gross_charge":12907.0,"discounted_cash":12907.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC REMV EXT CANAL SOFT TISSUE LESN","code_information":[{"code":"3616914501","type":"CDM"},{"code":"0361","type":"RC"},{"code":"69145","type":"HCPCS"}],"standard_charges":[{"gross_charge":18162.0,"discounted_cash":18162.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC REMV EXT CANAL FOREIGN BODY","code_information":[{"code":"3616920001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"69200","type":"HCPCS"}],"standard_charges":[{"gross_charge":912.0,"discounted_cash":912.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC REMOVAL IMPACTED CERUMEN IRRIGATION/LVG UNILAT","code_information":[{"code":"3616920901","type":"CDM"},{"code":"0361","type":"RC"},{"code":"69209","type":"HCPCS"}],"standard_charges":[{"gross_charge":54.0,"discounted_cash":54.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC REMOVAL IMPACTED CERUMEN INSTRUMENTATION UNILAT","code_information":[{"code":"3616921001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"69210","type":"HCPCS"}],"standard_charges":[{"gross_charge":246.0,"discounted_cash":246.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INCISION EARDRUM ASP & EUST TUBE INF","code_information":[{"code":"3616942001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"69420","type":"HCPCS"}],"standard_charges":[{"gross_charge":679.0,"discounted_cash":679.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CREATE EARDRUM OPENING,LOC/TOP ANESTH","code_information":[{"code":"3616943301","type":"CDM"},{"code":"0361","type":"RC"},{"code":"69433","type":"HCPCS"}],"standard_charges":[{"gross_charge":1506.0,"discounted_cash":1506.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DEBRIDEMENT OPEN WOUND 20 SQ CM<","code_information":[{"code":"3619759701","type":"CDM"},{"code":"0361","type":"RC"},{"code":"97597","type":"HCPCS"}],"standard_charges":[{"gross_charge":534.0,"discounted_cash":534.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DEBRIDEMENT OPEN WOUND EA ADDL 20 SQ CM","code_information":[{"code":"3619759801","type":"CDM"},{"code":"0361","type":"RC"},{"code":"97598","type":"HCPCS"}],"standard_charges":[{"gross_charge":571.0,"discounted_cash":571.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC WOUND DEBRIDEMNT, NON-SELECTIVE, EA","code_information":[{"code":"3619760201","type":"CDM"},{"code":"0361","type":"RC"},{"code":"97602","type":"HCPCS"}],"standard_charges":[{"gross_charge":367.0,"discounted_cash":367.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC NEGATIVE PRESSURE WOUND THERAPY DME </= 50 SQ CM","code_information":[{"code":"3619760501","type":"CDM"},{"code":"0361","type":"RC"},{"code":"97605","type":"HCPCS"}],"standard_charges":[{"gross_charge":496.0,"discounted_cash":496.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC NEGATIVE PRESSURE WOUND THERAPY DME >50 SQ CM","code_information":[{"code":"3619760601","type":"CDM"},{"code":"0361","type":"RC"},{"code":"97606","type":"HCPCS"}],"standard_charges":[{"gross_charge":611.0,"discounted_cash":611.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC NEG PRESSURE WOUND THERAPY NON DME </= 50 SQ CM","code_information":[{"code":"3619760701","type":"CDM"},{"code":"0361","type":"RC"},{"code":"97607","type":"HCPCS"}],"standard_charges":[{"gross_charge":496.0,"discounted_cash":496.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC WOUND CLOSURE BY ADHESIVE","code_information":[{"code":"361G016801","type":"CDM"},{"code":"0361","type":"RC"},{"code":"G0168","type":"HCPCS"}],"standard_charges":[{"gross_charge":347.0,"discounted_cash":347.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GENERAL ANESTHESIA TIME - INITIAL 30 MINUTES","code_information":[{"code":"3700000001","type":"CDM"},{"code":"0370","type":"RC"}],"standard_charges":[{"gross_charge":3087.0,"discounted_cash":3087.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GENERAL ANESTHESIA TIME - EACH ADDL MINUTE","code_information":[{"code":"3700000002","type":"CDM"},{"code":"0370","type":"RC"}],"standard_charges":[{"gross_charge":37.0,"discounted_cash":37.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC REGIONAL ANESTHESIA TIME - INITIAL 30 MINUTES","code_information":[{"code":"3700000003","type":"CDM"},{"code":"0370","type":"RC"}],"standard_charges":[{"gross_charge":1341.0,"discounted_cash":1341.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC REGIONAL ANESTHESIA TIME - EACH ADDL MINUTE","code_information":[{"code":"3700000004","type":"CDM"},{"code":"0370","type":"RC"}],"standard_charges":[{"gross_charge":29.0,"discounted_cash":29.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MONITORED ANESTHESIA CARE ANESTHESIA TIME - INITIAL 30 MINUTES","code_information":[{"code":"3700000005","type":"CDM"},{"code":"0370","type":"RC"}],"standard_charges":[{"gross_charge":1643.0,"discounted_cash":1643.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MONITORED ANESTHESIA CARE ANESTHESIA TIME - EACH ADDL MINUTE","code_information":[{"code":"3700000006","type":"CDM"},{"code":"0370","type":"RC"}],"standard_charges":[{"gross_charge":30.0,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ANES LABOR EPIDURAL","code_information":[{"code":"3700000007","type":"CDM"},{"code":"0370","type":"RC"}],"standard_charges":[{"gross_charge":2340.0,"discounted_cash":2340.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MODERATE SEDATION TIME - INITIAL 15 MINUTES 5/> YEARS","code_information":[{"code":"3700000012","type":"CDM"},{"code":"0370","type":"RC"}],"standard_charges":[{"gross_charge":658.0,"discounted_cash":658.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MODERATE SEDATION TIME - EACH ADDITIONAL 15 MINUTES","code_information":[{"code":"3700000013","type":"CDM"},{"code":"0370","type":"RC"}],"standard_charges":[{"gross_charge":413.0,"discounted_cash":413.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC AN EPIDURAL BLOCK CHARGE","code_information":[{"code":"3700000014","type":"CDM"},{"code":"0370","type":"RC"}],"standard_charges":[{"gross_charge":2452.0,"discounted_cash":2452.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INJ,ANES AGENT,FEMORAL NERVE,SINGLE","code_information":[{"code":"3706444701","type":"CDM"},{"code":"0370","type":"RC"},{"code":"64447","type":"HCPCS"}],"standard_charges":[{"gross_charge":3981.0,"discounted_cash":3981.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MOD SED SAME PHYS/QHP INITIAL 15 MINS <5 YRS","code_information":[{"code":"3709915101","type":"CDM"},{"code":"0370","type":"RC"},{"code":"99151","type":"HCPCS"}],"standard_charges":[{"gross_charge":845.0,"discounted_cash":845.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MOD SED SAME PHYS/QHP INITIAL 15 MINS 5/> YRS","code_information":[{"code":"3709915201","type":"CDM"},{"code":"0370","type":"RC"},{"code":"99152","type":"HCPCS"}],"standard_charges":[{"gross_charge":845.0,"discounted_cash":845.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MOD SED SAME PHYS/QHP INIT 15 MINS 5/> YRS GI ONLY","code_information":[{"code":"3709915202","type":"CDM"},{"code":"0370","type":"RC"},{"code":"99152","type":"HCPCS"}],"standard_charges":[{"gross_charge":845.0,"discounted_cash":845.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MOD SED SAME PHYS/QHP EACH ADDL 15 MINS","code_information":[{"code":"3709915301","type":"CDM"},{"code":"0370","type":"RC"},{"code":"99153","type":"HCPCS"}],"standard_charges":[{"gross_charge":240.0,"discounted_cash":240.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MOD SED OTHER PHYS/QHP INITIAL 15 MINS <5 YRS","code_information":[{"code":"3709915501","type":"CDM"},{"code":"0370","type":"RC"},{"code":"99155","type":"HCPCS"}],"standard_charges":[{"gross_charge":845.0,"discounted_cash":845.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MOD SED OTHER PHYS/QHP INITIAL 15 MINS 5/> YRS","code_information":[{"code":"3709915601","type":"CDM"},{"code":"0370","type":"RC"},{"code":"99156","type":"HCPCS"}],"standard_charges":[{"gross_charge":845.0,"discounted_cash":845.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MOD SED OTHER PHYS/QHP EACH ADDL 15 MINS","code_information":[{"code":"3709915701","type":"CDM"},{"code":"0370","type":"RC"},{"code":"99157","type":"HCPCS"}],"standard_charges":[{"gross_charge":240.0,"discounted_cash":240.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BLOOD PRODUCT IRRADIATION - EACH","code_information":[{"code":"3908694501","type":"CDM"},{"code":"0390","type":"RC"},{"code":"86945","type":"HCPCS"}],"standard_charges":[{"gross_charge":166.0,"discounted_cash":166.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BLOOD PRODUCT - CRYOPRECIPITATE UNIT","code_information":[{"code":"390P901201","type":"CDM"},{"code":"0390","type":"RC"},{"code":"P9012","type":"HCPCS"}],"standard_charges":[{"gross_charge":189.0,"discounted_cash":189.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BLOOD PRODUCT - RBC LEUKO REDUCED UNIT","code_information":[{"code":"390P901601","type":"CDM"},{"code":"0390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":1102.0,"discounted_cash":1102.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BLOOD PRODUCT - PLATELET PHERESIS LEUKO REDUCED UNIT","code_information":[{"code":"390P903501","type":"CDM"},{"code":"0390","type":"RC"},{"code":"P9035","type":"HCPCS"}],"standard_charges":[{"gross_charge":1881.0,"discounted_cash":1881.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PLATELET PHERES LEUKOREDUCED LVDS","code_information":[{"code":"390P903502","type":"CDM"},{"code":"0390","type":"RC"},{"code":"P9035","type":"HCPCS"}],"standard_charges":[{"gross_charge":6930.0,"discounted_cash":6930.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PLATE PHERES LEUKOREDU IRRAD LVDS","code_information":[{"code":"390P903702","type":"CDM"},{"code":"0390","type":"RC"},{"code":"P9037","type":"HCPCS"}],"standard_charges":[{"gross_charge":8791.0,"discounted_cash":8791.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BLOOD PRODUCT - RBC LEUKO REDUCED IRRADIATED UNIT","code_information":[{"code":"390P904001","type":"CDM"},{"code":"0390","type":"RC"},{"code":"P9040","type":"HCPCS"}],"standard_charges":[{"gross_charge":1412.0,"discounted_cash":1412.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC WHOLE BLOOD LEUKOREDUCE IRRAD UNIT","code_information":[{"code":"390P905601","type":"CDM"},{"code":"0390","type":"RC"},{"code":"P9056","type":"HCPCS"}],"standard_charges":[{"gross_charge":1563.0,"discounted_cash":1563.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BLOOD PRODUCT - FRESH FROZEN PLASMA 24H UNIT","code_information":[{"code":"390P905901","type":"CDM"},{"code":"0390","type":"RC"},{"code":"P9059","type":"HCPCS"}],"standard_charges":[{"gross_charge":485.0,"discounted_cash":485.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BLOOD TRANSFUSION SERVICE","code_information":[{"code":"3913643001","type":"CDM"},{"code":"0391","type":"RC"},{"code":"36430","type":"HCPCS"}],"standard_charges":[{"gross_charge":1530.0,"discounted_cash":1530.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INTRAUTERINE TRANSFUSION FETAL","code_information":[{"code":"3913646001","type":"CDM"},{"code":"0391","type":"RC"},{"code":"36460","type":"HCPCS"}],"standard_charges":[{"gross_charge":4510.0,"discounted_cash":4510.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DIGITAL BREAST TOMOSYNTHESIS UNILATERAL","code_information":[{"code":"4017706101","type":"CDM"},{"code":"0401","type":"RC"},{"code":"77061","type":"HCPCS"}],"standard_charges":[{"gross_charge":168.0,"discounted_cash":168.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DIGITAL BREAST TOMOSYNTHESIS BILATERAL","code_information":[{"code":"4017706201","type":"CDM"},{"code":"0401","type":"RC"},{"code":"77062","type":"HCPCS"}],"standard_charges":[{"gross_charge":242.0,"discounted_cash":242.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI","code_information":[{"code":"4017706505","type":"CDM"},{"code":"0401","type":"RC"},{"code":"77065","type":"HCPCS"}],"standard_charges":[{"gross_charge":712.0,"discounted_cash":712.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI","code_information":[{"code":"4017706602","type":"CDM"},{"code":"0401","type":"RC"},{"code":"77066","type":"HCPCS"}],"standard_charges":[{"gross_charge":829.0,"discounted_cash":829.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RAD GUIDED,PERCUT DRAINAGE,W/CATH PLACE","code_information":[{"code":"4027598901","type":"CDM"},{"code":"0402","type":"RC"},{"code":"75989","type":"HCPCS"}],"standard_charges":[{"gross_charge":1806.0,"discounted_cash":1806.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC US 3D RENDERING W/INTERP & POSTPROCESS SUPERVISION","code_information":[{"code":"4027637601","type":"CDM"},{"code":"0402","type":"RC"},{"code":"76376","type":"HCPCS"}],"standard_charges":[{"gross_charge":686.0,"discounted_cash":686.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC US, HEAD, REAL TIME","code_information":[{"code":"4027650602","type":"CDM"},{"code":"0402","type":"RC"},{"code":"76506","type":"HCPCS"}],"standard_charges":[{"gross_charge":1051.0,"discounted_cash":1051.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC US, HEAD/NECK TISSUES,REAL TIME","code_information":[{"code":"4027653603","type":"CDM"},{"code":"0402","type":"RC"},{"code":"76536","type":"HCPCS"}],"standard_charges":[{"gross_charge":1054.0,"discounted_cash":1054.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC US, CHEST,REAL TIME","code_information":[{"code":"4027660401","type":"CDM"},{"code":"0402","type":"RC"},{"code":"76604","type":"HCPCS"}],"standard_charges":[{"gross_charge":1051.0,"discounted_cash":1051.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC US BREAST UNI REAL TIME WITH IMAGE COMPLETE","code_information":[{"code":"4027664102","type":"CDM"},{"code":"0402","type":"RC"},{"code":"76641","type":"HCPCS"}],"standard_charges":[{"gross_charge":574.0,"discounted_cash":574.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC US BREAST UNI REAL TIME WITH IMAGE LIMITED","code_information":[{"code":"4027664201","type":"CDM"},{"code":"0402","type":"RC"},{"code":"76642","type":"HCPCS"}],"standard_charges":[{"gross_charge":574.0,"discounted_cash":574.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE","code_information":[{"code":"4027670001","type":"CDM"},{"code":"0402","type":"RC"},{"code":"76700","type":"HCPCS"}],"standard_charges":[{"gross_charge":1319.0,"discounted_cash":1319.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC US, ABDOMEN LIMITED","code_information":[{"code":"4027670501","type":"CDM"},{"code":"0402","type":"RC"},{"code":"76705","type":"HCPCS"}],"standard_charges":[{"gross_charge":1088.0,"discounted_cash":1088.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC US ABDOMINAL AORTA REAL TIME SCREEN STUDY AAA","code_information":[{"code":"4027670601","type":"CDM"},{"code":"0402","type":"RC"},{"code":"76706","type":"HCPCS"}],"standard_charges":[{"gross_charge":989.0,"discounted_cash":989.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC US,RETROPERIT, B-SCAN/REAL TIME,COMPLETE","code_information":[{"code":"4027677002","type":"CDM"},{"code":"0402","type":"RC"},{"code":"76770","type":"HCPCS"}],"standard_charges":[{"gross_charge":1104.0,"discounted_cash":1104.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC US, RETROPERITNL ABD, LTD","code_information":[{"code":"4027677502","type":"CDM"},{"code":"0402","type":"RC"},{"code":"76775","type":"HCPCS"}],"standard_charges":[{"gross_charge":1005.0,"discounted_cash":1005.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC US,TRANSPLANTED KIDNEY, REAL TIME/ DOPPLER","code_information":[{"code":"4027677601","type":"CDM"},{"code":"0402","type":"RC"},{"code":"76776","type":"HCPCS"}],"standard_charges":[{"gross_charge":1821.0,"discounted_cash":1821.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC US, SPINAL CANAL & CONTENTS","code_information":[{"code":"4027680001","type":"CDM"},{"code":"0402","type":"RC"},{"code":"76800","type":"HCPCS"}],"standard_charges":[{"gross_charge":891.0,"discounted_cash":891.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC US, OB < 14 WKS, SINGLE FETUS","code_information":[{"code":"4027680101","type":"CDM"},{"code":"0402","type":"RC"},{"code":"76801","type":"HCPCS"}],"standard_charges":[{"gross_charge":984.0,"discounted_cash":984.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC US, OB >/= 14 WKS, SNGL FETUS","code_information":[{"code":"4027680501","type":"CDM"},{"code":"0402","type":"RC"},{"code":"76805","type":"HCPCS"}],"standard_charges":[{"gross_charge":1051.0,"discounted_cash":1051.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC US,PREGNANT UTERUS,LIMITED, 1/> FETUSES","code_information":[{"code":"4027681501","type":"CDM"},{"code":"0402","type":"RC"},{"code":"76815","type":"HCPCS"}],"standard_charges":[{"gross_charge":751.0,"discounted_cash":751.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC US,PREGNANT UTERUS,F/U,TRANSABD APP","code_information":[{"code":"4027681601","type":"CDM"},{"code":"0402","type":"RC"},{"code":"76816","type":"HCPCS"}],"standard_charges":[{"gross_charge":646.0,"discounted_cash":646.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC US,PREGNANT UTERUS,TRANSVAGINAL","code_information":[{"code":"4027681701","type":"CDM"},{"code":"0402","type":"RC"},{"code":"76817","type":"HCPCS"}],"standard_charges":[{"gross_charge":1171.0,"discounted_cash":1171.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FETAL BIOPHYSICAL PROFILE","code_information":[{"code":"4027681801","type":"CDM"},{"code":"0402","type":"RC"},{"code":"76818","type":"HCPCS"}],"standard_charges":[{"gross_charge":1051.0,"discounted_cash":1051.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FETAL BIOPHYS PROF,W/O NST","code_information":[{"code":"4027681901","type":"CDM"},{"code":"0402","type":"RC"},{"code":"76819","type":"HCPCS"}],"standard_charges":[{"gross_charge":1051.0,"discounted_cash":1051.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DOPPLER FETAL UMBILICAL ARTERY","code_information":[{"code":"4027682001","type":"CDM"},{"code":"0402","type":"RC"},{"code":"76820","type":"HCPCS"}],"standard_charges":[{"gross_charge":1461.0,"discounted_cash":1461.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ECHOGRAPHY,TRANSVAGINAL","code_information":[{"code":"4027683002","type":"CDM"},{"code":"0402","type":"RC"},{"code":"76830","type":"HCPCS"}],"standard_charges":[{"gross_charge":1003.0,"discounted_cash":1003.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ECHO,PELVIC (NONOBSTETRIC)","code_information":[{"code":"4027685601","type":"CDM"},{"code":"0402","type":"RC"},{"code":"76856","type":"HCPCS"}],"standard_charges":[{"gross_charge":1102.0,"discounted_cash":1102.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SONO PELVIS LIMITED","code_information":[{"code":"4027685701","type":"CDM"},{"code":"0402","type":"RC"},{"code":"76857","type":"HCPCS"}],"standard_charges":[{"gross_charge":1225.0,"discounted_cash":1225.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ECHO,SCROTUM & CONTENTS","code_information":[{"code":"4027687001","type":"CDM"},{"code":"0402","type":"RC"},{"code":"76870","type":"HCPCS"}],"standard_charges":[{"gross_charge":1099.0,"discounted_cash":1099.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ECHO,TRANSRECTAL","code_information":[{"code":"4027687201","type":"CDM"},{"code":"0402","type":"RC"},{"code":"76872","type":"HCPCS"}],"standard_charges":[{"gross_charge":1014.0,"discounted_cash":1014.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC US COMPLETE JOINT REAL TIME W IMAGE DOCUMENTATION","code_information":[{"code":"4027688121","type":"CDM"},{"code":"0402","type":"RC"},{"code":"76881","type":"HCPCS"}],"standard_charges":[{"gross_charge":1134.0,"discounted_cash":1134.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC US LMTD JOINT/OTH NONVASC XTR STRUX R-T W/IMG","code_information":[{"code":"4027688202","type":"CDM"},{"code":"0402","type":"RC"},{"code":"76882","type":"HCPCS"}],"standard_charges":[{"gross_charge":1051.0,"discounted_cash":1051.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC US GUIDE, VASCULAR ACCESS","code_information":[{"code":"4027693701","type":"CDM"},{"code":"0402","type":"RC"},{"code":"76937","type":"HCPCS"}],"standard_charges":[{"gross_charge":978.0,"discounted_cash":978.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SONO GUIDE NEEDLE BIOPSY","code_information":[{"code":"4027694232","type":"CDM"},{"code":"0402","type":"RC"},{"code":"76942","type":"HCPCS"}],"standard_charges":[{"gross_charge":772.0,"discounted_cash":772.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC VASCULAR STUDY - US ABDOMEN DOPPLER LIMITED","code_information":[{"code":"4029397601","type":"CDM"},{"code":"0402","type":"RC"},{"code":"93976","type":"HCPCS"}],"standard_charges":[{"gross_charge":1982.0,"discounted_cash":1982.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SCREENING DIGITAL BREAST TOMOSYNTHESIS BI","code_information":[{"code":"4037706302","type":"CDM"},{"code":"0403","type":"RC"},{"code":"77063","type":"HCPCS"}],"standard_charges":[{"gross_charge":105.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD","code_information":[{"code":"4037706702","type":"CDM"},{"code":"0403","type":"RC"},{"code":"77067","type":"HCPCS"}],"standard_charges":[{"gross_charge":663.0,"discounted_cash":663.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PET IMAGING WHOLE BODY","code_information":[{"code":"4047881301","type":"CDM"},{"code":"0404","type":"RC"},{"code":"78813","type":"HCPCS"}],"standard_charges":[{"gross_charge":10667.0,"discounted_cash":10667.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PET IMAGING CT ATTENUATION SKULL BASE MID-THIGH","code_information":[{"code":"4047881501","type":"CDM"},{"code":"0404","type":"RC"},{"code":"78815","type":"HCPCS"}],"standard_charges":[{"gross_charge":9919.0,"discounted_cash":9919.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PET IMAGING FOR CT ATTENUATION WHOLE BODY","code_information":[{"code":"4047881601","type":"CDM"},{"code":"0404","type":"RC"},{"code":"78816","type":"HCPCS"}],"standard_charges":[{"gross_charge":10911.0,"discounted_cash":10911.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RT VENT MGMT, INPATIENT, INITIAL DAY","code_information":[{"code":"4109400201","type":"CDM"},{"code":"0410","type":"RC"},{"code":"94002","type":"HCPCS"}],"standard_charges":[{"gross_charge":4375.0,"discounted_cash":4375.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RT VENT MGMT, INPATIENT, SUBQ DAY","code_information":[{"code":"4109400301","type":"CDM"},{"code":"0410","type":"RC"},{"code":"94003","type":"HCPCS"}],"standard_charges":[{"gross_charge":3706.0,"discounted_cash":3706.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RT HIGH FREQ OSCILLAT SUBSEQ DAY","code_information":[{"code":"4109400303","type":"CDM"},{"code":"0410","type":"RC"},{"code":"94003","type":"HCPCS"}],"standard_charges":[{"gross_charge":2276.0,"discounted_cash":2276.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RT INHALATION TREATMENT","code_information":[{"code":"4109464001","type":"CDM"},{"code":"0410","type":"RC"},{"code":"94640","type":"HCPCS"}],"standard_charges":[{"gross_charge":111.0,"discounted_cash":111.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RT MDI/DPI","code_information":[{"code":"4109464002","type":"CDM"},{"code":"0410","type":"RC"},{"code":"94640","type":"HCPCS"}],"standard_charges":[{"gross_charge":1079.0,"discounted_cash":1079.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RT INDUCED SPUTUM","code_information":[{"code":"4109464003","type":"CDM"},{"code":"0410","type":"RC"},{"code":"94640","type":"HCPCS"}],"standard_charges":[{"gross_charge":145.0,"discounted_cash":145.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RT HAND HELD NEBULIZER","code_information":[{"code":"4109464004","type":"CDM"},{"code":"0410","type":"RC"},{"code":"94640","type":"HCPCS"}],"standard_charges":[{"gross_charge":145.0,"discounted_cash":145.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RT PENTAMADINE TX","code_information":[{"code":"4109464201","type":"CDM"},{"code":"0410","type":"RC"},{"code":"94642","type":"HCPCS"}],"standard_charges":[{"gross_charge":1619.0,"discounted_cash":1619.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RT CPAP NON-EMERGENT","code_information":[{"code":"4109466001","type":"CDM"},{"code":"0410","type":"RC"},{"code":"94660","type":"HCPCS"}],"standard_charges":[{"gross_charge":3321.0,"discounted_cash":3321.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RT BIPAP NON-EMERGENT","code_information":[{"code":"4109466006","type":"CDM"},{"code":"0410","type":"RC"},{"code":"94660","type":"HCPCS"}],"standard_charges":[{"gross_charge":802.0,"discounted_cash":802.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DEMO &/OR EVAL,PT USE,AEROSOL DEVICE","code_information":[{"code":"4109466401","type":"CDM"},{"code":"0410","type":"RC"},{"code":"94664","type":"HCPCS"}],"standard_charges":[{"gross_charge":157.0,"discounted_cash":157.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CHEST WALL MANIPULATION,INITIAL","code_information":[{"code":"4109466701","type":"CDM"},{"code":"0410","type":"RC"},{"code":"94667","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":300.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CHEST WALL MANIPULATION,SUBSEQUENT","code_information":[{"code":"4109466801","type":"CDM"},{"code":"0410","type":"RC"},{"code":"94668","type":"HCPCS"}],"standard_charges":[{"gross_charge":270.0,"discounted_cash":270.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MECHANICAL CHEST WALL OSCILLATION LUNG FUNCTION","code_information":[{"code":"4109466901","type":"CDM"},{"code":"0410","type":"RC"},{"code":"94669","type":"HCPCS"}],"standard_charges":[{"gross_charge":405.0,"discounted_cash":405.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BREATH RECORDING, INFANT","code_information":[{"code":"4109477201","type":"CDM"},{"code":"0410","type":"RC"},{"code":"94772","type":"HCPCS"}],"standard_charges":[{"gross_charge":1900.0,"discounted_cash":1900.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC THERAPEUTIC PROCD STRG ENDUR","code_information":[{"code":"410G023701","type":"CDM"},{"code":"0410","type":"RC"},{"code":"G0237","type":"HCPCS"}],"standard_charges":[{"gross_charge":278.0,"discounted_cash":278.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OTH RESP PROC, GROUP","code_information":[{"code":"410G023901","type":"CDM"},{"code":"0410","type":"RC"},{"code":"G0239","type":"HCPCS"}],"standard_charges":[{"gross_charge":176.0,"discounted_cash":176.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HYPERBARIC OXYGEN THERAPY (HBO) PER 30 MIN","code_information":[{"code":"4139918301","type":"CDM"},{"code":"0413","type":"RC"},{"code":"99183","type":"HCPCS"}],"standard_charges":[{"gross_charge":802.0,"discounted_cash":802.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CANALITH REPOSITIONING PROCEDURE, PER DAY","code_information":[{"code":"4209599201","type":"CDM"},{"code":"0420","type":"RC"},{"code":"95992","type":"HCPCS"}],"standard_charges":[{"gross_charge":104.0,"discounted_cash":104.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PT THERAPEUTIC EXERCISES","code_information":[{"code":"4209711001","type":"CDM"},{"code":"0420","type":"RC"},{"code":"97110","type":"HCPCS"}],"standard_charges":[{"gross_charge":113.0,"discounted_cash":113.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PT NEUROMUSC REEDUCAT,1+ AREAS, EA 15 MIN","code_information":[{"code":"4209711201","type":"CDM"},{"code":"0420","type":"RC"},{"code":"97112","type":"HCPCS"}],"standard_charges":[{"gross_charge":122.0,"discounted_cash":122.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GAIT TRAINING THERAPY","code_information":[{"code":"4209711601","type":"CDM"},{"code":"0420","type":"RC"},{"code":"97116","type":"HCPCS"}],"standard_charges":[{"gross_charge":97.0,"discounted_cash":97.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PT MASSAGE THERAPY","code_information":[{"code":"4209712401","type":"CDM"},{"code":"0420","type":"RC"},{"code":"97124","type":"HCPCS"}],"standard_charges":[{"gross_charge":97.0,"discounted_cash":97.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PT MANUAL THER TECH,1+REGIONS,EA 15 MIN","code_information":[{"code":"4209714001","type":"CDM"},{"code":"0420","type":"RC"},{"code":"97140","type":"HCPCS"}],"standard_charges":[{"gross_charge":139.0,"discounted_cash":139.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PT GROUP THERAPEUTIC PROCEDURES","code_information":[{"code":"4209715001","type":"CDM"},{"code":"0420","type":"RC"},{"code":"97150","type":"HCPCS"}],"standard_charges":[{"gross_charge":66.0,"discounted_cash":66.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PT THERAPEUT ACTVITY DIRECT PT CONTACT EACH 15 MIN","code_information":[{"code":"4209753001","type":"CDM"},{"code":"0420","type":"RC"},{"code":"97530","type":"HCPCS"}],"standard_charges":[{"gross_charge":103.0,"discounted_cash":103.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PT SENSORY INTEGRATIVE TECHNIQUES EACH 15 MINUTES","code_information":[{"code":"4209753301","type":"CDM"},{"code":"0420","type":"RC"},{"code":"97533","type":"HCPCS"}],"standard_charges":[{"gross_charge":166.0,"discounted_cash":166.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PT SELF-CARE/HOME MGMT TRAINING EACH 15 MINUTES","code_information":[{"code":"4209753501","type":"CDM"},{"code":"0420","type":"RC"},{"code":"97535","type":"HCPCS"}],"standard_charges":[{"gross_charge":100.0,"discounted_cash":100.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PT WHEELCHAIR MNGEMENT TRAINING, EA 15 MIN","code_information":[{"code":"4209754201","type":"CDM"},{"code":"0420","type":"RC"},{"code":"97542","type":"HCPCS"}],"standard_charges":[{"gross_charge":117.0,"discounted_cash":117.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PT GROUP CAREGIVER TRAINING W/O PT","code_information":[{"code":"4209755201","type":"CDM"},{"code":"0420","type":"RC"},{"code":"97552","type":"HCPCS"}],"standard_charges":[{"gross_charge":28.0,"discounted_cash":28.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PT ORTHOTIC MGMT AND TRAINING, EACH 15 MIN","code_information":[{"code":"4209776001","type":"CDM"},{"code":"0420","type":"RC"},{"code":"97760","type":"HCPCS"}],"standard_charges":[{"gross_charge":147.0,"discounted_cash":147.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PT ORTHOTICS/PROSTH MGMT &/TRAINJ SBSQ ENCTR 15 MIN","code_information":[{"code":"4209776301","type":"CDM"},{"code":"0420","type":"RC"},{"code":"97763","type":"HCPCS"}],"standard_charges":[{"gross_charge":113.0,"discounted_cash":113.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PHYSICAL THERAPY EVALUATION LOW COMPLEX 20 MINS","code_information":[{"code":"4249716101","type":"CDM"},{"code":"0424","type":"RC"},{"code":"97161","type":"HCPCS"}],"standard_charges":[{"gross_charge":230.0,"discounted_cash":230.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PHYSICAL THERAPY EVALUATION MOD COMPLEX 30 MINS","code_information":[{"code":"4249716201","type":"CDM"},{"code":"0424","type":"RC"},{"code":"97162","type":"HCPCS"}],"standard_charges":[{"gross_charge":345.0,"discounted_cash":345.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PHYSICAL THERAPY EVALUATION HIGH COMPLEX 45 MINS","code_information":[{"code":"4249716301","type":"CDM"},{"code":"0424","type":"RC"},{"code":"97163","type":"HCPCS"}],"standard_charges":[{"gross_charge":517.0,"discounted_cash":517.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PHYSICAL THERAPY RE-EVAL EST PLAN CARE 20 MINS","code_information":[{"code":"4249716401","type":"CDM"},{"code":"0424","type":"RC"},{"code":"97164","type":"HCPCS"}],"standard_charges":[{"gross_charge":129.0,"discounted_cash":129.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OT APPLY FOREARM SPLINT,STATIC","code_information":[{"code":"4302912501","type":"CDM"},{"code":"0430","type":"RC"},{"code":"29125","type":"HCPCS"}],"standard_charges":[{"gross_charge":444.2,"discounted_cash":444.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OT STRAPPING OF KNEE","code_information":[{"code":"4302953001","type":"CDM"},{"code":"0430","type":"RC"},{"code":"29530","type":"HCPCS"}],"standard_charges":[{"gross_charge":807.18,"discounted_cash":807.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OT STRAPPING; ANKLE &/OR FOOT","code_information":[{"code":"4302954001","type":"CDM"},{"code":"0430","type":"RC"},{"code":"29540","type":"HCPCS"}],"standard_charges":[{"gross_charge":1137.06,"discounted_cash":1137.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OT STRAPPING OF TOES","code_information":[{"code":"4302955001","type":"CDM"},{"code":"0430","type":"RC"},{"code":"29550","type":"HCPCS"}],"standard_charges":[{"gross_charge":631.56,"discounted_cash":631.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OT CANALITH REPOSITIONING PROCEDURE, PER DAY","code_information":[{"code":"4309599202","type":"CDM"},{"code":"0430","type":"RC"},{"code":"95992","type":"HCPCS"}],"standard_charges":[{"gross_charge":104.0,"discounted_cash":104.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OT THERAPEUTIC EXERCISES","code_information":[{"code":"4309711001","type":"CDM"},{"code":"0430","type":"RC"},{"code":"97110","type":"HCPCS"}],"standard_charges":[{"gross_charge":113.0,"discounted_cash":113.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OT NEUROMUSC REEDUCAT,1+ AREAS, EA 15 MIN","code_information":[{"code":"4309711201","type":"CDM"},{"code":"0430","type":"RC"},{"code":"97112","type":"HCPCS"}],"standard_charges":[{"gross_charge":122.0,"discounted_cash":122.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OT AQUATIC THERAPY/EXERCISES","code_information":[{"code":"4309711301","type":"CDM"},{"code":"0430","type":"RC"},{"code":"97113","type":"HCPCS"}],"standard_charges":[{"gross_charge":120.0,"discounted_cash":120.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OT MASSAGE THERAPY","code_information":[{"code":"4309712401","type":"CDM"},{"code":"0430","type":"RC"},{"code":"97124","type":"HCPCS"}],"standard_charges":[{"gross_charge":102.0,"discounted_cash":102.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC  OT COGNITIVE SKILLS DEV INIT 15 MIN","code_information":[{"code":"4309712901","type":"CDM"},{"code":"0430","type":"RC"},{"code":"97129","type":"HCPCS"}],"standard_charges":[{"gross_charge":124.0,"discounted_cash":124.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC  OT COGNITIVE SKILLS DEV ADDITIONAL 15 MIN","code_information":[{"code":"4309713001","type":"CDM"},{"code":"0430","type":"RC"},{"code":"97130","type":"HCPCS"}],"standard_charges":[{"gross_charge":124.0,"discounted_cash":124.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OT MANUAL THER TECH,1+REGIONS,EA 15 MIN","code_information":[{"code":"4309714001","type":"CDM"},{"code":"0430","type":"RC"},{"code":"97140","type":"HCPCS"}],"standard_charges":[{"gross_charge":139.0,"discounted_cash":139.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OT GROUP THERAPEUTIC PROCEDURES","code_information":[{"code":"4309715001","type":"CDM"},{"code":"0430","type":"RC"},{"code":"97150","type":"HCPCS"}],"standard_charges":[{"gross_charge":63.0,"discounted_cash":63.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OT THERAPEUT ACTVITY DIRECT PT CONTACT EACH 15 MIN","code_information":[{"code":"4309753001","type":"CDM"},{"code":"0430","type":"RC"},{"code":"97530","type":"HCPCS"}],"standard_charges":[{"gross_charge":103.0,"discounted_cash":103.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OT SENSORY INTEGRATIVE TECHNIQUES EACH 15 MINUTES","code_information":[{"code":"4309753301","type":"CDM"},{"code":"0430","type":"RC"},{"code":"97533","type":"HCPCS"}],"standard_charges":[{"gross_charge":76.0,"discounted_cash":76.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OT SELF-CARE/HOME MGMT TRAINING EACH 15 MINUTES","code_information":[{"code":"4309753501","type":"CDM"},{"code":"0430","type":"RC"},{"code":"97535","type":"HCPCS"}],"standard_charges":[{"gross_charge":100.0,"discounted_cash":100.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OT COMMUNITY/WORK REINTEGRATION TRAINJ EA 15 MIN","code_information":[{"code":"4309753701","type":"CDM"},{"code":"0430","type":"RC"},{"code":"97537","type":"HCPCS"}],"standard_charges":[{"gross_charge":106.0,"discounted_cash":106.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OT ORTHOTIC MGMT AND TRAINING, EACH 15 MIN","code_information":[{"code":"4309776001","type":"CDM"},{"code":"0430","type":"RC"},{"code":"97760","type":"HCPCS"}],"standard_charges":[{"gross_charge":147.0,"discounted_cash":147.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OT ORTHOTICS/PROSTH MGMT &/TRAINJ SBSQ ENCTR 15 MIN","code_information":[{"code":"4309776301","type":"CDM"},{"code":"0430","type":"RC"},{"code":"97763","type":"HCPCS"}],"standard_charges":[{"gross_charge":58.0,"discounted_cash":58.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OCCUPATIONAL THERAPY EVAL LOW COMPLEX 30 MINS","code_information":[{"code":"4349716501","type":"CDM"},{"code":"0434","type":"RC"},{"code":"97165","type":"HCPCS"}],"standard_charges":[{"gross_charge":242.0,"discounted_cash":242.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OCCUPATIONAL THERAPY EVAL MOD COMPLEX 45 MINS","code_information":[{"code":"4349716601","type":"CDM"},{"code":"0434","type":"RC"},{"code":"97166","type":"HCPCS"}],"standard_charges":[{"gross_charge":363.0,"discounted_cash":363.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OCCUPATIONAL THERAPY EVAL HIGH COMPLEX 60 MINS","code_information":[{"code":"4349716701","type":"CDM"},{"code":"0434","type":"RC"},{"code":"97167","type":"HCPCS"}],"standard_charges":[{"gross_charge":484.0,"discounted_cash":484.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OCCUPATIONAL THER RE-EVAL EST PLAN CARE 30 MINS","code_information":[{"code":"4349716801","type":"CDM"},{"code":"0434","type":"RC"},{"code":"97168","type":"HCPCS"}],"standard_charges":[{"gross_charge":137.0,"discounted_cash":137.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SPEECH/HEARING THERAPY, INDIVIDUAL","code_information":[{"code":"4409250701","type":"CDM"},{"code":"0440","type":"RC"},{"code":"92507","type":"HCPCS"}],"standard_charges":[{"gross_charge":213.0,"discounted_cash":213.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SPEECH/HEARING THERAPY, GROUP","code_information":[{"code":"4409250801","type":"CDM"},{"code":"0440","type":"RC"},{"code":"92508","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.0,"discounted_cash":132.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ORAL FUNCTION THERAPY","code_information":[{"code":"4409252601","type":"CDM"},{"code":"0440","type":"RC"},{"code":"92526","type":"HCPCS"}],"standard_charges":[{"gross_charge":396.0,"discounted_cash":396.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC THER SRVC, SPEECH GEN DEV USE, W/PROG","code_information":[{"code":"4409260901","type":"CDM"},{"code":"0440","type":"RC"},{"code":"92609","type":"HCPCS"}],"standard_charges":[{"gross_charge":267.0,"discounted_cash":267.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC EVALUATION OF SPEECH FLUENCY (STUTTER CLUTTER)","code_information":[{"code":"4449252101","type":"CDM"},{"code":"0444","type":"RC"},{"code":"92521","type":"HCPCS"}],"standard_charges":[{"gross_charge":380.0,"discounted_cash":380.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC EVALUATION OF SPEECH SOUND PRODUCTION ARTICULATE","code_information":[{"code":"4449252201","type":"CDM"},{"code":"0444","type":"RC"},{"code":"92522","type":"HCPCS"}],"standard_charges":[{"gross_charge":309.0,"discounted_cash":309.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC EVAL SPEECH SOUND PRODUCT LANGUAGE COMPREHENSION","code_information":[{"code":"4449252301","type":"CDM"},{"code":"0444","type":"RC"},{"code":"92523","type":"HCPCS"}],"standard_charges":[{"gross_charge":640.0,"discounted_cash":640.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BEHAVIORAL & QUALIT ANALYSIS VOICE AND RESONANCE","code_information":[{"code":"4449252401","type":"CDM"},{"code":"0444","type":"RC"},{"code":"92524","type":"HCPCS"}],"standard_charges":[{"gross_charge":327.0,"discounted_cash":327.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC EVAL VOICE PROSTH DEVICE","code_information":[{"code":"4449259701","type":"CDM"},{"code":"0444","type":"RC"},{"code":"92597","type":"HCPCS"}],"standard_charges":[{"gross_charge":279.0,"discounted_cash":279.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC EVAL,SPEECH-GEN AUG/ALT COMM DEV,1ST HR","code_information":[{"code":"4449260701","type":"CDM"},{"code":"0444","type":"RC"},{"code":"92607","type":"HCPCS"}],"standard_charges":[{"gross_charge":500.0,"discounted_cash":500.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC EVAL,ORAL & PHARYNGEAL SWALLOW FUNCTION","code_information":[{"code":"4449261001","type":"CDM"},{"code":"0444","type":"RC"},{"code":"92610","type":"HCPCS"}],"standard_charges":[{"gross_charge":486.0,"discounted_cash":486.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC EVAL,SWALLOW FUNCTION,CINE/VIDEO RECORD","code_information":[{"code":"4449261101","type":"CDM"},{"code":"0444","type":"RC"},{"code":"92611","type":"HCPCS"}],"standard_charges":[{"gross_charge":508.0,"discounted_cash":508.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ENDOSCOPIC EVAL,SWALLOW,CINE/VIDEO","code_information":[{"code":"4449261201","type":"CDM"},{"code":"0444","type":"RC"},{"code":"92612","type":"HCPCS"}],"standard_charges":[{"gross_charge":269.0,"discounted_cash":269.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSESSMENT OF APHASIA","code_information":[{"code":"4449610501","type":"CDM"},{"code":"0444","type":"RC"},{"code":"96105","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":300.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC EMERGENCY DEPARTMENT SEXUAL ASSAULT EXAM","code_information":[{"code":"4500000001","type":"CDM"},{"code":"0450","type":"RC"}],"standard_charges":[{"gross_charge":1212.0,"discounted_cash":1212.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC EMERGENCY DEPARTMENT VISIT LEVEL 1","code_information":[{"code":"4509928101","type":"CDM"},{"code":"0450","type":"RC"},{"code":"99281","type":"HCPCS"}],"standard_charges":[{"gross_charge":428.0,"discounted_cash":428.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC EMERGENCY DEPT VISIT LEFT BEFORE SEEING PROVIDER","code_information":[{"code":"4509928103","type":"CDM"},{"code":"0450","type":"RC"},{"code":"99281","type":"HCPCS"}],"standard_charges":[{"gross_charge":400.0,"discounted_cash":400.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC EMERGENCY DEPARTMENT VISIT LEVEL 2","code_information":[{"code":"4509928201","type":"CDM"},{"code":"0450","type":"RC"},{"code":"99282","type":"HCPCS"}],"standard_charges":[{"gross_charge":717.0,"discounted_cash":717.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC EMERGENCY DEPARTMENT VISIT LEVEL 3","code_information":[{"code":"4509928301","type":"CDM"},{"code":"0450","type":"RC"},{"code":"99283","type":"HCPCS"}],"standard_charges":[{"gross_charge":1219.0,"discounted_cash":1219.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC EMERGENCY DEPARTMENT VISIT LEVEL 4","code_information":[{"code":"4509928401","type":"CDM"},{"code":"0450","type":"RC"},{"code":"99284","type":"HCPCS"}],"standard_charges":[{"gross_charge":2017.0,"discounted_cash":2017.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC EMERGENCY DEPARTMENT VISIT LEVEL 5","code_information":[{"code":"4509928501","type":"CDM"},{"code":"0450","type":"RC"},{"code":"99285","type":"HCPCS"}],"standard_charges":[{"gross_charge":3262.0,"discounted_cash":3262.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CRITICAL CARE, E/M 30-74 MINUTES","code_information":[{"code":"4509929101","type":"CDM"},{"code":"0450","type":"RC"},{"code":"99291","type":"HCPCS"}],"standard_charges":[{"gross_charge":6750.0,"discounted_cash":6750.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CRITICAL CARE, ADDL 30 MIN","code_information":[{"code":"4509929201","type":"CDM"},{"code":"0450","type":"RC"},{"code":"99292","type":"HCPCS"}],"standard_charges":[{"gross_charge":1673.0,"discounted_cash":1673.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BREATHING CAPACITY TEST","code_information":[{"code":"4609401002","type":"CDM"},{"code":"0460","type":"RC"},{"code":"94010","type":"HCPCS"}],"standard_charges":[{"gross_charge":431.0,"discounted_cash":431.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC EVAL OF BRONCHOSPASM","code_information":[{"code":"4609406001","type":"CDM"},{"code":"0460","type":"RC"},{"code":"94060","type":"HCPCS"}],"standard_charges":[{"gross_charge":557.0,"discounted_cash":557.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC VITAL CAPACITY TEST","code_information":[{"code":"4609415002","type":"CDM"},{"code":"0460","type":"RC"},{"code":"94150","type":"HCPCS"}],"standard_charges":[{"gross_charge":229.0,"discounted_cash":229.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC LUNG FUNCTION TEST (MBC/MVV)","code_information":[{"code":"4609420001","type":"CDM"},{"code":"0460","type":"RC"},{"code":"94200","type":"HCPCS"}],"standard_charges":[{"gross_charge":386.0,"discounted_cash":386.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RESPIRATORY FLOW VOLUME LOOP","code_information":[{"code":"4609437501","type":"CDM"},{"code":"0460","type":"RC"},{"code":"94375","type":"HCPCS"}],"standard_charges":[{"gross_charge":386.0,"discounted_cash":386.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PULMONARY STRESS TEST - SIMPLE","code_information":[{"code":"4609461801","type":"CDM"},{"code":"0460","type":"RC"},{"code":"94618","type":"HCPCS"}],"standard_charges":[{"gross_charge":1143.0,"discounted_cash":1143.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PLETHYSMOGRAPHY LUNG VOLUMES W/WO AIRWAY RESIST","code_information":[{"code":"4609472601","type":"CDM"},{"code":"0460","type":"RC"},{"code":"94726","type":"HCPCS"}],"standard_charges":[{"gross_charge":488.0,"discounted_cash":488.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GAS DILUT/WASHOUT LUNG VOL W/WO DISTRIB VENT&VOL","code_information":[{"code":"4609472701","type":"CDM"},{"code":"0460","type":"RC"},{"code":"94727","type":"HCPCS"}],"standard_charges":[{"gross_charge":488.0,"discounted_cash":488.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DIFFUSING CAPACITY","code_information":[{"code":"4609472901","type":"CDM"},{"code":"0460","type":"RC"},{"code":"94729","type":"HCPCS"}],"standard_charges":[{"gross_charge":782.0,"discounted_cash":782.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RT NONINVASV OXYGEN SATUR;SINGLE","code_information":[{"code":"4609476001","type":"CDM"},{"code":"0460","type":"RC"},{"code":"94760","type":"HCPCS"}],"standard_charges":[{"gross_charge":173.0,"discounted_cash":173.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC NONINVASV OXYGEN SATUR,MULTIPLE","code_information":[{"code":"4609476101","type":"CDM"},{"code":"0460","type":"RC"},{"code":"94761","type":"HCPCS"}],"standard_charges":[{"gross_charge":328.0,"discounted_cash":328.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC NONINVASV OXYGEN SATUT CONTINUOUS","code_information":[{"code":"4609476201","type":"CDM"},{"code":"0460","type":"RC"},{"code":"94762","type":"HCPCS"}],"standard_charges":[{"gross_charge":945.0,"discounted_cash":945.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CAR SEAT/BED TEST INFT THRU 12 MO 60 MIN","code_information":[{"code":"4609478001","type":"CDM"},{"code":"0460","type":"RC"},{"code":"94780","type":"HCPCS"}],"standard_charges":[{"gross_charge":482.0,"discounted_cash":482.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CAR SEAT/BED TESTNG W/INTERP & REPORT +30MIN","code_information":[{"code":"4609478101","type":"CDM"},{"code":"0460","type":"RC"},{"code":"94781","type":"HCPCS"}],"standard_charges":[{"gross_charge":241.0,"discounted_cash":241.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CALORIC VESTIBULAR TEST W/REC BI BITHERMAL","code_information":[{"code":"4719253701","type":"CDM"},{"code":"0471","type":"RC"},{"code":"92537","type":"HCPCS"}],"standard_charges":[{"gross_charge":1708.0,"discounted_cash":1708.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BASIC VESTIBULAR EVAL","code_information":[{"code":"4719254001","type":"CDM"},{"code":"0471","type":"RC"},{"code":"92540","type":"HCPCS"}],"standard_charges":[{"gross_charge":328.0,"discounted_cash":328.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SUPPLEMENTAL ELECTRICAL TEST","code_information":[{"code":"4719254701","type":"CDM"},{"code":"0471","type":"RC"},{"code":"92547","type":"HCPCS"}],"standard_charges":[{"gross_charge":851.0,"discounted_cash":851.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TYMPANOMETRY AND REFLEX THRESHOLD MEASUREMENTS","code_information":[{"code":"4719255001","type":"CDM"},{"code":"0471","type":"RC"},{"code":"92550","type":"HCPCS"}],"standard_charges":[{"gross_charge":1066.0,"discounted_cash":1066.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PURE TONE AUDIOMETRY, AIR","code_information":[{"code":"4719255201","type":"CDM"},{"code":"0471","type":"RC"},{"code":"92552","type":"HCPCS"}],"standard_charges":[{"gross_charge":701.0,"discounted_cash":701.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC AUDIOMETRY, AIR & BONE","code_information":[{"code":"4719255301","type":"CDM"},{"code":"0471","type":"RC"},{"code":"92553","type":"HCPCS"}],"standard_charges":[{"gross_charge":1026.0,"discounted_cash":1026.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SPEECH THRESHOLD AUDIOMETRY","code_information":[{"code":"4719255501","type":"CDM"},{"code":"0471","type":"RC"},{"code":"92555","type":"HCPCS"}],"standard_charges":[{"gross_charge":270.0,"discounted_cash":270.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SPEECH AUDIOMETRY, COMPLETE","code_information":[{"code":"4719255601","type":"CDM"},{"code":"0471","type":"RC"},{"code":"92556","type":"HCPCS"}],"standard_charges":[{"gross_charge":389.0,"discounted_cash":389.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC COMPREHENSIVE HEARING TEST","code_information":[{"code":"4719255701","type":"CDM"},{"code":"0471","type":"RC"},{"code":"92557","type":"HCPCS"}],"standard_charges":[{"gross_charge":295.0,"discounted_cash":295.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TYMPANOMETRY","code_information":[{"code":"4719256701","type":"CDM"},{"code":"0471","type":"RC"},{"code":"92567","type":"HCPCS"}],"standard_charges":[{"gross_charge":280.0,"discounted_cash":280.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ACOUSTIC IMMIT TEST TYMPANOMETRY/ACOUST REFLEX/DECAY","code_information":[{"code":"4719257001","type":"CDM"},{"code":"0471","type":"RC"},{"code":"92570","type":"HCPCS"}],"standard_charges":[{"gross_charge":129.0,"discounted_cash":129.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC VISUAL AUDIOMETRY (VRA)","code_information":[{"code":"4719257901","type":"CDM"},{"code":"0471","type":"RC"},{"code":"92579","type":"HCPCS"}],"standard_charges":[{"gross_charge":874.0,"discounted_cash":874.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ELECTROCOCHLEOGRAPHY","code_information":[{"code":"4719258401","type":"CDM"},{"code":"0471","type":"RC"},{"code":"92584","type":"HCPCS"}],"standard_charges":[{"gross_charge":1301.0,"discounted_cash":1301.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC EVOKED AUDITORY TEST,LIMITED","code_information":[{"code":"4719258701","type":"CDM"},{"code":"0471","type":"RC"},{"code":"92587","type":"HCPCS"}],"standard_charges":[{"gross_charge":526.0,"discounted_cash":526.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC AUD: AUDITORY EVOKED POTENTIALS, HEARING STATUS DETERMINATION AUTOMATED","code_information":[{"code":"4719265001","type":"CDM"},{"code":"0471","type":"RC"},{"code":"92650","type":"HCPCS"}],"standard_charges":[{"gross_charge":1250.0,"discounted_cash":1250.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC AUDITORY EVOKED POTENTIAL NEURODIAGNOSTIC WITH INTERP AND REPORT","code_information":[{"code":"4719265301","type":"CDM"},{"code":"0471","type":"RC"},{"code":"92653","type":"HCPCS"}],"standard_charges":[{"gross_charge":2192.0,"discounted_cash":2192.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CORONARY FRACT FLOW RESRV CTA DATA PREP AND TRANSMIT","code_information":[{"code":"4800502T01","type":"CDM"},{"code":"0480","type":"RC"},{"code":"0502T","type":"HCPCS"}],"standard_charges":[{"gross_charge":806.0,"discounted_cash":806.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CORONARY FRACT FLOW RESRV ANALYSIS AND MODELING","code_information":[{"code":"4800503T01","type":"CDM"},{"code":"0480","type":"RC"},{"code":"0503T","type":"HCPCS"}],"standard_charges":[{"gross_charge":5788.0,"discounted_cash":5788.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC NON-INVAS EST C-FFR SFTW ANAL CTA","code_information":[{"code":"4807558001","type":"CDM"},{"code":"0480","type":"RC"},{"code":"75580","type":"HCPCS"}],"standard_charges":[{"gross_charge":6469.0,"discounted_cash":6469.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HEART/LUNG RESUSCITATION (CPR)","code_information":[{"code":"4809295001","type":"CDM"},{"code":"0480","type":"RC"},{"code":"92950","type":"HCPCS"}],"standard_charges":[{"gross_charge":1265.0,"discounted_cash":1265.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CARDIOVERSION, ELECTIVE;EXTERN","code_information":[{"code":"4809296001","type":"CDM"},{"code":"0480","type":"RC"},{"code":"92960","type":"HCPCS"}],"standard_charges":[{"gross_charge":4223.0,"discounted_cash":4223.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PROGRAM EVAL IMPLANTABLE IN PERSN DUAL LD PACER","code_information":[{"code":"4809328006","type":"CDM"},{"code":"0480","type":"RC"},{"code":"93280","type":"HCPCS"}],"standard_charges":[{"gross_charge":461.0,"discounted_cash":461.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC EP PRGRMG EVAL IMPLANTABLE IN PRSN DUAL LEAD DFB","code_information":[{"code":"4809328301","type":"CDM"},{"code":"0480","type":"RC"},{"code":"93283","type":"HCPCS"}],"standard_charges":[{"gross_charge":303.0,"discounted_cash":303.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INTERROG DEV EVAL PM/LDLS PM PHYS/QHP IN PERSON","code_information":[{"code":"4809328805","type":"CDM"},{"code":"0480","type":"RC"},{"code":"93288","type":"HCPCS"}],"standard_charges":[{"gross_charge":130.0,"discounted_cash":130.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INTERROG DEVICE EVAL HEART - CARD DEVICE IN CLINIC - ICD","code_information":[{"code":"4809328903","type":"CDM"},{"code":"0480","type":"RC"},{"code":"93289","type":"HCPCS"}],"standard_charges":[{"gross_charge":321.0,"discounted_cash":321.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ILR DEVICE INTERROGAT REMOTE - CARD DEVICE REMOTE - LOOP RECORDER","code_information":[{"code":"4809329802","type":"CDM"},{"code":"0480","type":"RC"},{"code":"93298","type":"HCPCS"}],"standard_charges":[{"gross_charge":176.0,"discounted_cash":176.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OP PAD REHAB (SET)","code_information":[{"code":"4809366801","type":"CDM"},{"code":"0480","type":"RC"},{"code":"93668","type":"HCPCS"}],"standard_charges":[{"gross_charge":182.65,"discounted_cash":182.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ICM/ILR REMOTE TECH SERVICE","code_information":[{"code":"480G206601","type":"CDM"},{"code":"0480","type":"RC"},{"code":"G2066","type":"HCPCS"}],"standard_charges":[{"gross_charge":461.0,"discounted_cash":461.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CARDIAC STRESS TEST EXERCISE/PHARM - TRACING ONLY","code_information":[{"code":"4829301701","type":"CDM"},{"code":"0482","type":"RC"},{"code":"93017","type":"HCPCS"}],"standard_charges":[{"gross_charge":1059.0,"discounted_cash":1059.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CARDIAC STRESS TST,TRACING - STRESS TEST ONLY, EXERCISE","code_information":[{"code":"4829301702","type":"CDM"},{"code":"0482","type":"RC"},{"code":"93017","type":"HCPCS"}],"standard_charges":[{"gross_charge":1059.0,"discounted_cash":1059.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CARDIAC STRESS TST,TRACING - ECHOCARDIOGRAM EXERCISE STRESS TEST","code_information":[{"code":"4829301734","type":"CDM"},{"code":"0482","type":"RC"},{"code":"93017","type":"HCPCS"}],"standard_charges":[{"gross_charge":1059.0,"discounted_cash":1059.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CARDIAC STRESS TST,TRACING ONLY - COMPLETE ECHOCARDIOGRAM EXERCISE","code_information":[{"code":"4829301735","type":"CDM"},{"code":"0482","type":"RC"},{"code":"93017","type":"HCPCS"}],"standard_charges":[{"gross_charge":1059.0,"discounted_cash":1059.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CARDIAC STRESS TST,TRACING - STRESS TEST ONLY, PHARM","code_information":[{"code":"4829301752","type":"CDM"},{"code":"0482","type":"RC"},{"code":"93017","type":"HCPCS"}],"standard_charges":[{"gross_charge":1059.0,"discounted_cash":1059.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TTE W/DOPPLER COMPLETE - TTE COMPLETE","code_information":[{"code":"4839330602","type":"CDM"},{"code":"0483","type":"RC"},{"code":"93306","type":"HCPCS"}],"standard_charges":[{"gross_charge":2120.0,"discounted_cash":2120.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TTE W/DOPPLER W OR WO FOL W CONTRAST","code_information":[{"code":"4839330603","type":"CDM"},{"code":"0483","type":"RC"},{"code":"93306","type":"HCPCS"}],"standard_charges":[{"gross_charge":2120.0,"discounted_cash":2120.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TTE F-UP OR LMTD W OR WO FOL W CONTRAST","code_information":[{"code":"4839330807","type":"CDM"},{"code":"0483","type":"RC"},{"code":"93308","type":"HCPCS"}],"standard_charges":[{"gross_charge":2842.0,"discounted_cash":2842.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TTE F-UP OR LMTD - TTE LIMITED W/ COLOR","code_information":[{"code":"4839330809","type":"CDM"},{"code":"0483","type":"RC"},{"code":"93308","type":"HCPCS"}],"standard_charges":[{"gross_charge":2127.0,"discounted_cash":2127.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TTE F-UP OR LMTD - TTE LIMITED W/ DOPPLER AND COLOR","code_information":[{"code":"4839330810","type":"CDM"},{"code":"0483","type":"RC"},{"code":"93308","type":"HCPCS"}],"standard_charges":[{"gross_charge":719.0,"discounted_cash":719.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TTE F-UP OR LMTD W/ DOPPLER/COLOR W OR WO FOL W CONT","code_information":[{"code":"4839330811","type":"CDM"},{"code":"0483","type":"RC"},{"code":"93308","type":"HCPCS"}],"standard_charges":[{"gross_charge":3258.0,"discounted_cash":3258.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TEE COMPLETE W OR WO FOL W CONTRAST","code_information":[{"code":"4839331204","type":"CDM"},{"code":"0483","type":"RC"},{"code":"93312","type":"HCPCS"}],"standard_charges":[{"gross_charge":6120.0,"discounted_cash":6120.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ECHO TRANSESOPHAGEAL - TEE COMPLETE W/ DOPPLER & COLOR","code_information":[{"code":"4839331206","type":"CDM"},{"code":"0483","type":"RC"},{"code":"93312","type":"HCPCS"}],"standard_charges":[{"gross_charge":6818.0,"discounted_cash":6818.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ECHO TRANSESOPHAGEAL - TEE COMPLETE W/ COLOR","code_information":[{"code":"4839331208","type":"CDM"},{"code":"0483","type":"RC"},{"code":"93312","type":"HCPCS"}],"standard_charges":[{"gross_charge":5422.0,"discounted_cash":5422.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DOPPLER ECHO HEART,COMPLETE","code_information":[{"code":"4839332007","type":"CDM"},{"code":"0483","type":"RC"},{"code":"93320","type":"HCPCS"}],"standard_charges":[{"gross_charge":644.0,"discounted_cash":644.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DOPPLER ECHO HEART,LIMITED,F/U","code_information":[{"code":"4839332104","type":"CDM"},{"code":"0483","type":"RC"},{"code":"93321","type":"HCPCS"}],"standard_charges":[{"gross_charge":781.0,"discounted_cash":781.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DOPPLER COLOR FLOW VELOCITY MAP","code_information":[{"code":"4839332527","type":"CDM"},{"code":"0483","type":"RC"},{"code":"93325","type":"HCPCS"}],"standard_charges":[{"gross_charge":367.0,"discounted_cash":367.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC STRESS TTE W OR WO FOL W CONTRAST ECG","code_information":[{"code":"4839335002","type":"CDM"},{"code":"0483","type":"RC"},{"code":"93350","type":"HCPCS"}],"standard_charges":[{"gross_charge":1308.0,"discounted_cash":1308.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC STRESS TTE ONLY - ECHOCARDIOGRAM EXERCISE STRESS TEST","code_information":[{"code":"4839335003","type":"CDM"},{"code":"0483","type":"RC"},{"code":"93350","type":"HCPCS"}],"standard_charges":[{"gross_charge":1308.0,"discounted_cash":1308.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ECHO TTHRC R-T 2D W/WO M-MODE REST&STRS CONT ECG","code_information":[{"code":"4839335101","type":"CDM"},{"code":"0483","type":"RC"},{"code":"93351","type":"HCPCS"}],"standard_charges":[{"gross_charge":6818.0,"discounted_cash":6818.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MYOCRD STRAIN IMG SPECKLE TRCK ASSMT MYOCRD MECH","code_information":[{"code":"4839335601","type":"CDM"},{"code":"0483","type":"RC"},{"code":"93356","type":"HCPCS"}],"standard_charges":[{"gross_charge":831.0,"discounted_cash":831.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OFFICE OUTPATIENT NEW PT SF MDM","code_information":[{"code":"51099202PB","type":"CDM"},{"code":"0510","type":"RC"},{"code":"99202","type":"HCPCS"}],"standard_charges":[{"gross_charge":299.0,"discounted_cash":299.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OFFICE OUTPATIENT NEW PT LOW LVL MDM","code_information":[{"code":"51099203PB","type":"CDM"},{"code":"0510","type":"RC"},{"code":"99203","type":"HCPCS"}],"standard_charges":[{"gross_charge":339.0,"discounted_cash":339.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OFFICE OUTPATIENT NEW PT MOD LVL MDM","code_information":[{"code":"51099204PB","type":"CDM"},{"code":"0510","type":"RC"},{"code":"99204","type":"HCPCS"}],"standard_charges":[{"gross_charge":361.0,"discounted_cash":361.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OFFICE OUTPATIENT NEW PT HIGH LVL MDM","code_information":[{"code":"51099205PB","type":"CDM"},{"code":"0510","type":"RC"},{"code":"99205","type":"HCPCS"}],"standard_charges":[{"gross_charge":379.0,"discounted_cash":379.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OFFICE OUTPATIENT VISIT EST PT MINIMAL","code_information":[{"code":"51099211PB","type":"CDM"},{"code":"0510","type":"RC"},{"code":"99211","type":"HCPCS"}],"standard_charges":[{"gross_charge":201.0,"discounted_cash":201.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OFFICE OUTPATIENT VISIT EST PT SF MDM","code_information":[{"code":"51099212PB","type":"CDM"},{"code":"0510","type":"RC"},{"code":"99212","type":"HCPCS"}],"standard_charges":[{"gross_charge":326.0,"discounted_cash":326.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OFFICE OUTPATIENT VISIT EST PT LOW LVL MDM","code_information":[{"code":"51099213PB","type":"CDM"},{"code":"0510","type":"RC"},{"code":"99213","type":"HCPCS"}],"standard_charges":[{"gross_charge":343.0,"discounted_cash":343.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OFFICE OUTPATIENT VISIT EST PT MOD LVL MDM","code_information":[{"code":"51099214PB","type":"CDM"},{"code":"0510","type":"RC"},{"code":"99214","type":"HCPCS"}],"standard_charges":[{"gross_charge":361.0,"discounted_cash":361.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OFFICE OUTPATIENT VISIT EST PT HIGH LVL MDM","code_information":[{"code":"51099215PB","type":"CDM"},{"code":"0510","type":"RC"},{"code":"99215","type":"HCPCS"}],"standard_charges":[{"gross_charge":374.0,"discounted_cash":374.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OFFICE/OP CONSULT NEW/ESTAB PATIENT 20 MIN","code_information":[{"code":"5109924201","type":"CDM"},{"code":"0510","type":"RC"},{"code":"99242","type":"HCPCS"}],"standard_charges":[{"gross_charge":268.0,"discounted_cash":268.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PREVENT COUNSEL,INDIV,30 MIN","code_information":[{"code":"5109940201","type":"CDM"},{"code":"0510","type":"RC"},{"code":"99402","type":"HCPCS"}],"standard_charges":[{"gross_charge":68.0,"discounted_cash":68.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PREVENT COUNSEL INDIV 45 MIN","code_information":[{"code":"5109940301","type":"CDM"},{"code":"0510","type":"RC"},{"code":"99403","type":"HCPCS"}],"standard_charges":[{"gross_charge":91.0,"discounted_cash":91.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PREVENT COUNSEL INDIV 60 MIN","code_information":[{"code":"5109940401","type":"CDM"},{"code":"0510","type":"RC"},{"code":"99404","type":"HCPCS"}],"standard_charges":[{"gross_charge":108.0,"discounted_cash":108.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PBB TRANSITIONAL CARE MANAGE SERVICE 14 DAY DISCHRGE","code_information":[{"code":"51099495PB","type":"CDM"},{"code":"0510","type":"RC"},{"code":"99495","type":"HCPCS"}],"standard_charges":[{"gross_charge":1398.0,"discounted_cash":1398.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PBB TRANSITIONAL CARE MANAGE SERVICE 7 DAY DISCHARGE","code_information":[{"code":"51099496PB","type":"CDM"},{"code":"0510","type":"RC"},{"code":"99496","type":"HCPCS"}],"standard_charges":[{"gross_charge":1398.0,"discounted_cash":1398.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PROLONGED OFFICE /OP VISIT EACH ADDL 15 MIN","code_information":[{"code":"510G221201","type":"CDM"},{"code":"0510","type":"RC"},{"code":"G2212","type":"HCPCS"}],"standard_charges":[{"gross_charge":82.0,"discounted_cash":82.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OSTEOPATH MANIP TX 1-2 REGIONS","code_information":[{"code":"5309892501","type":"CDM"},{"code":"0530","type":"RC"},{"code":"98925","type":"HCPCS"}],"standard_charges":[{"gross_charge":101.0,"discounted_cash":101.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OSTEOPATH MANIP TX 3-4 REGIONS","code_information":[{"code":"5309892601","type":"CDM"},{"code":"0530","type":"RC"},{"code":"98926","type":"HCPCS"}],"standard_charges":[{"gross_charge":101.0,"discounted_cash":101.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OSTEOPATH MANIP TX 5-6 REGIONS","code_information":[{"code":"5309892701","type":"CDM"},{"code":"0530","type":"RC"},{"code":"98927","type":"HCPCS"}],"standard_charges":[{"gross_charge":101.0,"discounted_cash":101.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OSTEOPATH MANIP TX 7-8 REGIONS","code_information":[{"code":"5309892801","type":"CDM"},{"code":"0530","type":"RC"},{"code":"98928","type":"HCPCS"}],"standard_charges":[{"gross_charge":101.0,"discounted_cash":101.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OSTEOPATH MANIP TX 9-10 REGIONS","code_information":[{"code":"5309892901","type":"CDM"},{"code":"0530","type":"RC"},{"code":"98929","type":"HCPCS"}],"standard_charges":[{"gross_charge":101.0,"discounted_cash":101.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MRI, CHEST","code_information":[{"code":"6107155001","type":"CDM"},{"code":"0610","type":"RC"},{"code":"71550","type":"HCPCS"}],"standard_charges":[{"gross_charge":3994.0,"discounted_cash":3994.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MRI, CHEST, COMBO","code_information":[{"code":"6107155202","type":"CDM"},{"code":"0610","type":"RC"},{"code":"71552","type":"HCPCS"}],"standard_charges":[{"gross_charge":7374.0,"discounted_cash":7374.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MR SAFTEY IMPLANT & FOREIGN BODY ASSMT CLIN STAFF 1ST 15 MIN","code_information":[{"code":"6107601401","type":"CDM"},{"code":"0610","type":"RC"},{"code":"76014","type":"HCPCS"}],"standard_charges":[{"gross_charge":63.32,"discounted_cash":63.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MR SAFTEY IMPLANT & FOREIGN BODY ASSMT CLIN STAFF EA ADD 30 MIN","code_information":[{"code":"6107601501","type":"CDM"},{"code":"0610","type":"RC"},{"code":"76015","type":"HCPCS"}],"standard_charges":[{"gross_charge":126.63,"discounted_cash":126.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MR SAFETY DETERMINATION PHYSICIAN/OTHER QHP","code_information":[{"code":"6107601601","type":"CDM"},{"code":"0610","type":"RC"},{"code":"76016","type":"HCPCS"}],"standard_charges":[{"gross_charge":226.75,"discounted_cash":226.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MR SAFETY MED PHYSICS XM CUSTOMIZATION PLNG&MNTR","code_information":[{"code":"6107601701","type":"CDM"},{"code":"0610","type":"RC"},{"code":"76017","type":"HCPCS"}],"standard_charges":[{"gross_charge":624.82,"discounted_cash":624.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MR SAFETY IMPLT ELECTRONICS PREP SUPV PHYS/QHP","code_information":[{"code":"6107601801","type":"CDM"},{"code":"0610","type":"RC"},{"code":"76018","type":"HCPCS"}],"standard_charges":[{"gross_charge":237.69,"discounted_cash":237.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MR SAFETY IMPLANT POS/IMMOBL SUPV PHYS/QHP","code_information":[{"code":"6107601901","type":"CDM"},{"code":"0610","type":"RC"},{"code":"76019","type":"HCPCS"}],"standard_charges":[{"gross_charge":151.01,"discounted_cash":151.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MR 3D RENDERING W/INTERP&POSTPROC DIFF WORK STATION","code_information":[{"code":"6107637701","type":"CDM"},{"code":"0610","type":"RC"},{"code":"76377","type":"HCPCS"}],"standard_charges":[{"gross_charge":772.0,"discounted_cash":772.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MRI BREAST WO CONTRAST BILATERAL","code_information":[{"code":"6107704701","type":"CDM"},{"code":"0610","type":"RC"},{"code":"77047","type":"HCPCS"}],"standard_charges":[{"gross_charge":5282.0,"discounted_cash":5282.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MRI BRAIN","code_information":[{"code":"6117055102","type":"CDM"},{"code":"0611","type":"RC"},{"code":"70551","type":"HCPCS"}],"standard_charges":[{"gross_charge":3896.0,"discounted_cash":3896.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MRI BRAIN CONTRAST","code_information":[{"code":"6117055202","type":"CDM"},{"code":"0611","type":"RC"},{"code":"70552","type":"HCPCS"}],"standard_charges":[{"gross_charge":5604.0,"discounted_cash":5604.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MRI BRAIN COMBO","code_information":[{"code":"6117055302","type":"CDM"},{"code":"0611","type":"RC"},{"code":"70553","type":"HCPCS"}],"standard_charges":[{"gross_charge":7080.0,"discounted_cash":7080.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MRI, CERV SPINE","code_information":[{"code":"6127214102","type":"CDM"},{"code":"0612","type":"RC"},{"code":"72141","type":"HCPCS"}],"standard_charges":[{"gross_charge":5094.0,"discounted_cash":5094.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MRI, CERV SPINE CONTRAST","code_information":[{"code":"6127214201","type":"CDM"},{"code":"0612","type":"RC"},{"code":"72142","type":"HCPCS"}],"standard_charges":[{"gross_charge":5560.0,"discounted_cash":5560.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MRI, DORSAL SPINE","code_information":[{"code":"6127214602","type":"CDM"},{"code":"0612","type":"RC"},{"code":"72146","type":"HCPCS"}],"standard_charges":[{"gross_charge":3994.0,"discounted_cash":3994.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MRI, DORSAL SPINE CONTRAST","code_information":[{"code":"6127214701","type":"CDM"},{"code":"0612","type":"RC"},{"code":"72147","type":"HCPCS"}],"standard_charges":[{"gross_charge":5863.86,"discounted_cash":5863.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MRI, LUMBAR SPINE","code_information":[{"code":"6127214802","type":"CDM"},{"code":"0612","type":"RC"},{"code":"72148","type":"HCPCS"}],"standard_charges":[{"gross_charge":4104.0,"discounted_cash":4104.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MRI, LUMBAR SPINE CONTRAST","code_information":[{"code":"6127214901","type":"CDM"},{"code":"0612","type":"RC"},{"code":"72149","type":"HCPCS"}],"standard_charges":[{"gross_charge":5984.0,"discounted_cash":5984.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MRI, CERV SPINE COMBO","code_information":[{"code":"6127215601","type":"CDM"},{"code":"0612","type":"RC"},{"code":"72156","type":"HCPCS"}],"standard_charges":[{"gross_charge":7021.0,"discounted_cash":7021.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MRI, DORSAL SPINE COMBO","code_information":[{"code":"6127215701","type":"CDM"},{"code":"0612","type":"RC"},{"code":"72157","type":"HCPCS"}],"standard_charges":[{"gross_charge":7374.0,"discounted_cash":7374.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MRI, LUMBAR SPINE COMBO","code_information":[{"code":"6127215801","type":"CDM"},{"code":"0612","type":"RC"},{"code":"72158","type":"HCPCS"}],"standard_charges":[{"gross_charge":7540.0,"discounted_cash":7540.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MRI, TMJ","code_information":[{"code":"6147033601","type":"CDM"},{"code":"0614","type":"RC"},{"code":"70336","type":"HCPCS"}],"standard_charges":[{"gross_charge":4211.0,"discounted_cash":4211.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MRI, PELVIS, W/O CONTRAST","code_information":[{"code":"6147219501","type":"CDM"},{"code":"0614","type":"RC"},{"code":"72195","type":"HCPCS"}],"standard_charges":[{"gross_charge":5342.0,"discounted_cash":5342.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MRI, PELVIS W/CONTRAST","code_information":[{"code":"6147219601","type":"CDM"},{"code":"0614","type":"RC"},{"code":"72196","type":"HCPCS"}],"standard_charges":[{"gross_charge":5618.0,"discounted_cash":5618.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MRI, PELVIS, COMBO","code_information":[{"code":"6147219701","type":"CDM"},{"code":"0614","type":"RC"},{"code":"72197","type":"HCPCS"}],"standard_charges":[{"gross_charge":7047.0,"discounted_cash":7047.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MRI, UPPER EXTREMITY W/O CONTRAST","code_information":[{"code":"6147321803","type":"CDM"},{"code":"0614","type":"RC"},{"code":"73218","type":"HCPCS"}],"standard_charges":[{"gross_charge":4669.0,"discounted_cash":4669.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MRI UPPER EXTREMITY COMBO","code_information":[{"code":"6147322004","type":"CDM"},{"code":"0614","type":"RC"},{"code":"73220","type":"HCPCS"}],"standard_charges":[{"gross_charge":8289.0,"discounted_cash":8289.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MRI, JOINT UPPER EXTREM","code_information":[{"code":"6147322106","type":"CDM"},{"code":"0614","type":"RC"},{"code":"73221","type":"HCPCS"}],"standard_charges":[{"gross_charge":4840.0,"discounted_cash":4840.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MRI, JOINT UPPER EXTREM W/CONTRAST","code_information":[{"code":"6147322205","type":"CDM"},{"code":"0614","type":"RC"},{"code":"73222","type":"HCPCS"}],"standard_charges":[{"gross_charge":4966.0,"discounted_cash":4966.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MRI, JOINT UPPER EXTREM COMBO","code_information":[{"code":"6147322306","type":"CDM"},{"code":"0614","type":"RC"},{"code":"73223","type":"HCPCS"}],"standard_charges":[{"gross_charge":8289.0,"discounted_cash":8289.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MRI, LOWER EXTREM","code_information":[{"code":"6147371806","type":"CDM"},{"code":"0614","type":"RC"},{"code":"73718","type":"HCPCS"}],"standard_charges":[{"gross_charge":3954.0,"discounted_cash":3954.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MRI LWR EXTREMITY W/O&W/DYE - MR LOWER EXTREMITY W AND WO IV CONT","code_information":[{"code":"6147372008","type":"CDM"},{"code":"0614","type":"RC"},{"code":"73720","type":"HCPCS"}],"standard_charges":[{"gross_charge":7320.0,"discounted_cash":7320.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MRI LOWER EXTREMITY JOINT, W/O CONTRAST","code_information":[{"code":"6147372103","type":"CDM"},{"code":"0614","type":"RC"},{"code":"73721","type":"HCPCS"}],"standard_charges":[{"gross_charge":4104.0,"discounted_cash":4104.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MRI, JOINT OF LEG W/CONTRAST","code_information":[{"code":"6147372207","type":"CDM"},{"code":"0614","type":"RC"},{"code":"73722","type":"HCPCS"}],"standard_charges":[{"gross_charge":5821.0,"discounted_cash":5821.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MRI, JOINT OF LEG. COMBO - MR LOWER EXTREMITY W AND WO IV CONTRAST","code_information":[{"code":"6147372305","type":"CDM"},{"code":"0614","type":"RC"},{"code":"73723","type":"HCPCS"}],"standard_charges":[{"gross_charge":7320.0,"discounted_cash":7320.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MRI, ABDOMEN (MRI)","code_information":[{"code":"6147418102","type":"CDM"},{"code":"0614","type":"RC"},{"code":"74181","type":"HCPCS"}],"standard_charges":[{"gross_charge":4109.0,"discounted_cash":4109.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MRI, ABDOMEN W/CONTRAST","code_information":[{"code":"6147418202","type":"CDM"},{"code":"0614","type":"RC"},{"code":"74182","type":"HCPCS"}],"standard_charges":[{"gross_charge":5821.0,"discounted_cash":5821.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MRI, ABDOMEN, COMBO","code_information":[{"code":"6147418303","type":"CDM"},{"code":"0614","type":"RC"},{"code":"74183","type":"HCPCS"}],"standard_charges":[{"gross_charge":7320.0,"discounted_cash":7320.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MRI BREAST W/WO CONTRAST W/ CAD","code_information":[{"code":"6147704801","type":"CDM"},{"code":"0614","type":"RC"},{"code":"77048","type":"HCPCS"}],"standard_charges":[{"gross_charge":6757.0,"discounted_cash":6757.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MRI BREAST W/WO CONTRAST W/ CAD BILATERAL","code_information":[{"code":"6147704901","type":"CDM"},{"code":"0614","type":"RC"},{"code":"77049","type":"HCPCS"}],"standard_charges":[{"gross_charge":9095.0,"discounted_cash":9095.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MRI, FACE, NECK","code_information":[{"code":"6157054002","type":"CDM"},{"code":"0615","type":"RC"},{"code":"70540","type":"HCPCS"}],"standard_charges":[{"gross_charge":3754.0,"discounted_cash":3754.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MRI, FACE, NECK W/CONTRAST","code_information":[{"code":"6157054202","type":"CDM"},{"code":"0615","type":"RC"},{"code":"70542","type":"HCPCS"}],"standard_charges":[{"gross_charge":5469.0,"discounted_cash":5469.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MRI, FACE, NECK, COMBO","code_information":[{"code":"6157054302","type":"CDM"},{"code":"0615","type":"RC"},{"code":"70543","type":"HCPCS"}],"standard_charges":[{"gross_charge":6872.0,"discounted_cash":6872.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MRA HEAD W/O CONTRAST","code_information":[{"code":"6157054401","type":"CDM"},{"code":"0615","type":"RC"},{"code":"70544","type":"HCPCS"}],"standard_charges":[{"gross_charge":3891.0,"discounted_cash":3891.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MR ANGIO, HEAD, COMBO","code_information":[{"code":"6157054601","type":"CDM"},{"code":"0615","type":"RC"},{"code":"70546","type":"HCPCS"}],"standard_charges":[{"gross_charge":6557.0,"discounted_cash":6557.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MRA NECK W/O CONTRAST","code_information":[{"code":"6157054701","type":"CDM"},{"code":"0615","type":"RC"},{"code":"70547","type":"HCPCS"}],"standard_charges":[{"gross_charge":3746.0,"discounted_cash":3746.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MR ANGIO, NECK, COMBO","code_information":[{"code":"6157054901","type":"CDM"},{"code":"0615","type":"RC"},{"code":"70549","type":"HCPCS"}],"standard_charges":[{"gross_charge":6869.0,"discounted_cash":6869.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MRA CHEST WO CONTRAST","code_information":[{"code":"6187155503","type":"CDM"},{"code":"0618","type":"RC"},{"code":"71555","type":"HCPCS"}],"standard_charges":[{"gross_charge":3345.28,"discounted_cash":3345.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MRA ABDOMEN W/WO CONTRAST","code_information":[{"code":"618C890201","type":"CDM"},{"code":"0618","type":"RC"},{"code":"C8902","type":"HCPCS"}],"standard_charges":[{"gross_charge":8544.0,"discounted_cash":8544.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MRA CHEST W/WO CONTRAST","code_information":[{"code":"618C891101","type":"CDM"},{"code":"0618","type":"RC"},{"code":"C8911","type":"HCPCS"}],"standard_charges":[{"gross_charge":7318.0,"discounted_cash":7318.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RHO(D) RHOGAM 300MCG NDC 00562780501","code_information":[{"code":"636J279001","type":"CDM"},{"code":"0636","type":"RC"},{"code":"J2790","type":"HCPCS"}],"standard_charges":[{"gross_charge":236.59,"discounted_cash":236.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RHIG RHOPHYLAC 300MCG/2ML NDC 44206030001","code_information":[{"code":"636J279102","type":"CDM"},{"code":"0636","type":"RC"},{"code":"J2791","type":"HCPCS"}],"standard_charges":[{"gross_charge":13.37,"discounted_cash":13.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC APPLY RIGID LEG CAST","code_information":[{"code":"7002944501","type":"CDM"},{"code":"0700","type":"RC"},{"code":"29445","type":"HCPCS"}],"standard_charges":[{"gross_charge":1267.0,"discounted_cash":1267.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CAST REMOVAL","code_information":[{"code":"7002970001","type":"CDM"},{"code":"0700","type":"RC"},{"code":"29700","type":"HCPCS"}],"standard_charges":[{"gross_charge":529.0,"discounted_cash":529.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PACU RECOVERY PHASE 1 - INITIAL 30 MINUTES","code_information":[{"code":"7100000003","type":"CDM"},{"code":"0710","type":"RC"}],"standard_charges":[{"gross_charge":1251.0,"discounted_cash":1251.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PACU RECOVERY PHASE 1 - EACH ADDL MIN","code_information":[{"code":"7100000004","type":"CDM"},{"code":"0710","type":"RC"}],"standard_charges":[{"gross_charge":10.0,"discounted_cash":10.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PACU RECOVERY PHASE 2 - INITIAL 30 MINUTES","code_information":[{"code":"7100000005","type":"CDM"},{"code":"0710","type":"RC"}],"standard_charges":[{"gross_charge":416.0,"discounted_cash":416.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PACU RECOVERY PHASE 2 - EACH ADDL MIN","code_information":[{"code":"7100000006","type":"CDM"},{"code":"0710","type":"RC"}],"standard_charges":[{"gross_charge":8.0,"discounted_cash":8.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FETAL CONTRACTN STRESS TEST","code_information":[{"code":"7205902001","type":"CDM"},{"code":"0720","type":"RC"},{"code":"59020","type":"HCPCS"}],"standard_charges":[{"gross_charge":511.0,"discounted_cash":511.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FETAL NON-STRESS TEST","code_information":[{"code":"7205902501","type":"CDM"},{"code":"0720","type":"RC"},{"code":"59025","type":"HCPCS"}],"standard_charges":[{"gross_charge":471.0,"discounted_cash":471.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OBSTETRICAL CARE,VAG DELIVERY ROUTINE","code_information":[{"code":"7205940901","type":"CDM"},{"code":"0720","type":"RC"},{"code":"59409","type":"HCPCS"}],"standard_charges":[{"gross_charge":4721.0,"discounted_cash":4721.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OBSTETRICAL CARE,VAG DELIVERY COMPLEX","code_information":[{"code":"7205940902","type":"CDM"},{"code":"0720","type":"RC"},{"code":"59409","type":"HCPCS"}],"standard_charges":[{"gross_charge":5879.0,"discounted_cash":5879.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DELIVER PLACENTA","code_information":[{"code":"7225941401","type":"CDM"},{"code":"0722","type":"RC"},{"code":"59414","type":"HCPCS"}],"standard_charges":[{"gross_charge":2916.0,"discounted_cash":2916.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DELIVERY/BIRTHING ROOM RESUSCITATION","code_information":[{"code":"7229946501","type":"CDM"},{"code":"0722","type":"RC"},{"code":"99465","type":"HCPCS"}],"standard_charges":[{"gross_charge":652.0,"discounted_cash":652.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CIRCUMCISION,OTHR,NEWBORN","code_information":[{"code":"7230000001","type":"CDM"},{"code":"0723","type":"RC"}],"standard_charges":[{"gross_charge":1212.0,"discounted_cash":1212.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ELECTROCARDIOGRAM, TRACING - ECG 12-LEAD","code_information":[{"code":"7309300502","type":"CDM"},{"code":"0730","type":"RC"},{"code":"93005","type":"HCPCS"}],"standard_charges":[{"gross_charge":309.0,"discounted_cash":309.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC EEG INIT PREVENT EXAM","code_information":[{"code":"730G040401","type":"CDM"},{"code":"0760","type":"RC"},{"code":"G0404","type":"HCPCS"}],"standard_charges":[{"gross_charge":217.0,"discounted_cash":217.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC EXT ECG RECORD CONTIN 48 HR, RECORD - HOLTER MONITOR - 24 HOUR","code_information":[{"code":"7319322502","type":"CDM"},{"code":"0731","type":"RC"},{"code":"93225","type":"HCPCS"}],"standard_charges":[{"gross_charge":905.0,"discounted_cash":905.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC EXT ECG RECORD CONTIN 48 HR, RECORD - HOLTER MONITOR - 48 HOUR","code_information":[{"code":"7319322503","type":"CDM"},{"code":"0731","type":"RC"},{"code":"93225","type":"HCPCS"}],"standard_charges":[{"gross_charge":615.0,"discounted_cash":615.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ECG MONIT/REPRT UP TO 48 HRS - HOLTER MONITOR - 24 HOUR","code_information":[{"code":"7319322601","type":"CDM"},{"code":"0731","type":"RC"},{"code":"93226","type":"HCPCS"}],"standard_charges":[{"gross_charge":1309.0,"discounted_cash":1309.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ECG MONIT/REPRT UP TO 48 HRS - HOLTER MONITOR - 48 HOUR","code_information":[{"code":"7319322602","type":"CDM"},{"code":"0731","type":"RC"},{"code":"93226","type":"HCPCS"}],"standard_charges":[{"gross_charge":1368.0,"discounted_cash":1368.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ECG RECORDING >48 HOURS  <7 DAYS - HOLTER RECORDING  - 2 DAYS TO 7 DAYS","code_information":[{"code":"7319324201","type":"CDM"},{"code":"0731","type":"RC"},{"code":"93242","type":"HCPCS"}],"standard_charges":[{"gross_charge":615.0,"discounted_cash":615.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ECG ANALYSIS/RPT >48 HRS  <7 DAYS - HOLTER REC ANALYSIS/RPT - 2 -7 DAYS","code_information":[{"code":"7319324301","type":"CDM"},{"code":"0731","type":"RC"},{"code":"93243","type":"HCPCS"}],"standard_charges":[{"gross_charge":834.0,"discounted_cash":834.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ECG RECORDING >7 DAYS  <15 DAYS - HOLTER RECORDING  - 7 DAYS TO 15 DAYS","code_information":[{"code":"7319324601","type":"CDM"},{"code":"0731","type":"RC"},{"code":"93246","type":"HCPCS"}],"standard_charges":[{"gross_charge":1231.0,"discounted_cash":1231.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ECG ANALYSIS/RPT >7 DAYS  <15 DAYS - HOLTER REC ANALYSIS/RPT - 7-15 DAYS","code_information":[{"code":"7319324701","type":"CDM"},{"code":"0731","type":"RC"},{"code":"93247","type":"HCPCS"}],"standard_charges":[{"gross_charge":834.0,"discounted_cash":834.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC EEG CONT REC W/VIDEO & EDUC 8+ CHAN TECH","code_information":[{"code":"7409570001","type":"CDM"},{"code":"0740","type":"RC"},{"code":"95700","type":"HCPCS"}],"standard_charges":[{"gross_charge":876.0,"discounted_cash":876.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC EEG 2-12 HR W/VIDEO, TECH, INTERMIT MON","code_information":[{"code":"7409571201","type":"CDM"},{"code":"0740","type":"RC"},{"code":"95712","type":"HCPCS"}],"standard_charges":[{"gross_charge":995.0,"discounted_cash":995.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC EEG W/ VID 12-26HRS UNMON","code_information":[{"code":"7409571401","type":"CDM"},{"code":"0740","type":"RC"},{"code":"95714","type":"HCPCS"}],"standard_charges":[{"gross_charge":4444.0,"discounted_cash":4444.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC EEG 12-26 HR W/VIDEO, TECH, INTERMIT MON","code_information":[{"code":"7409571501","type":"CDM"},{"code":"0740","type":"RC"},{"code":"95715","type":"HCPCS"}],"standard_charges":[{"gross_charge":1928.0,"discounted_cash":1928.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MULTIPLE SLEEP LATENCY TEST","code_information":[{"code":"7409580501","type":"CDM"},{"code":"0740","type":"RC"},{"code":"95805","type":"HCPCS"}],"standard_charges":[{"gross_charge":5547.0,"discounted_cash":5547.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND","code_information":[{"code":"7409581001","type":"CDM"},{"code":"0740","type":"RC"},{"code":"95810","type":"HCPCS"}],"standard_charges":[{"gross_charge":3828.0,"discounted_cash":3828.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC POLYSOM 6/>YRS SLEEP W/CPAP 4/> ADDL PARAM ATTND","code_information":[{"code":"7409581101","type":"CDM"},{"code":"0740","type":"RC"},{"code":"95811","type":"HCPCS"}],"standard_charges":[{"gross_charge":4501.0,"discounted_cash":4501.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC EEG,EXTENDED MONITORING,41-60 MINUTES","code_information":[{"code":"7409581201","type":"CDM"},{"code":"0740","type":"RC"},{"code":"95812","type":"HCPCS"}],"standard_charges":[{"gross_charge":1576.0,"discounted_cash":1576.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC EEG,W/AWAKE & DROWSY RECORD","code_information":[{"code":"7409581601","type":"CDM"},{"code":"0740","type":"RC"},{"code":"95816","type":"HCPCS"}],"standard_charges":[{"gross_charge":980.0,"discounted_cash":980.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC EEG,W/AWAKE & ASLEEP RECORD","code_information":[{"code":"7409581901","type":"CDM"},{"code":"0740","type":"RC"},{"code":"95819","type":"HCPCS"}],"standard_charges":[{"gross_charge":2548.0,"discounted_cash":2548.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GI/ENDO - LEVEL 1 FIRST 5 MINUTES","code_information":[{"code":"7500000001","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"gross_charge":1162.0,"discounted_cash":1162.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GI/ENDO - LEVEL 1 EACH ADDL MINUTE","code_information":[{"code":"7500000002","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"gross_charge":21.96,"discounted_cash":21.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GI/ENDO - LEVEL 2 FIRST 5 MINUTES","code_information":[{"code":"7500000003","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"gross_charge":2785.0,"discounted_cash":2785.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GI/ENDO - LEVEL 2 EACH ADDL MINUTE","code_information":[{"code":"7500000004","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"gross_charge":52.65,"discounted_cash":52.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GI/ENDO - LEVEL 3 FIRST 5 MINUTES","code_information":[{"code":"7500000005","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"gross_charge":4644.0,"discounted_cash":4644.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GI/ENDO - LEVEL 3 EACH ADDL MINUTE","code_information":[{"code":"7500000006","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"gross_charge":83.88,"discounted_cash":83.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GI/ENDO - LEVEL 4 FIRST 5 MINUTES","code_information":[{"code":"7500000007","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"gross_charge":6500.0,"discounted_cash":6500.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GI/ENDO - LEVEL 4 EACH ADDL MINUTE","code_information":[{"code":"7500000008","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"gross_charge":122.84,"discounted_cash":122.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GI/ENDO - LEVEL 5 FIRST 5 MINUTES","code_information":[{"code":"7500000009","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"gross_charge":7430.0,"discounted_cash":7430.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GI/ENDO - LEVEL 5 EACH ADDL MINUTE","code_information":[{"code":"7500000010","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"gross_charge":140.43,"discounted_cash":140.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OR ENDO - LEVEL 3 EACH ADDL MINUTE","code_information":[{"code":"75000000B1","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"gross_charge":83.88,"discounted_cash":83.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OR ENDO - LEVEL 1 FIRST 5 MINUTES","code_information":[{"code":"75000000B2","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"gross_charge":1162.0,"discounted_cash":1162.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OR ENDO - LEVEL 1 EACH ADDL MINUTE","code_information":[{"code":"75000000B3","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"gross_charge":21.96,"discounted_cash":21.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OR ENDO - LEVEL 2 FIRST 5 MINUTES","code_information":[{"code":"75000000B4","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"gross_charge":2785.0,"discounted_cash":2785.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OR ENDO - LEVEL 2 EACH ADDL MINUTE","code_information":[{"code":"75000000B5","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"gross_charge":52.65,"discounted_cash":52.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OR ENDO - LEVEL 3 FIRST 5 MINUTES","code_information":[{"code":"75000000B6","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"gross_charge":4644.0,"discounted_cash":4644.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OR ENDO - LEVEL 4 FIRST 5 MINUTES","code_information":[{"code":"75000000B8","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"gross_charge":6500.0,"discounted_cash":6500.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OR ENDO - LEVEL 4 EACH ADDL MINUTE","code_information":[{"code":"75000000B9","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"gross_charge":122.84,"discounted_cash":122.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OR ENDO - LEVEL 5 FIRST 5 MINUTES","code_information":[{"code":"75000000C1","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"gross_charge":7430.0,"discounted_cash":7430.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OR ENDO - LEVEL 5 EACH ADDL MINUTE","code_information":[{"code":"75000000C2","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"gross_charge":140.43,"discounted_cash":140.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OBSERVATION CARVE-OUT","code_information":[{"code":"762G037803","type":"CDM"},{"code":"0762","type":"RC"},{"code":"G0378","type":"HCPCS"}],"standard_charges":[{"gross_charge":34.0,"discounted_cash":34.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OBSERVATION CARVE-OUT - CARDIOLOGY","code_information":[{"code":"762G037804","type":"CDM"},{"code":"0762","type":"RC"},{"code":"G0378","type":"HCPCS"}],"standard_charges":[{"gross_charge":34.0,"discounted_cash":34.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OBSERVATION CARVE-OUT - RESPIRATORY","code_information":[{"code":"762G037805","type":"CDM"},{"code":"0762","type":"RC"},{"code":"G0378","type":"HCPCS"}],"standard_charges":[{"gross_charge":34.0,"discounted_cash":34.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OBSERVATION CARVE-OUT - SURGICAL","code_information":[{"code":"762G037806","type":"CDM"},{"code":"0762","type":"RC"},{"code":"G0378","type":"HCPCS"}],"standard_charges":[{"gross_charge":34.0,"discounted_cash":34.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OBSERVATION CARVE-OUT - G.I.","code_information":[{"code":"762G037809","type":"CDM"},{"code":"0762","type":"RC"},{"code":"G0378","type":"HCPCS"}],"standard_charges":[{"gross_charge":34.0,"discounted_cash":34.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OBSERVATION CARVE-OUT - RADIOLOGY","code_information":[{"code":"762G037810","type":"CDM"},{"code":"0762","type":"RC"},{"code":"G0378","type":"HCPCS"}],"standard_charges":[{"gross_charge":34.0,"discounted_cash":34.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OBSERVATION CARVE-OUT - INFUSION","code_information":[{"code":"762G037811","type":"CDM"},{"code":"0762","type":"RC"},{"code":"G0378","type":"HCPCS"}],"standard_charges":[{"gross_charge":34.0,"discounted_cash":34.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OBSERVATION CARVE-OUT - RECOVERY TIME","code_information":[{"code":"762G037812","type":"CDM"},{"code":"0762","type":"RC"},{"code":"G0378","type":"HCPCS"}],"standard_charges":[{"gross_charge":34.0,"discounted_cash":34.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OBSERVATION CARVE-OUT - REVENUE INTEGRITY","code_information":[{"code":"762G037813","type":"CDM"},{"code":"0762","type":"RC"},{"code":"G0378","type":"HCPCS"}],"standard_charges":[{"gross_charge":34.0,"discounted_cash":34.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OBSERVATION CARVE-OUT - PT OT ST","code_information":[{"code":"762G037814","type":"CDM"},{"code":"0762","type":"RC"},{"code":"G0378","type":"HCPCS"}],"standard_charges":[{"gross_charge":34.0,"discounted_cash":34.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DIRECT REFER HOSPITAL OBSERV","code_information":[{"code":"762G037901","type":"CDM"},{"code":"0762","type":"RC"},{"code":"G0379","type":"HCPCS"}],"standard_charges":[{"gross_charge":439.0,"discounted_cash":439.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CA SCREEN;PELVIC/BREAST EXAM","code_information":[{"code":"770G010101","type":"CDM"},{"code":"0770","type":"RC"},{"code":"G0101","type":"HCPCS"}],"standard_charges":[{"gross_charge":660.0,"discounted_cash":660.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OBTAINING SCREEN PAP SMEAR","code_information":[{"code":"770Q009101","type":"CDM"},{"code":"0770","type":"RC"},{"code":"Q0091","type":"HCPCS"}],"standard_charges":[{"gross_charge":85.0,"discounted_cash":85.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IMMUNIZ ADMIN, THRU AGE 18, ANY ROUTE,W COUNSEL, 1ST VACCINE/TOXOID","code_information":[{"code":"7719046001","type":"CDM"},{"code":"0771","type":"RC"},{"code":"90460","type":"HCPCS"}],"standard_charges":[{"gross_charge":81.0,"discounted_cash":81.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IMMUNIZ ADMIN,1 SINGLE/COMB VAC/TOXOID","code_information":[{"code":"7719047101","type":"CDM"},{"code":"0771","type":"RC"},{"code":"90471","type":"HCPCS"}],"standard_charges":[{"gross_charge":183.0,"discounted_cash":183.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IMMUNIZ ADMIN, INFLUENZA","code_information":[{"code":"7719047102","type":"CDM"},{"code":"0771","type":"RC"},{"code":"90471","type":"HCPCS"}],"standard_charges":[{"gross_charge":183.0,"discounted_cash":183.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IMMUNIZ ADMIN, PNEUMOCOCCAL","code_information":[{"code":"7719047103","type":"CDM"},{"code":"0771","type":"RC"},{"code":"90471","type":"HCPCS"}],"standard_charges":[{"gross_charge":183.0,"discounted_cash":183.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IMMUNIZ,ADMIN,EACH ADDL","code_information":[{"code":"7719047201","type":"CDM"},{"code":"0771","type":"RC"},{"code":"90472","type":"HCPCS"}],"standard_charges":[{"gross_charge":183.0,"discounted_cash":183.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IMMUNE ADMIN ORAL/NASAL 1 VAC","code_information":[{"code":"7719047301","type":"CDM"},{"code":"0771","type":"RC"},{"code":"90473","type":"HCPCS"}],"standard_charges":[{"gross_charge":56.0,"discounted_cash":56.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ADMIN HEPATITIS B VACCINE","code_information":[{"code":"771G001001","type":"CDM"},{"code":"0771","type":"RC"},{"code":"G0010","type":"HCPCS"}],"standard_charges":[{"gross_charge":399.0,"discounted_cash":399.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FRAGMENT KIDNEY STONE/ ESWL","code_information":[{"code":"7905059001","type":"CDM"},{"code":"0790","type":"RC"},{"code":"50590","type":"HCPCS"}],"standard_charges":[{"gross_charge":21312.0,"discounted_cash":21312.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INPT HEMODIALYSIS PROCEDURE W/ PHYS/QHP SNGL EVALUATION","code_information":[{"code":"8019093501","type":"CDM"},{"code":"0801","type":"RC"},{"code":"90935","type":"HCPCS"}],"standard_charges":[{"gross_charge":1687.0,"discounted_cash":1687.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HEMODIALYSIS PROCEDURE INPATIENT HD W/ SINGLE EVALUATION","code_information":[{"code":"8019093502","type":"CDM"},{"code":"0801","type":"RC"},{"code":"90935","type":"HCPCS"}],"standard_charges":[{"gross_charge":1665.0,"discounted_cash":1665.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HEMODIALYSIS PROCEDURE INPATIENT CRRT W/ SINGLE EVALUATION","code_information":[{"code":"8019093503","type":"CDM"},{"code":"0801","type":"RC"},{"code":"90935","type":"HCPCS"}],"standard_charges":[{"gross_charge":1727.0,"discounted_cash":1727.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HEMODIALYSIS, W/ REPEATED EVALS","code_information":[{"code":"8019093701","type":"CDM"},{"code":"0801","type":"RC"},{"code":"90937","type":"HCPCS"}],"standard_charges":[{"gross_charge":2675.0,"discounted_cash":2675.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HEMODIALYSIS PROCEDURE W/ PHYS/QHP EVALUATION","code_information":[{"code":"8219093501","type":"CDM"},{"code":"0821","type":"RC"},{"code":"90935","type":"HCPCS"}],"standard_charges":[{"gross_charge":1674.0,"discounted_cash":1674.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC UNSCHED DIALYSIS ESRD PT HOS","code_information":[{"code":"829G025701","type":"CDM"},{"code":"0829","type":"RC"},{"code":"G0257","type":"HCPCS"}],"standard_charges":[{"gross_charge":3161.0,"discounted_cash":3161.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PSYCHIATRIC DIAGNOSTIC EVALUATION","code_information":[{"code":"9009079101","type":"CDM"},{"code":"0900","type":"RC"},{"code":"90791","type":"HCPCS"}],"standard_charges":[{"gross_charge":297.0,"discounted_cash":297.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PSYCHIATRIC DIAGNOSTIC EVAL W/MEDICAL SERVICES","code_information":[{"code":"9009079201","type":"CDM"},{"code":"0900","type":"RC"},{"code":"90792","type":"HCPCS"}],"standard_charges":[{"gross_charge":297.0,"discounted_cash":297.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BH IOP PER DIEM PSYCHIATRIC","code_information":[{"code":"9050000001","type":"CDM"},{"code":"0905","type":"RC"}],"standard_charges":[{"gross_charge":1215.0,"discounted_cash":1215.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PSYCHOTHERAPY PATIENT &/ FAMILY 30 MINUTES","code_information":[{"code":"9149083201","type":"CDM"},{"code":"0914","type":"RC"},{"code":"90832","type":"HCPCS"}],"standard_charges":[{"gross_charge":295.0,"discounted_cash":295.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PSYCHOTHERAPY PATIENT &/ FAMILY 45 MINUTES","code_information":[{"code":"9149083401","type":"CDM"},{"code":"0914","type":"RC"},{"code":"90834","type":"HCPCS"}],"standard_charges":[{"gross_charge":295.0,"discounted_cash":295.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PSYCHOTHERAPY W/ PT 60 MINUTES","code_information":[{"code":"9149083701","type":"CDM"},{"code":"0914","type":"RC"},{"code":"90837","type":"HCPCS"}],"standard_charges":[{"gross_charge":295.0,"discounted_cash":295.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PSYCHOTHERAPY CRISIS INIT 60 MIN","code_information":[{"code":"9149083901","type":"CDM"},{"code":"0914","type":"RC"},{"code":"90839","type":"HCPCS"}],"standard_charges":[{"gross_charge":388.0,"discounted_cash":388.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GROUP PSYCHOTHERAPY, IOP/PHP","code_information":[{"code":"9159085301","type":"CDM"},{"code":"0915","type":"RC"},{"code":"90853","type":"HCPCS"}],"standard_charges":[{"gross_charge":155.0,"discounted_cash":155.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GROUP PSYCHOTHERAPY, VIRTUAL/IN-PERSON","code_information":[{"code":"9159085302","type":"CDM"},{"code":"0915","type":"RC"},{"code":"90853","type":"HCPCS"}],"standard_charges":[{"gross_charge":165.0,"discounted_cash":165.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FAMILY PSYCHOTHERAPY W/ PT 50 MIN","code_information":[{"code":"9169084701","type":"CDM"},{"code":"0916","type":"RC"},{"code":"90847","type":"HCPCS"}],"standard_charges":[{"gross_charge":324.0,"discounted_cash":324.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BRIEF BEHAVIOR ASSESS W/SCORING/DOC PER INSTRUMENT","code_information":[{"code":"9189612702","type":"CDM"},{"code":"0918","type":"RC"},{"code":"96127","type":"HCPCS"}],"standard_charges":[{"gross_charge":117.0,"discounted_cash":117.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PSYCH TEST EVAL BY PHYS 1ST HR","code_information":[{"code":"9189613001","type":"CDM"},{"code":"0918","type":"RC"},{"code":"96130","type":"HCPCS"}],"standard_charges":[{"gross_charge":800.0,"discounted_cash":800.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC COMPLEX UROFLOWMETRY","code_information":[{"code":"9205174101","type":"CDM"},{"code":"0920","type":"RC"},{"code":"51741","type":"HCPCS"}],"standard_charges":[{"gross_charge":161.0,"discounted_cash":161.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC VOIDING PRESS STUDY INTRA-ABDOMINAL VOID","code_information":[{"code":"9205179701","type":"CDM"},{"code":"0920","type":"RC"},{"code":"51797","type":"HCPCS"}],"standard_charges":[{"gross_charge":1033.0,"discounted_cash":1033.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MULTIPLE SLEEP LATENCY TEST W/ SCORING","code_information":[{"code":"9209580501","type":"CDM"},{"code":"0920","type":"RC"},{"code":"95805","type":"HCPCS"}],"standard_charges":[{"gross_charge":5547.0,"discounted_cash":5547.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SLEEP STUDY, UNATTENDED, SIMUL RECORD HR/O2 SAT/RESP FLOW/RESP EFF","code_information":[{"code":"9209580601","type":"CDM"},{"code":"0920","type":"RC"},{"code":"95806","type":"HCPCS"}],"standard_charges":[{"gross_charge":1257.0,"discounted_cash":1257.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND","code_information":[{"code":"9209581002","type":"CDM"},{"code":"0920","type":"RC"},{"code":"95810","type":"HCPCS"}],"standard_charges":[{"gross_charge":3828.0,"discounted_cash":3828.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC POLYSOM 6/>YRS SLEEP W/CPAP 4/> ADDL PARAM ATTND","code_information":[{"code":"9209581102","type":"CDM"},{"code":"0920","type":"RC"},{"code":"95811","type":"HCPCS"}],"standard_charges":[{"gross_charge":4501.0,"discounted_cash":4501.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ELEC ANAL IMP NEUROSTIM NPGT W/O PROG","code_information":[{"code":"9209597001","type":"CDM"},{"code":"0920","type":"RC"},{"code":"95970","type":"HCPCS"}],"standard_charges":[{"gross_charge":302.0,"discounted_cash":302.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ELEC ALYS IMPLT NPGT CPLX SP/PN PRGRMG","code_information":[{"code":"9209597201","type":"CDM"},{"code":"0920","type":"RC"},{"code":"95972","type":"HCPCS"}],"standard_charges":[{"gross_charge":982.0,"discounted_cash":982.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ELEC ANAL IMP NEURSTM NPGT SIM CRN NRV W/PRG","code_information":[{"code":"9209597601","type":"CDM"},{"code":"0920","type":"RC"},{"code":"95976","type":"HCPCS"}],"standard_charges":[{"gross_charge":102.0,"discounted_cash":102.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ELEC ANAL IMP NEURO CPLX NPGT W/PROG","code_information":[{"code":"9209597701","type":"CDM"},{"code":"0920","type":"RC"},{"code":"95977","type":"HCPCS"}],"standard_charges":[{"gross_charge":291.0,"discounted_cash":291.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DUPLEX SCAN EXTRACRANIAL,BILAT","code_information":[{"code":"9219388003","type":"CDM"},{"code":"0921","type":"RC"},{"code":"93880","type":"HCPCS"}],"standard_charges":[{"gross_charge":1538.0,"discounted_cash":1538.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DUPLEX SCAN EXTRACRANIAL,LIMITED","code_information":[{"code":"9219388201","type":"CDM"},{"code":"0921","type":"RC"},{"code":"93882","type":"HCPCS"}],"standard_charges":[{"gross_charge":652.0,"discounted_cash":652.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC NON-INVAS PHYSIOLOGIC STD EXTREMITY ART 1-2 LEVEL","code_information":[{"code":"9219392203","type":"CDM"},{"code":"0921","type":"RC"},{"code":"93922","type":"HCPCS"}],"standard_charges":[{"gross_charge":1248.0,"discounted_cash":1248.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC NON-INVASIVE PHYSIOLOGIC STUDY EXTREMITY 3 LEVELS","code_information":[{"code":"9219392301","type":"CDM"},{"code":"0921","type":"RC"},{"code":"93923","type":"HCPCS"}],"standard_charges":[{"gross_charge":1568.0,"discounted_cash":1568.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC NON-INVASIVE LOWER EXTREM ART STRESS/REST, COMPLETE,BILATERAL","code_information":[{"code":"9219392401","type":"CDM"},{"code":"0921","type":"RC"},{"code":"93924","type":"HCPCS"}],"standard_charges":[{"gross_charge":3104.0,"discounted_cash":3104.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DUPLEX LO EXTREM ART BILAT","code_information":[{"code":"9219392502","type":"CDM"},{"code":"0921","type":"RC"},{"code":"93925","type":"HCPCS"}],"standard_charges":[{"gross_charge":2544.0,"discounted_cash":2544.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DUPLEX LO EXTREM ART UNILAT/LTD","code_information":[{"code":"9219392602","type":"CDM"},{"code":"0921","type":"RC"},{"code":"93926","type":"HCPCS"}],"standard_charges":[{"gross_charge":1694.0,"discounted_cash":1694.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DUPLEX UP EXTREM ART BILAT","code_information":[{"code":"9219393003","type":"CDM"},{"code":"0921","type":"RC"},{"code":"93930","type":"HCPCS"}],"standard_charges":[{"gross_charge":1863.0,"discounted_cash":1863.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DUPLEX UP EXTREM ART UNILAT/LTD","code_information":[{"code":"9219393101","type":"CDM"},{"code":"0921","type":"RC"},{"code":"93931","type":"HCPCS"}],"standard_charges":[{"gross_charge":1694.0,"discounted_cash":1694.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DUPLEX EXTREM VENOUS,BILAT","code_information":[{"code":"9219397001","type":"CDM"},{"code":"0921","type":"RC"},{"code":"93970","type":"HCPCS"}],"standard_charges":[{"gross_charge":3117.0,"discounted_cash":3117.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DUPLEX EXTREM VENOUS,UNI OR LTD - US DOPPLER VENOUS ARM","code_information":[{"code":"9219397102","type":"CDM"},{"code":"0921","type":"RC"},{"code":"93971","type":"HCPCS"}],"standard_charges":[{"gross_charge":1121.0,"discounted_cash":1121.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DUPLEX EXTREM VENOUS,UNI OR LTD - CV US DOPPLER VENOUS LEG","code_information":[{"code":"9219397104","type":"CDM"},{"code":"0921","type":"RC"},{"code":"93971","type":"HCPCS"}],"standard_charges":[{"gross_charge":1121.0,"discounted_cash":1121.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC VASCULAR STUDY - RENAL ARTERY DUPLEX","code_information":[{"code":"9219397502","type":"CDM"},{"code":"0921","type":"RC"},{"code":"93975","type":"HCPCS"}],"standard_charges":[{"gross_charge":3080.0,"discounted_cash":3080.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC VASC DUPLEX ABD/PEL VASC STUDY,COMPLETE","code_information":[{"code":"9219397504","type":"CDM"},{"code":"0921","type":"RC"},{"code":"93975","type":"HCPCS"}],"standard_charges":[{"gross_charge":1228.0,"discounted_cash":1228.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC VASCULAR STUDY - US ABDOMEN DOPPLER LIMITED","code_information":[{"code":"9219397601","type":"CDM"},{"code":"0921","type":"RC"},{"code":"93976","type":"HCPCS"}],"standard_charges":[{"gross_charge":1982.0,"discounted_cash":1982.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PENILE VASCULAR STUDY,LTD OR F/U - US PENIS DOPPLER LIMITED","code_information":[{"code":"9219398101","type":"CDM"},{"code":"0921","type":"RC"},{"code":"93981","type":"HCPCS"}],"standard_charges":[{"gross_charge":1451.0,"discounted_cash":1451.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ANAL/URINARY MUSCLE STUDY","code_information":[{"code":"9225178401","type":"CDM"},{"code":"0922","type":"RC"},{"code":"51784","type":"HCPCS"}],"standard_charges":[{"gross_charge":985.0,"discounted_cash":985.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC NEEDLE EMG EA EXTREMITY W/PARASPINL AREA LIMITED","code_information":[{"code":"9229588501","type":"CDM"},{"code":"0922","type":"RC"},{"code":"95885","type":"HCPCS"}],"standard_charges":[{"gross_charge":404.0,"discounted_cash":404.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC NEEDLE EMG EA EXTREMTY W/PARASPINL AREA COMPLETE","code_information":[{"code":"9229588601","type":"CDM"},{"code":"0922","type":"RC"},{"code":"95886","type":"HCPCS"}],"standard_charges":[{"gross_charge":312.0,"discounted_cash":312.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC NEEDLE EMG NONEXTREMTY MSCLES W/NERVE CONDUCTION","code_information":[{"code":"9229588701","type":"CDM"},{"code":"0922","type":"RC"},{"code":"95887","type":"HCPCS"}],"standard_charges":[{"gross_charge":451.0,"discounted_cash":451.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MOTOR &/SENS 1-2 NRV CNDJ PRECONF ELTRODE LIMB","code_information":[{"code":"9229590701","type":"CDM"},{"code":"0922","type":"RC"},{"code":"95907","type":"HCPCS"}],"standard_charges":[{"gross_charge":1056.0,"discounted_cash":1056.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MOTOR &/SENS 3-4 NRV CNDJ PRECONF ELTRODE LIMB","code_information":[{"code":"9229590801","type":"CDM"},{"code":"0922","type":"RC"},{"code":"95908","type":"HCPCS"}],"standard_charges":[{"gross_charge":1889.0,"discounted_cash":1889.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MOTOR &/SENS 5-6 NRV CNDJ PRECONF ELTRODE LIMB","code_information":[{"code":"9229590901","type":"CDM"},{"code":"0922","type":"RC"},{"code":"95909","type":"HCPCS"}],"standard_charges":[{"gross_charge":1929.0,"discounted_cash":1929.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MOTOR &/SENS 7-8 NRV CNDJ PRECONF ELTRODE LIMB","code_information":[{"code":"9229591001","type":"CDM"},{"code":"0922","type":"RC"},{"code":"95910","type":"HCPCS"}],"standard_charges":[{"gross_charge":647.0,"discounted_cash":647.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MOTOR &/SENS 9-10 NRV CNDJ PRECONF ELTRODE LIMB","code_information":[{"code":"9229591101","type":"CDM"},{"code":"0922","type":"RC"},{"code":"95911","type":"HCPCS"}],"standard_charges":[{"gross_charge":3229.0,"discounted_cash":3229.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MOTOR &/SENS 9-10 NRV CNDJ PRECONF ELTRODE LIMB","code_information":[{"code":"92295911PB","type":"CDM"},{"code":"0922","type":"RC"},{"code":"95911","type":"HCPCS"}],"standard_charges":[{"gross_charge":1944.0,"discounted_cash":1944.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MOTOR &/SENS 11-12 NRV CNDJ PRECONF ELTRODE LIMB","code_information":[{"code":"9229591201","type":"CDM"},{"code":"0922","type":"RC"},{"code":"95912","type":"HCPCS"}],"standard_charges":[{"gross_charge":3430.0,"discounted_cash":3430.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MOTOR &/SENS 13/> NRV CNDJ PRECONF ELTRODE LIMB","code_information":[{"code":"9229591301","type":"CDM"},{"code":"0922","type":"RC"},{"code":"95913","type":"HCPCS"}],"standard_charges":[{"gross_charge":3966.0,"discounted_cash":3966.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IMMUNOTHERAPY, 2+ INJECTIONS","code_information":[{"code":"9409511701","type":"CDM"},{"code":"0940","type":"RC"},{"code":"95117","type":"HCPCS"}],"standard_charges":[{"gross_charge":314.0,"discounted_cash":314.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC THERAPEUTIC PHLEBOTOMY (SEPARATE PROCEDURE)","code_information":[{"code":"9409919501","type":"CDM"},{"code":"0940","type":"RC"},{"code":"99195","type":"HCPCS"}],"standard_charges":[{"gross_charge":407.0,"discounted_cash":407.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DIET ASSESSMENT BRIEF","code_information":[{"code":"9420000001","type":"CDM"},{"code":"0942","type":"RC"}],"standard_charges":[{"gross_charge":23.0,"discounted_cash":23.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DIET ASSESSMENT 31 TO 60 MINUTES","code_information":[{"code":"9420000003","type":"CDM"},{"code":"0942","type":"RC"}],"standard_charges":[{"gross_charge":192.0,"discounted_cash":192.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TOBACCO USE CESSATION INTERMEDIATE 3-10 MINUTES","code_information":[{"code":"9429940601","type":"CDM"},{"code":"0942","type":"RC"},{"code":"99406","type":"HCPCS"}],"standard_charges":[{"gross_charge":69.0,"discounted_cash":69.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TOBACCO USE CESSATION INTENSIVE >10 MINUTES","code_information":[{"code":"9429940701","type":"CDM"},{"code":"0942","type":"RC"},{"code":"99407","type":"HCPCS"}],"standard_charges":[{"gross_charge":144.0,"discounted_cash":144.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OUTPATIENT CARDIAC REHAB W/O CONT ECG MONITOR","code_information":[{"code":"9439379701","type":"CDM"},{"code":"0943","type":"RC"},{"code":"93797","type":"HCPCS"}],"standard_charges":[{"gross_charge":261.0,"discounted_cash":261.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OUTPATIENT CARDIAC REHAB W/CONT ECG MONITORING","code_information":[{"code":"9439379801","type":"CDM"},{"code":"0943","type":"RC"},{"code":"93798","type":"HCPCS"}],"standard_charges":[{"gross_charge":261.0,"discounted_cash":261.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PULMONARY REHAB W/ OXI MONITOR PER SESSION","code_information":[{"code":"9489462601","type":"CDM"},{"code":"0948","type":"RC"},{"code":"94626","type":"HCPCS"}],"standard_charges":[{"gross_charge":276.0,"discounted_cash":276.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MAINTENANCE CARDIAC REHAB","code_information":[{"code":"9970000001","type":"CDM"},{"code":"0997","type":"RC"}],"standard_charges":[{"gross_charge":27.0,"discounted_cash":27.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MAINTENANCE PULMONARY REHAB","code_information":[{"code":"9970000002","type":"CDM"},{"code":"0997","type":"RC"}],"standard_charges":[{"gross_charge":64.0,"discounted_cash":64.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PATHOLOGIST INTERPRETATION    SCREENING","code_information":[{"code":"999P300101","type":"CDM"},{"code":"0999","type":"RC"},{"code":"P3001","type":"HCPCS"}],"standard_charges":[{"gross_charge":31.0,"discounted_cash":31.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Digestive Malignancy With Mcc","code_information":[{"code":"374","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16486.95,"maximum":42882.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":31470.97},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16486.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16816.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33669.55},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16486.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16486.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16651.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16486.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16981.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":42882.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":16486.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16486.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16486.95,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Digestive Malignancy With Cc","code_information":[{"code":"375","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10048.41,"maximum":26135.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":17799.26},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10048.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10249.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19042.73},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10048.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10048.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10148.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10048.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10349.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":26135.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":10048.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10048.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10048.41,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Digestive Malignancy Without Cc/Mcc","code_information":[{"code":"376","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8071.32,"maximum":20993.50,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":13601.07},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8071.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8232.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14551.25},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8071.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8071.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8152.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8071.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8313.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":20993.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":8071.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8071.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8071.32,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Gastrointestinal Hemorrhage With Mcc","code_information":[{"code":"377","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14333.84,"maximum":37282.32,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":26899.02},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14333.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14620.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28778.2},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14333.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14333.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14477.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14333.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14763.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":37282.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":14333.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14333.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14333.84,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13000.78,"10th_percentile":13000.78,"90th_percentile":13000.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Gastrointestinal Hemorrhage With Cc","code_information":[{"code":"378","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8462.16,"maximum":22010.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":14431.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8462.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8631.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15439.16},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8462.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8462.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8546.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8462.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8716.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":22010.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":8462.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8462.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8462.16,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"1 through 10","median_amount":11543.24,"10th_percentile":11543.24,"90th_percentile":11543.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"1 through 10","median_amount":32748.82,"10th_percentile":32748.82,"90th_percentile":32748.82},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":17407.26,"10th_percentile":17407.26,"90th_percentile":17407.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Gastrointestinal Hemorrhage Without Cc/Mcc","code_information":[{"code":"379","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6034.63,"maximum":15696.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":9276.34},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6034.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6155.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9924.39},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6034.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6034.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6094.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6034.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6215.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":15696.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":6034.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6034.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6034.63,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complicated Peptic Ulcer With Mcc","code_information":[{"code":"380","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15263.83,"maximum":39701.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":28873.77},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15263.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15569.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30890.91},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15263.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15263.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15416.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15263.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15721.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":39701.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":15263.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15263.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15263.83,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complicated Peptic Ulcer With Cc","code_information":[{"code":"381","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9174.55,"maximum":23863.00,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":15943.7},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9174.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9358.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17057.54},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9174.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9174.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9266.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9174.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9449.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":23863.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":9174.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9174.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9174.55,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complicated Peptic Ulcer Without Cc/Mcc","code_information":[{"code":"382","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7214.09,"maximum":18763.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":11780.83},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7214.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7358.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12603.85},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7214.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7214.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7286.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7214.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7430.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":18763.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":7214.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7214.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7214.09,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uncomplicated Peptic Ulcer With Mcc","code_information":[{"code":"383","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11234.11,"maximum":29219.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":20317.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11234.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11458.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21736.36},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11234.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11234.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11346.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11234.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11571.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":29219.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":11234.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11234.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11234.11,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uncomplicated Peptic Ulcer Without Mcc","code_information":[{"code":"384","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7589.69,"maximum":19740.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":12578.38},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7589.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7741.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13457.12},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7589.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7589.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7665.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7589.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7817.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":19740.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":7589.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7589.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7589.69,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/Mcc","code_information":[{"code":"373","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6706.83,"maximum":17444.46,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":10703.69},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6706.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6840.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11451.46},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6706.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6706.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6773.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6706.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6908.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17444.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":6706.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6706.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6706.83,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Gastrointestinal Disorders And Peritoneal Infections With Cc","code_information":[{"code":"372","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8741.44,"maximum":22736.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":15024.02},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8741.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8916.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16073.6},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8741.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8741.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8828.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8741.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9003.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":22736.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":8741.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8741.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8741.44,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7379.14,"10th_percentile":7379.14,"90th_percentile":7379.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Major Gastrointestinal Disorders And Peritoneal Infections With Mcc","code_information":[{"code":"371","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13953.39,"maximum":36292.77,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":26091.17},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13953.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14232.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27913.91},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13953.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13953.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14092.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13953.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14371.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":36292.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":13953.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13953.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13953.39,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Esophageal Disorders Without Cc/Mcc","code_information":[{"code":"370","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6522.49,"maximum":16965.00,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":10312.27},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6522.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6652.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11032.69},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6522.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6522.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6587.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6522.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6718.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":16965.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":6522.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6522.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6522.49,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Esophageal Disorders With Cc","code_information":[{"code":"369","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8597.29,"maximum":22361.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":14717.94},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8597.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8769.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15746.15},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8597.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8597.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8683.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8597.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8855.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":22361.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":8597.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8597.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8597.29,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Esophageal Disorders With Mcc","code_information":[{"code":"368","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12697.7,"maximum":33026.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":23424.81},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12697.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12951.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25061.28},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12697.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12697.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12824.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12697.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13078.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":33026.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":12697.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12697.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12697.7,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Coronary Atherectomy With Intraluminal Device Without Mcc","code_information":[{"code":"360","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18396.82,"maximum":47850.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":35526.42},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18396.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18764.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38008.32},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18396.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18396.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18580.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18396.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18948.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":47850.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":18396.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18396.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18396.82,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Coronary Atherectomy With Intraluminal Device With Mcc","code_information":[{"code":"359","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":25495.09,"maximum":66312.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":50599.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25495.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26004.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":54133.88},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25495.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25495.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25750.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25495.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26259.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":66312.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":25495.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25495.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25495.09,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Digestive System O.R. Procedures Without Cc/Mcc","code_information":[{"code":"358","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11353.3,"maximum":29529.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":20570.1},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11353.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11580.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22007.14},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11353.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11353.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11466.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11353.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11693.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":29529.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":11353.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11353.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11353.3,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Digestive System O.R. Procedures With Cc","code_information":[{"code":"357","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17781.45,"maximum":46249.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":34219.73},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17781.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18137.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36610.35},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17781.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17781.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17959.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17781.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18314.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":46249.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":17781.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17781.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17781.45,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Digestive System O.R. Procedures With Mcc","code_information":[{"code":"356","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":32107.57,"maximum":83511.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":64640.05},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":32107.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32749.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":69155.85},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32107.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32107.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32428.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32107.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":33070.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":83511.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":32107.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32107.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":32107.57,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hernia Procedures Except Inguinal And Femoral Without Cc/Mcc","code_information":[{"code":"355","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10986.71,"maximum":28576.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":19791.68},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10986.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11206.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21174.34},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10986.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10986.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11096.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10986.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11316.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":28576.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":10986.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10986.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10986.71,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hernia Procedures Except Inguinal And Femoral With Cc","code_information":[{"code":"354","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13324.85,"maximum":34657.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":24756.52},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13324.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13591.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26486.02},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13324.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13324.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13458.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13324.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13724.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":34657.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":13324.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13324.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13324.85,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13210.94,"10th_percentile":13210.94,"90th_percentile":13210.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":15781.04,"10th_percentile":15781.04,"90th_percentile":15781.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hernia Procedures Except Inguinal And Femoral With Mcc","code_information":[{"code":"353","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21776.52,"maximum":56640.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":42702.93},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21776.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22212.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":45686.19},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21776.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21776.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21994.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21776.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22429.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":56640.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":21776.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21776.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21776.52,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21593.45,"10th_percentile":21593.45,"90th_percentile":21593.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inguinal And Femoral Hernia Procedures Without Cc/Mcc","code_information":[{"code":"352","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9758.74,"maximum":25382.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":17184.18},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9758.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9953.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18384.68},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9758.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9758.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9856.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9758.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10051.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":25382.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":9758.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9758.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9758.74,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inguinal And Femoral Hernia Procedures With Cc","code_information":[{"code":"351","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12230.62,"maximum":31811.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":22433.02},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12230.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12475.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24000.2},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12230.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12230.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12352.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12230.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12597.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":31811.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":12230.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12230.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12230.62,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inguinal And Femoral Hernia Procedures With Mcc","code_information":[{"code":"350","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18934.58,"maximum":49248.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":36668.31},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18934.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19313.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39229.98},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18934.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18934.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19123.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18934.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19502.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":49248.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":18934.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18934.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18934.58,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Anal And Stomal Procedures Without Cc/Mcc","code_information":[{"code":"349","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7699.18,"maximum":20025.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":12810.88},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7699.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7853.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13705.86},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7699.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7699.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7776.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7699.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7930.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":20025.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":7699.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7699.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7699.18,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Anal And Stomal Procedures With Cc","code_information":[{"code":"348","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10735.85,"maximum":27923.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":19258.99},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10735.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10950.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20604.44},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10735.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10735.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10843.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10735.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11057.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":27923.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":10735.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10735.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10735.85,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Anal And Stomal Procedures With Mcc","code_information":[{"code":"347","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17574.25,"maximum":45710.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":33779.75},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17574.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17925.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36139.63},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17574.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17574.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17749.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17574.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18101.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":45710.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":17574.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17574.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17574.25,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Minor Small And Large Bowel Procedures Without Cc/Mcc","code_information":[{"code":"346","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9886.25,"maximum":25714.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":17454.93},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9886.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10083.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18674.35},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9886.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9886.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9985.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9886.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10182.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":25714.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":9886.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9886.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9886.25,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Minor Small And Large Bowel Procedures With Cc","code_information":[{"code":"345","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12093.41,"maximum":31454.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":22141.66},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12093.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12335.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23688.49},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12093.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12093.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12214.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12093.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12456.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":31454.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":12093.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12093.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12093.41,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Minor Small And Large Bowel Procedures With Mcc","code_information":[{"code":"344","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19564.5,"maximum":50887.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":38005.9},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19564.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19955.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":40661.02},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19564.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19564.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19760.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19564.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20151.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":50887.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":19564.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19564.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19564.5,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peritoneal Adhesiolysis Without Cc/Mcc","code_information":[{"code":"337","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12303.39,"maximum":32001.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":22587.53},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12303.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12549.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24165.51},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12303.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12303.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12426.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12303.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12672.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":32001.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":12303.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12303.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12303.39,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peritoneal Adhesiolysis With Cc","code_information":[{"code":"336","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16279.05,"maximum":42341.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":31029.52},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16279.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16604.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33197.26},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16279.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16279.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16441.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16279.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16767.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":42341.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":16279.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16279.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16279.05,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peritoneal Adhesiolysis With Mcc","code_information":[{"code":"335","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":26411.91,"maximum":68697.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":52545.79},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26411.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26940.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":56216.68},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26411.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26411.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26676.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26411.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27204.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":68697.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":26411.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26411.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26411.91,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Rectal Resection Without Cc/Mcc","code_information":[{"code":"334","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13016.47,"maximum":33855.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":24101.7},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13016.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13276.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25785.46},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13016.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13016.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13146.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13016.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13406.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":33855.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":13016.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13016.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13016.47,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Rectal Resection With Cc","code_information":[{"code":"333","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17897.18,"maximum":46550.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":34465.47},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17897.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18255.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36873.25},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17897.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17897.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18076.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17897.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18434.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":46550.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":17897.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17897.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17897.18,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Rectal Resection With Mcc","code_information":[{"code":"332","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":26757.01,"maximum":69594.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":53278.6},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26757.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27292.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":57000.68},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26757.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26757.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27024.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26757.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27559.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":69594.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":26757.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26757.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26757.01,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Small And Large Bowel Procedures Without Cc/Mcc","code_information":[{"code":"331","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13328.32,"maximum":34666.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":24763.87},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13328.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13594.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26493.89},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13328.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13328.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13461.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13328.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13728.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":34666.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":13328.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13328.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13328.32,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"1 through 10","median_amount":20915.82,"10th_percentile":20915.82,"90th_percentile":20915.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Small And Large Bowel Procedures With Cc","code_information":[{"code":"330","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18278.32,"maximum":47541.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":35274.8},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18278.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18643.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37739.12},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18278.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18278.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18461.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18278.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18826.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":47541.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":18278.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18278.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18278.32,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17723.93,"10th_percentile":17723.93,"90th_percentile":17723.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"1 through 10","median_amount":18352.95,"10th_percentile":18352.95,"90th_percentile":18352.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Small And Large Bowel Procedures With Mcc","code_information":[{"code":"329","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":33519.18,"maximum":87183.39,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":67637.5},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":33519.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34189.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":72362.7},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33519.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33519.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33854.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33519.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":34524.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":87183.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":33519.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33519.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":33519.18,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":37037.37,"10th_percentile":37037.37,"90th_percentile":37037.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"1 through 10","median_amount":18344.59,"10th_percentile":18344.59,"90th_percentile":18344.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Stomach, Esophageal And Duodenal Procedures Without Cc/Mcc","code_information":[{"code":"328","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12769.77,"maximum":33214.17,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":23577.84},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12769.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13025.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25225.01},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12769.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12769.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12897.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12769.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13152.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":33214.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":12769.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12769.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12769.77,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Stomach, Esophageal And Duodenal Procedures With Cc","code_information":[{"code":"327","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18604.02,"maximum":48389.06,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":35966.4},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18604.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18976.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38479.04},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18604.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18604.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18790.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18604.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19162.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":48389.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":18604.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18604.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18604.02,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Stomach, Esophageal And Duodenal Procedures With Mcc","code_information":[{"code":"326","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":36228.07,"maximum":94229.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":73389.59},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36228.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36952.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":78516.64},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36228.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36228.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36590.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36228.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":37314.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":94229.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":36228.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36228.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36228.07,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Intravascular Lithotripsy Without Intraluminal Device","code_information":[{"code":"325","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23913.69,"maximum":62199.51,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":47241.04},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23913.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24391.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":50541.33},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23913.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23913.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24152.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23913.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24631.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":62199.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":23913.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23913.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23913.69,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Intravascular Lithotripsy With Intraluminal Device Without Mcc","code_information":[{"code":"324","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23502.06,"maximum":61128.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":46366.97},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23502.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23972.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":49606.19},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23502.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23502.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23737.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23502.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24207.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":61128.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":23502.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23502.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23502.06,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Intravascular Lithotripsy With Intraluminal Device With Mcc","code_information":[{"code":"323","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":31654.35,"maximum":82332.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":63677.69},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":31654.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32287.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":68126.26},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31654.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31654.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31970.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31654.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":32603.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":82332.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":31654.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31654.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":31654.35,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Cardiovascular Procedures With Intraluminal Device Without Mcc","code_information":[{"code":"322","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13883.4,"maximum":36110.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":25942.55},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13883.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14161.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27754.91},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13883.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13883.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14022.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13883.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14299.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":36110.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":13883.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13883.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13883.4,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Cardiovascular Procedures With Intraluminal Device With Mcc Or 4+ Arteries/Intraluminal","code_information":[{"code":"321","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20520.83,"maximum":53374.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":40036.57},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20520.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20931.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":42833.55},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20520.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20520.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20726.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20520.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21136.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":53374.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":20520.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20520.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20520.83,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Endovascular Cardiac Valve Procedures Without Mcc","code_information":[{"code":"320","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18334.45,"maximum":47687.90,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":35393.99},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18334.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18701.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37866.64},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18334.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18334.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18517.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18334.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18884.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":47687.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":18334.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18334.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18334.45,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Endovascular Cardiac Valve Procedures With Mcc","code_information":[{"code":"319","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":32593.35,"maximum":84775.30,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":65671.57},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":32593.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33245.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":70259.43},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32593.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32593.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32919.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32593.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":33571.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":84775.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":32593.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32593.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":32593.35,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Coronary Atherectomy Without Intraluminal Device","code_information":[{"code":"318","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18451.57,"maximum":47992.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":35642.67},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18451.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18820.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38132.69},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18451.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18451.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18636.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18451.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19005.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":47992.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":18451.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18451.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18451.57,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Concomitant Left Atrial Appendage Closure And Cardiac Ablation","code_information":[{"code":"317","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":48002.6,"maximum":124854.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":98391.85},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":48002.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":48962.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":105265.57},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":48002.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48002.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":48482.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48002.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":49442.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":124854.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":48002.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":48002.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":48002.6,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Circulatory System Diagnoses Without Cc/Mcc","code_information":[{"code":"316","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6392.9,"maximum":16627.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":10037.1},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6392.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6520.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10738.3},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6392.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6392.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6456.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6392.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6584.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":16627.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":6392.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6392.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6392.9,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Circulatory System Diagnoses With Cc","code_information":[{"code":"315","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8341.58,"maximum":21696.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":14174.96},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8341.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8508.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15165.23},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8341.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8341.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8425.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8341.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8591.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":21696.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":8341.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8341.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8341.58,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Circulatory System Diagnoses With Mcc","code_information":[{"code":"314","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16116.2,"maximum":41918.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":30683.72},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16116.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16438.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32827.3},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16116.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16116.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16277.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16116.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16599.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":41918.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":16116.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16116.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16116.2,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chest Pain","code_information":[{"code":"313","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6655.55,"maximum":17311.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":10594.8},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6655.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6788.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11334.96},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6655.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6655.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6722.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6655.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6855.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17311.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":6655.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6655.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6655.55,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Syncope And Collapse","code_information":[{"code":"312","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7706.11,"maximum":20043.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":12825.59},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7706.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7860.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13721.6},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7706.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7706.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7783.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7706.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7937.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":20043.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":7706.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7706.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7706.11,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Angina Pectoris","code_information":[{"code":"311","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6530.11,"maximum":16984.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":10328.46},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6530.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6660.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11050.01},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6530.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6530.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6595.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6530.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6726.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":16984.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":6530.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6530.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6530.11,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Arrhythmia And Conduction Disorders Without Cc/Mcc","code_information":[{"code":"310","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5589.04,"maximum":14537.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":8330.16},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5589.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5700.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8912.11},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5589.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5589.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5644.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5589.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5756.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14537.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":5589.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5589.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5589.04,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"1 through 10","median_amount":8330.16,"10th_percentile":8330.16,"90th_percentile":8330.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"1 through 10","median_amount":8329.03,"10th_percentile":8329.03,"90th_percentile":8329.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"1 through 10","median_amount":5586.89,"10th_percentile":5586.89,"90th_percentile":5586.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Arrhythmia And Conduction Disorders With Cc","code_information":[{"code":"309","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6764.34,"maximum":17594.05,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":10825.83},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6764.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6899.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11582.13},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6764.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6764.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6831.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6764.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6967.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17594.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":6764.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6764.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6764.34,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Arrhythmia And Conduction Disorders With Mcc","code_information":[{"code":"308","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10009.6,"maximum":26034.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":17716.86},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10009.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10209.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18954.57},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10009.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10009.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10109.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10009.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10309.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":26034.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":10009.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10009.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10009.6,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"1 through 10","median_amount":10066.43,"10th_percentile":10066.43,"90th_percentile":10066.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Congenital And Valvular Disorders Without Mcc","code_information":[{"code":"307","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7994.4,"maximum":20793.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":13437.74},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7994.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8154.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14376.51},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7994.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7994.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8074.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7994.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8234.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":20793.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":7994.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7994.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7994.4,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Congenital And Valvular Disorders With Mcc","code_information":[{"code":"306","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12586.13,"maximum":32736.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":23187.9},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12586.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12837.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24807.82},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12586.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12586.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12711.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12586.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12963.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":32736.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":12586.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12586.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12586.13,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hypertension Without Mcc","code_information":[{"code":"305","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6898.78,"maximum":17943.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":11111.3},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6898.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7036.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11887.54},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6898.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6898.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6967.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6898.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7105.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17943.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":6898.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6898.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6898.78,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hypertension With Mcc","code_information":[{"code":"304","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9912.58,"maximum":25782.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":17510.85},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9912.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10110.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18734.17},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9912.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9912.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10011.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9912.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10209.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":25782.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":9912.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9912.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9912.58,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Atherosclerosis Without Mcc","code_information":[{"code":"303","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6331.23,"maximum":16467.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":9906.14},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6331.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6457.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10598.19},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6331.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6331.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6394.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6331.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6521.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":16467.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":6331.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6331.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6331.23,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Atherosclerosis With Mcc","code_information":[{"code":"302","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9958.32,"maximum":25901.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":17607.97},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9958.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10157.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18838.07},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9958.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9958.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10057.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9958.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10257.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":25901.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":9958.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9958.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9958.32,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peripheral Vascular Disorders Without Cc/Mcc","code_information":[{"code":"301","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6653.47,"maximum":17305.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":10590.39},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6653.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6786.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11330.24},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6653.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6653.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6720.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6653.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6853.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17305.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":6653.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6653.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6653.47,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peripheral Vascular Disorders With Cc","code_information":[{"code":"300","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9063.67,"maximum":23574.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":15708.26},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9063.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9244.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16805.65},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9063.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9063.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9154.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9063.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9335.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":23574.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":9063.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9063.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9063.67,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peripheral Vascular Disorders With Mcc","code_information":[{"code":"299","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12980.44,"maximum":33762.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":24025.18},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12980.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13240.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25703.6},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12980.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12980.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13110.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12980.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13369.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":33762.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":12980.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12980.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12980.44,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12890.5,"10th_percentile":12890.5,"90th_percentile":12890.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Arrest, Unexplained Without Cc/Mcc","code_information":[{"code":"298","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4819.82,"maximum":12536.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":6696.8},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4819.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4916.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7164.64},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4819.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4819.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4868.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4819.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4964.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":12536.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":4819.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4819.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4819.82,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Arrest, Unexplained With Cc","code_information":[{"code":"297","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6059.58,"maximum":15760.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":9329.31},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6059.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6180.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9981.06},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6059.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6059.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6120.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6059.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6241.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":15760.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":6059.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6059.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6059.58,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Arrest, Unexplained With Mcc","code_information":[{"code":"296","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12489.8,"maximum":32485.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":22983.36},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12489.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12739.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24588.99},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12489.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12489.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12614.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12489.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12864.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":32485.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":12489.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12489.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12489.8,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Heart Failure And Shock Without Cc/Mcc","code_information":[{"code":"293","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5588.35,"maximum":14535.30,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":8328.69},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5588.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5700.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8910.54},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5588.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5588.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5644.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5588.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5756.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14535.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":5588.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5588.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5588.35,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Heart Failure And Shock With Cc","code_information":[{"code":"292","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7549.5,"maximum":19636.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":12493.04},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7549.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7700.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13365.81},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7549.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7549.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7625.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7549.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7775.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":19636.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":7549.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7549.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7549.5,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Heart Failure And Shock With Mcc","code_information":[{"code":"291","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10562.6,"maximum":27473.32,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":18891.12},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10562.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10773.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20210.86},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10562.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10562.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10668.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10562.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10879.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":27473.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":10562.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10562.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10562.6,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"1 through 10","median_amount":10612.66,"10th_percentile":10588.71,"90th_percentile":10780.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":11237.43,"10th_percentile":11237.43,"90th_percentile":11237.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10470.17,"10th_percentile":10470.17,"90th_percentile":10478.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8867.67,"10th_percentile":8867.67,"90th_percentile":8867.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Acute And Subacute Endocarditis Without Cc/Mcc","code_information":[{"code":"290","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8108.74,"maximum":21090.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":13680.54},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8108.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8270.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14636.27},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8108.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8108.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8189.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8108.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8352.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":21090.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":8108.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8108.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8108.74,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute And Subacute Endocarditis With Cc","code_information":[{"code":"289","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13494.63,"maximum":35099.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":25117.03},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13494.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13764.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26871.73},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13494.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13494.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13629.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13494.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13899.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":35099.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":13494.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13494.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13494.63,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute And Subacute Endocarditis With Mcc","code_information":[{"code":"288","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20419.65,"maximum":53111.51,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":39821.73},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20419.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20828.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":42603.71},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20419.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20419.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20623.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20419.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21032.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":53111.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":20419.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20419.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20419.65,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Circulatory Disorders Except Ami, With Cardiac Catheterization Without Mcc","code_information":[{"code":"287","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9081.69,"maximum":23621.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":15746.52},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9081.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9263.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16846.58},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9081.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9081.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9172.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9081.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9354.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":23621.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":9081.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9081.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9081.69,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Circulatory Disorders Except Ami, With Cardiac Catheterization With Mcc","code_information":[{"code":"286","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17000.45,"maximum":44218.17,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":32561.35},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17000.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17340.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34836.11},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17000.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17000.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17170.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17000.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17510.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":44218.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":17000.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17000.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17000.45,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Myocardial Infarction, Expired Without Cc/Mcc","code_information":[{"code":"285","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5816.34,"maximum":15128.30,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":8812.81},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5816.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5932.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9428.48},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5816.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5816.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5874.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5816.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5990.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":15128.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":5816.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5816.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5816.34,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Myocardial Infarction, Expired With Cc","code_information":[{"code":"284","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6462.89,"maximum":16809.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":10185.72},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6462.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6592.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10897.3},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6462.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6462.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6527.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6462.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6656.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":16809.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":6462.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6462.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6462.89,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Myocardial Infarction, Expired With Mcc","code_information":[{"code":"283","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15392.72,"maximum":40036.46,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":29147.47},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15392.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15700.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31183.73},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15392.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15392.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15546.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15392.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15854.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":40036.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":15392.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15392.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15392.72,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Myocardial Infarction, Discharged Alive Without Cc/Mcc","code_information":[{"code":"282","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6677.03,"maximum":17366.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":10640.42},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6677.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6810.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11383.76},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6677.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6677.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6743.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6677.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6877.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17366.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":6677.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6677.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6677.03,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Myocardial Infarction, Discharged Alive With Cc","code_information":[{"code":"281","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8035.28,"maximum":20899.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":13524.56},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8035.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8195.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14469.39},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8035.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8035.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8115.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8035.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8276.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":20899.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":8035.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8035.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8035.28,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Myocardial Infarction, Discharged Alive With Mcc","code_information":[{"code":"280","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12782.24,"maximum":33246.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":23604.33},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12782.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13037.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25253.35},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12782.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12782.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12910.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12782.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13165.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":33246.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":12782.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12782.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12782.24,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"1 through 10","median_amount":8055.94,"10th_percentile":8055.94,"90th_percentile":8055.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":13636.5,"10th_percentile":13636.5,"90th_percentile":13636.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures Without Mcc","code_information":[{"code":"279","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":26657.92,"maximum":69337.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":53068.18},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26657.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27191.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":56775.56},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26657.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26657.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26924.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26657.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27457.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":69337.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":26657.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26657.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26657.92,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures With Mcc","code_information":[{"code":"278","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":40239.07,"maximum":104661.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":81906.63},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":40239.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":41043.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":87628.69},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":40239.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40239.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":40641.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40239.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":41446.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":104661.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":40239.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":40239.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":40239.07,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant Without Mcc","code_information":[{"code":"277","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":33671.64,"maximum":87579.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":67961.23},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":33671.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34345.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":72709.05},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33671.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33671.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34008.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33671.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":34681.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":87579.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":33671.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33671.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":33671.64,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant With Mcc Or Carotid Sinus Neurostimulator","code_information":[{"code":"276","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":43290.99,"maximum":112599.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":88387.12},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":43290.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":44156.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":94561.9},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":43290.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43290.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":43723.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43290.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":44589.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":112599.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":43290.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":43290.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":43290.99,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc","code_information":[{"code":"275","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":51078.77,"maximum":132855.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":104923.84},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":51078.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":52100.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":112253.89},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":51078.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51078.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":51589.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51078.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":52611.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":132855.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":51078.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":51078.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":51078.77,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous And Other Intracardiac Procedures Without Mcc","code_information":[{"code":"274","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24477.09,"maximum":63664.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":48437.37},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24477.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24966.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":51821.23},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24477.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24477.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24721.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24477.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25211.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":63664.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":24477.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24477.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24477.09,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous And Other Intracardiac Procedures With Mcc","code_information":[{"code":"273","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":30255.21,"maximum":78693.80,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":60706.73},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30255.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30860.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":64947.75},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30255.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30255.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30557.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30255.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":31162.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":78693.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":30255.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30255.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30255.21,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Major Cardiovascular Procedures Without Cc/Mcc","code_information":[{"code":"272","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19357.99,"maximum":50350.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":37567.4},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19357.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19745.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":40191.88},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19357.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19357.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19551.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19357.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19938.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":50350.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":19357.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19357.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19357.99,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Major Cardiovascular Procedures With Cc","code_information":[{"code":"271","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":26310.73,"maximum":68434.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":52330.95},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26310.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26836.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":55986.83},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26310.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26310.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26573.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26310.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27100.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":68434.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":26310.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26310.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26310.73,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Major Cardiovascular Procedures With Mcc","code_information":[{"code":"270","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":38230.1,"maximum":99436.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":77640.75},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":38230.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38994.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":83064.79},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38230.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38230.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38612.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38230.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":39377.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":99436.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":38230.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38230.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":38230.1,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aortic And Heart Assist Procedures Except Pulsation Balloon Without Mcc","code_information":[{"code":"269","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":30932.26,"maximum":80454.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":62144.39},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30932.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31550.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":66485.84},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30932.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30932.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31241.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30932.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":31860.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":80454.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":30932.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30932.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30932.26,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc","code_information":[{"code":"268","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":49328.98,"maximum":128304.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":101208.3},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":49328.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":50315.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":108278.78},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":49328.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49328.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":49822.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49328.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":50808.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":128304.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":49328.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":49328.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":49328.98,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Endovascular Cardiac Valve Replacement And Supplement Procedures Without Mcc","code_information":[{"code":"267","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":34657.76,"maximum":90144.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":70055.17},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":34657.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35350.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":74949.27},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34657.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34657.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35004.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34657.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35697.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":90144.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":34657.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34657.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":34657.76,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc","code_information":[{"code":"266","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":44135.05,"maximum":114795.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":90179.41},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":44135.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":45017.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":96479.4},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":44135.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44135.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":44576.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44135.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":45459.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":114795.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":44135.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":44135.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":44135.05,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aicd Lead Procedures","code_information":[{"code":"265","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":26739.69,"maximum":69549.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":53241.81},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26739.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27274.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":56961.32},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26739.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26739.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27007.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26739.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27541.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":69549.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":26739.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26739.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26739.69,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Circulatory System O.R. Procedures","code_information":[{"code":"264","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24815.96,"maximum":64546.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":49156.93},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24815.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25312.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":52591.07},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24815.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24815.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25064.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24815.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25560.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":64546.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":24815.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24815.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24815.96,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vein Ligation And Stripping","code_information":[{"code":"263","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":22853.42,"maximum":59441.75,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":44989.64},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22853.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23310.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":48132.65},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22853.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22853.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23081.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22853.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23539.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":59441.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":22853.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22853.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22853.42,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Pacemaker Revision Except Device Replacement Without Cc/Mcc","code_information":[{"code":"262","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12961.03,"maximum":33711.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":23983.98},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12961.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13220.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25659.52},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12961.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12961.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13090.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12961.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13349.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":33711.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":12961.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12961.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12961.03,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Pacemaker Revision Except Device Replacement With Cc","code_information":[{"code":"261","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14766.96,"maximum":38408.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":27818.71},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14766.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15062.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29762.14},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14766.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14766.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14914.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14766.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15209.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":38408.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":14766.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14766.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14766.96,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Pacemaker Revision Except Device Replacement With Mcc","code_information":[{"code":"260","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24207.52,"maximum":62963.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":47864.95},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24207.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24691.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":51208.83},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24207.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24207.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24449.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24207.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24933.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":62963.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":24207.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24207.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24207.52,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Pacemaker Device Replacement Without Mcc","code_information":[{"code":"259","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15678.93,"maximum":40780.90,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":29755.2},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15678.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15992.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31833.92},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15678.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15678.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15835.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15678.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16149.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":40780.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":15678.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15678.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15678.93,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Pacemaker Device Replacement With Mcc","code_information":[{"code":"258","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23440.38,"maximum":60968.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":46236.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23440.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23909.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":49466.08},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23440.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23440.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23674.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23440.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24143.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":60968.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":23440.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23440.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23440.38,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Upper Limb And Toe Amputation For Circulatory System Disorders Without Cc/Mcc","code_information":[{"code":"257","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9234.84,"maximum":24019.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":16071.72},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9234.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9419.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17194.5},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9234.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9234.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9327.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9234.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9511.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":24019.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":9234.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9234.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9234.84,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Upper Limb And Toe Amputation For Circulatory System Disorders With Cc","code_information":[{"code":"256","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13432.26,"maximum":34937.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":24984.6},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13432.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13700.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26730.04},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13432.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13432.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13566.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13432.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13835.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":34937.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":13432.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13432.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13432.26,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Upper Limb And Toe Amputation For Circulatory System Disorders With Mcc","code_information":[{"code":"255","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20358.67,"maximum":52952.90,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":39692.24},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20358.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20765.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":42465.17},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20358.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20358.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20562.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20358.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20969.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":52952.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":20358.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20358.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20358.67,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Vascular Procedures Without Cc/Mcc","code_information":[{"code":"254","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14012.99,"maximum":36447.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":26217.72},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14012.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14293.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28049.3},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14012.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14012.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14153.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14012.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14433.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":36447.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":14012.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14012.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14012.99,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Vascular Procedures With Cc","code_information":[{"code":"253","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19653.21,"maximum":51118.00,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":38194.25},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19653.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20046.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":40862.53},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19653.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19653.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19849.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19653.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20242.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":51118.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":19653.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19653.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19653.21,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Vascular Procedures With Mcc","code_information":[{"code":"252","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":25839.5,"maximum":67208.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":51330.33},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25839.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26356.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":54916.31},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25839.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25839.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26097.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25839.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26614.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":67208.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":25839.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25839.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25839.5,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Cardiovascular Procedures Without Intraluminal Device Without Mcc","code_information":[{"code":"251","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12022.73,"maximum":31271.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":21991.57},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12022.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12263.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23527.91},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12022.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12022.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12142.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12022.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12383.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":31271.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":12022.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12022.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12022.73,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Cardiovascular Procedures Without Intraluminal Device With Mcc","code_information":[{"code":"250","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16790.48,"maximum":43672.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":32115.49},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16790.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17126.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34359.1},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16790.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16790.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16958.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16790.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17294.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":43672.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":16790.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16790.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16790.48,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aicd Generator Procedures","code_information":[{"code":"245","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":33282.87,"maximum":86568.74,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":67135.72},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":33282.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33948.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":71825.86},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33282.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33282.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33615.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33282.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":34281.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":86568.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":33282.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33282.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":33282.87,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Permanent Cardiac Pacemaker Implant Without Cc/Mcc","code_information":[{"code":"244","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14191.78,"maximum":36912.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":26597.36},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14191.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14475.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28455.47},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14191.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14191.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14333.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14191.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14617.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":36912.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":14191.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14191.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14191.78,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Permanent Cardiac Pacemaker Implant With Cc","code_information":[{"code":"243","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16432.9,"maximum":42741.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":31356.19},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16432.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16761.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33546.76},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16432.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16432.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16597.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16432.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16925.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":42741.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":16432.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16432.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16432.9,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Permanent Cardiac Pacemaker Implant With Mcc","code_information":[{"code":"242","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23791.72,"maximum":61882.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":46982.05},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23791.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24267.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":50264.25},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23791.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23791.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24029.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23791.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24505.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":61882.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":23791.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23791.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23791.72,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/Mcc","code_information":[{"code":"241","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11259.75,"maximum":29286.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":20371.45},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11259.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11484.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21794.61},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11259.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11259.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11372.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11259.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11597.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":29286.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":11259.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11259.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11259.75,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc","code_information":[{"code":"240","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21419.63,"maximum":55712.46,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":41945.11},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21419.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21848.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":44875.42},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21419.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21419.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21633.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21419.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22062.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":55712.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":21419.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21419.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21419.63,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation For Circulatory System Disorders Except Upper Limb And Toe With Mcc","code_information":[{"code":"239","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":35772.77,"maximum":93044.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":72422.82},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35772.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36488.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":77482.32},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35772.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35772.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36130.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35772.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36845.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":93044.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":35772.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35772.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35772.77,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Bypass Without Cardiac Catheterization Without Mcc","code_information":[{"code":"236","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":30693.87,"maximum":79834.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":61638.19},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30693.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31307.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":65944.28},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30693.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30693.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31000.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30693.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":31614.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":79834.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":30693.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30693.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30693.87,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Bypass Without Cardiac Catheterization With Mcc","code_information":[{"code":"235","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":42334.67,"maximum":110112.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":86356.45},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":42334.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":43181.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":92389.37},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":42334.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42334.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":42758.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42334.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":43604.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":110112.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":42334.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":42334.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":42334.67,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Bypass With Cardiac Catheterization Or Open Ablation Without Mcc","code_information":[{"code":"234","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":39521.83,"maximum":102796.28,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":80383.63},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":39521.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":40312.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":85999.29},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39521.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39521.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39917.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39521.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":40707.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":102796.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":39521.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39521.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":39521.83,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc","code_information":[{"code":"233","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":54646.27,"maximum":142134.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":112499.12},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":54646.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":55739.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":120358.38},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":54646.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54646.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":55192.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54646.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":56285.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":142134.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":54646.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":54646.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":54646.27,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Bypass With Ptca Without Mcc","code_information":[{"code":"232","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":43679.06,"maximum":113609.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":89211.16},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":43679.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":44552.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":95443.51},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":43679.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43679.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":44115.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43679.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":44989.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":113609.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":43679.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":43679.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":43679.06,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Bypass With Ptca With Mcc","code_information":[{"code":"231","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":60084.14,"maximum":156278.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":124045.98},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":60084.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":61285.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":132711.92},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":60084.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":60084.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":60684.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":60084.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":61886.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":156278.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":60084.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":60084.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":60084.14,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Cardiothoracic Procedures Without Mcc","code_information":[{"code":"229","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23491.66,"maximum":61101.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":46344.89},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23491.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23961.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":49582.58},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23491.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23491.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23726.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23491.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24196.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":61101.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":23491.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23491.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23491.66,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Cardiothoracic Procedures With Mcc","code_information":[{"code":"228","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":35950.87,"maximum":93508.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":72800.99},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35950.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36669.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":77886.92},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35950.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35950.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36310.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35950.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":37029.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":93508.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":35950.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35950.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35950.87,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/M","code_information":[{"code":"221","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":36593.96,"maximum":95180.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":74166.54},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36593.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37325.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":79347.87},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36593.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36593.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36959.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36593.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":37691.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":95180.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":36593.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36593.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36593.96,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc","code_information":[{"code":"220","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":38621.64,"maximum":100454.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":78472.15},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":38621.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39394.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":83954.27},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38621.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38621.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39007.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38621.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":39780.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":100454.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":38621.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38621.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":38621.64,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Mcc","code_information":[{"code":"219","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":54875.65,"maximum":142731.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":112986.18},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":54875.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":55973.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":120879.48},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":54875.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54875.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":55424.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54875.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":56521.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":142731.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":54875.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":54875.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":54875.65,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/Mcc","code_information":[{"code":"218","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":47232.0,"maximum":122850.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":96755.54},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":47232.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":48176.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":103514.95},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":47232.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47232.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":47704.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47232.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":48648.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":122850.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":47232.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":47232.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":47232.0,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc","code_information":[{"code":"217","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":47232.0,"maximum":122850.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":96755.54},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":47232.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":48176.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":103514.95},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":47232.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47232.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":47704.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47232.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":48648.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":122850.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":47232.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":47232.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":47232.0,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Mcc","code_information":[{"code":"216","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":69459.56,"maximum":180664.32,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":143953.9},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":69459.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":70848.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":154010.62},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":69459.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":69459.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":70154.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":69459.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":71543.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":180664.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":69459.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":69459.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":69459.56,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Heart Assist System Implant","code_information":[{"code":"215","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":70666.74,"maximum":183804.19,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":146517.26},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":70666.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":72080.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":156753.05},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":70666.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":70666.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":71373.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":70666.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":72786.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":183804.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":70666.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":70666.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":70666.74,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Endovascular Abdominal Aorta With Iliac Branch Procedures","code_information":[{"code":"213","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":41214.11,"maximum":107197.90,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":83977.03},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":41214.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":42038.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":89843.73},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":41214.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41214.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":41626.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41214.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":42450.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":107197.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":41214.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":41214.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":41214.11,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Concomitant Aortic And Mitral Valve Procedures","code_information":[{"code":"212","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":77022.12,"maximum":200334.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":160012.38},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":77022.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":78562.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":171190.96},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":77022.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":77022.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":77792.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":77022.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":79332.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":200334.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":77022.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":77022.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":77022.12,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complex Aortic Arch Procedures","code_information":[{"code":"209","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":80103.83,"maximum":208350.06,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":166556.14},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":80103.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":81705.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":178191.87},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":80103.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":80103.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":80904.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":80103.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":82506.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":208350.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":80103.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":80103.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":80103.83,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory System Diagnosis With Ventilator Support <=96 Hours","code_information":[{"code":"208","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20714.17,"maximum":53877.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":40447.12},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20714.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21128.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":43272.78},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20714.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20714.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20921.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20714.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21335.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":53877.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":20714.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20714.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20714.17,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory System Diagnosis With Ventilator Support >96 Hours","code_information":[{"code":"207","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":46257.66,"maximum":120316.17,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":94686.61},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":46257.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":47182.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":101301.48},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":46257.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46257.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":46720.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46257.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":47645.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":120316.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":46257.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":46257.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":46257.66,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Respiratory System Diagnoses Without Mcc","code_information":[{"code":"206","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8187.74,"maximum":21296.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":13848.29},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8187.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8351.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14815.74},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8187.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8187.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8269.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8187.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8433.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":21296.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":8187.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8187.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8187.74,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Respiratory System Diagnoses With Mcc","code_information":[{"code":"205","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14354.63,"maximum":37336.39,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":26943.17},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14354.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14641.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28825.43},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14354.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14354.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14498.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14354.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14785.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":37336.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":14354.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14354.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14354.63,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory Signs And Symptoms","code_information":[{"code":"204","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7261.22,"maximum":18886.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":11880.89},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7261.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7406.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12710.9},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7261.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7261.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7333.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7261.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7479.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":18886.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":7261.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7261.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7261.22,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bronchitis And Asthma Without Cc/Mcc","code_information":[{"code":"203","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6309.05,"maximum":16409.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":9859.05},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6309.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6435.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10547.81},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6309.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6309.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6372.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6309.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6498.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":16409.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":6309.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6309.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6309.05,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bronchitis And Asthma With Cc/Mcc","code_information":[{"code":"202","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8396.33,"maximum":21838.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":14291.21},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8396.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8564.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15289.6},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8396.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8396.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8480.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8396.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8648.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":21838.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":8396.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8396.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8396.33,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"1 through 10","median_amount":8409.79,"10th_percentile":8409.79,"90th_percentile":8409.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pneumothorax Without Cc/Mcc","code_information":[{"code":"201","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6621.59,"maximum":17222.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":10522.7},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6621.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6754.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11257.82},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6621.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6621.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6687.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6621.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6820.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17222.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":6621.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6621.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6621.59,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pneumothorax With Cc","code_information":[{"code":"200","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9284.04,"maximum":24147.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":16176.2},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9284.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9469.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17306.28},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9284.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9284.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9376.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9284.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9562.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":24147.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":9284.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9284.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9284.04,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pneumothorax With Mcc","code_information":[{"code":"199","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13891.02,"maximum":36130.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":25958.73},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13891.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14168.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27772.23},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13891.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13891.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14029.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13891.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14307.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":36130.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":13891.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13891.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13891.02,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Interstitial Lung Disease Without Cc/Mcc","code_information":[{"code":"198","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6629.21,"maximum":17242.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":10538.88},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6629.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6761.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11275.14},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6629.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6629.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6695.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6629.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6828.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17242.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":6629.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6629.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6629.21,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Interstitial Lung Disease With Cc","code_information":[{"code":"197","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8243.18,"maximum":21440.51,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":13966.01},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8243.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8408.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14941.68},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8243.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8243.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8325.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8243.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8490.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":21440.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":8243.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8243.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8243.18,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Interstitial Lung Disease With Mcc","code_information":[{"code":"196","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14744.09,"maximum":38349.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":27770.15},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14744.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15038.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29710.19},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14744.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14744.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14891.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14744.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15186.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":38349.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":14744.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14744.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14744.09,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Simple Pneumonia And Pleurisy Without Cc/Mcc","code_information":[{"code":"195","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6021.46,"maximum":15661.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":9248.38},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6021.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6141.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9894.48},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6021.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6021.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6081.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6021.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6202.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":15661.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":6021.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6021.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6021.46,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Simple Pneumonia And Pleurisy With Cc","code_information":[{"code":"194","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7250.82,"maximum":18859.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":11858.82},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7250.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7395.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12687.28},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7250.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7250.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7323.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7250.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7468.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":18859.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":7250.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7250.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7250.82,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Simple Pneumonia And Pleurisy With Mcc","code_information":[{"code":"193","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10774.66,"maximum":28024.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":19341.4},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10774.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10990.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20692.6},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10774.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10774.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10882.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10774.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11097.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":28024.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":10774.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10774.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10774.66,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"1 through 10","median_amount":11364.04,"10th_percentile":11364.04,"90th_percentile":11364.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10013.97,"10th_percentile":10013.97,"90th_percentile":10013.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"1 through 10","median_amount":10790.08,"10th_percentile":10790.08,"90th_percentile":10790.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":9862.95,"10th_percentile":9862.95,"90th_percentile":9862.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chronic Obstructive Pulmonary Disease Without Cc/Mcc","code_information":[{"code":"192","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6115.02,"maximum":15905.17,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":9447.03},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6115.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6237.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10107.01},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6115.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6115.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6176.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6115.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6298.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":15905.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":6115.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6115.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6115.02,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chronic Obstructive Pulmonary Disease With Cc","code_information":[{"code":"191","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7507.92,"maximum":19528.10,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":12404.75},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7507.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7658.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13271.35},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7507.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7507.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7583.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7507.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7733.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":19528.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":7507.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7507.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7507.92,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chronic Obstructive Pulmonary Disease With Mcc","code_information":[{"code":"190","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9342.26,"maximum":24299.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":16299.81},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9342.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9529.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17438.52},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9342.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9342.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9435.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9342.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9622.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":24299.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":9342.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9342.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9342.26,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"1 through 10","median_amount":6209.98,"10th_percentile":6209.98,"90th_percentile":6209.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pulmonary Edema And Respiratory Failure","code_information":[{"code":"189","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10227.2,"maximum":26600.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":18178.91},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10227.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10431.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19448.9},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10227.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10227.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10329.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10227.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10534.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":26600.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":10227.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10227.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10227.2,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"1 through 10","median_amount":10247.04,"10th_percentile":10247.04,"90th_percentile":10247.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":9613.26,"10th_percentile":9613.26,"90th_percentile":9613.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pleural Effusion Without Cc/Mcc","code_information":[{"code":"188","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6636.14,"maximum":17260.60,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":10553.6},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6636.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6768.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11290.88},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6636.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6636.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6702.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6636.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6835.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17260.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":6636.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6636.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6636.14,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pleural Effusion With Cc","code_information":[{"code":"187","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8520.37,"maximum":22161.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":14554.61},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8520.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8690.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15571.4},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8520.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8520.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8605.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8520.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8775.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":22161.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":8520.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8520.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8520.37,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pleural Effusion With Mcc","code_information":[{"code":"186","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12466.24,"maximum":32424.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":22933.33},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12466.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12715.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24535.47},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12466.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12466.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12590.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12466.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12840.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":32424.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":12466.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12466.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12466.24,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Chest Trauma Without Cc/Mcc","code_information":[{"code":"185","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7116.38,"maximum":18509.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":11573.35},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7116.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7258.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12381.87},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7116.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7116.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7187.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7116.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7329.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":18509.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":7116.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7116.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7116.38,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Chest Trauma With Cc","code_information":[{"code":"184","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9040.11,"maximum":23513.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":15658.23},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9040.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9220.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16752.13},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9040.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9040.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9130.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9040.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9311.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":23513.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":9040.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9040.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9040.11,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Chest Trauma With Mcc","code_information":[{"code":"183","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12268.05,"maximum":31909.20,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":22512.48},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12268.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12513.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24085.22},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12268.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12268.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12390.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12268.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12636.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":31909.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":12268.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12268.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12268.05,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory Neoplasms Without Cc/Mcc","code_information":[{"code":"182","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6889.77,"maximum":17920.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":11092.17},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6889.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7027.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11867.07},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6889.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6889.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6958.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6889.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7096.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17920.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":6889.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6889.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6889.77,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory Neoplasms With Cc","code_information":[{"code":"181","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9087.93,"maximum":23637.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":15759.77},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9087.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9269.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16860.75},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9087.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9087.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9178.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9087.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9360.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":23637.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":9087.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9087.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9087.93,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory Neoplasms With Mcc","code_information":[{"code":"180","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13904.19,"maximum":36164.80,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":25986.69},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13904.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14182.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27802.14},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13904.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13904.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14043.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13904.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14321.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":36164.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":13904.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13904.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13904.19,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory Infections And Inflammations Without Cc/Mcc","code_information":[{"code":"179","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6898.09,"maximum":17941.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":11109.83},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6898.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7036.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11885.97},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6898.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6898.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6967.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6898.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7105.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17941.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":6898.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6898.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6898.09,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory Infections And Inflammations With Cc","code_information":[{"code":"178","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8429.59,"maximum":21925.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":14361.84},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8429.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8598.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15365.17},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8429.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8429.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8513.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8429.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8682.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":21925.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":8429.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8429.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8429.59,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory Infections And Inflammations With Mcc","code_information":[{"code":"177","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12495.35,"maximum":32500.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":22995.13},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12495.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12745.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24601.59},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12495.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12495.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12620.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12495.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12870.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":32500.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":12495.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12495.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12495.35,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"1 through 10","median_amount":3957.87,"10th_percentile":3957.87,"90th_percentile":3957.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12389.89,"10th_percentile":12389.89,"90th_percentile":12389.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pulmonary Embolism Without Mcc","code_information":[{"code":"176","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7244.58,"maximum":18843.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":11845.58},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7244.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7389.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12673.12},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7244.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7244.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7317.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7244.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7461.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":18843.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":7244.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7244.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7244.58,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"1 through 10","median_amount":11448.05,"10th_percentile":11448.05,"90th_percentile":11448.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pulmonary Embolism With Mcc Or Acute Cor Pulmonale","code_information":[{"code":"175","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11184.91,"maximum":29091.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":20212.52},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11184.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11408.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21624.58},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11184.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11184.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11296.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11184.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11520.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":29091.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":11184.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11184.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11184.91,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8305.47,"10th_percentile":8305.47,"90th_percentile":8305.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ultrasound Accelerated And Other Thrombolysis With Principal Diagnosis Pulmonary Embolism","code_information":[{"code":"173","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":22292.1,"maximum":57981.75,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":43797.73},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22292.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22737.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":46857.47},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22292.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22292.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22515.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22292.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22960.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":57981.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":22292.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22292.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22292.1,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Respiratory System O.R. Procedures Without Cc/Mcc","code_information":[{"code":"168","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11135.01,"maximum":28962.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":20106.58},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11135.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11357.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21511.24},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11135.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11135.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11246.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11135.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11469.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":28962.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":11135.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11135.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11135.01,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Respiratory System O.R. Procedures With Cc","code_information":[{"code":"167","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14163.36,"maximum":36838.90,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":26537.03},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14163.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14446.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28390.93},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14163.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14163.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14304.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14163.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14588.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":36838.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":14163.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14163.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14163.36,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Respiratory System O.R. Procedures With Mcc","code_information":[{"code":"166","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":27567.81,"maximum":71703.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":55000.26},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27567.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28119.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":58842.61},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27567.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27567.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27843.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27567.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28394.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":71703.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":27567.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27567.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27567.81,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Chest Procedures Without Cc/Mcc","code_information":[{"code":"165","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14931.19,"maximum":38836.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":28167.45},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14931.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15229.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30135.25},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14931.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14931.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15080.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14931.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15379.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":38836.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":14931.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14931.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14931.19,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Chest Procedures With Cc","code_information":[{"code":"164","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19157.03,"maximum":49827.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":37140.66},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19157.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19540.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39735.33},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19157.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19157.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19348.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19157.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19731.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":49827.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":19157.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19157.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19157.03,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18987.48,"10th_percentile":18987.48,"90th_percentile":18987.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Chest Procedures With Mcc","code_information":[{"code":"163","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":32724.32,"maximum":85115.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":65949.69},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":32724.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33378.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":70556.98},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32724.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32724.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33051.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32724.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":33706.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":85115.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":32724.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32724.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":32724.32,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Dental And Oral Diseases Without Cc/Mcc","code_information":[{"code":"159","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6575.85,"maximum":17103.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":10425.58},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6575.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6707.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11153.92},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6575.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6575.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6641.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6575.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6773.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17103.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":6575.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6575.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6575.85,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Dental And Oral Diseases With Cc","code_information":[{"code":"158","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7970.83,"maximum":20732.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":13387.71},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7970.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8130.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14322.98},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7970.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7970.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8050.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7970.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8209.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":20732.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":7970.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7970.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7970.83,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Dental And Oral Diseases With Mcc","code_information":[{"code":"157","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13563.24,"maximum":35277.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":25262.71},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13563.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13834.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27027.58},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13563.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13563.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13698.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13563.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13970.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":35277.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":13563.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13563.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13563.24,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/Mcc","code_information":[{"code":"156","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6455.27,"maximum":16790.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":10169.54},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6455.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6584.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10879.99},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6455.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6455.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6519.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6455.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6648.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":16790.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":6455.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6455.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6455.27,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Ear, Nose, Mouth And Throat Diagnoses With Cc","code_information":[{"code":"155","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8017.26,"maximum":20852.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":13486.3},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8017.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8177.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14428.46},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8017.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8017.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8097.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8017.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8257.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":20852.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":8017.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8017.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8017.26,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Ear, Nose, Mouth And Throat Diagnoses With Mcc","code_information":[{"code":"154","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12500.89,"maximum":32514.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":23006.9},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12500.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12750.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24614.18},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12500.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12500.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12625.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12500.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12875.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":32514.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":12500.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12500.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12500.89,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Otitis Media And Uri Without Mcc","code_information":[{"code":"153","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6781.67,"maximum":17639.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":10862.61},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6781.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6917.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11621.48},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6781.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6781.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6849.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6781.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6985.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17639.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":6781.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6781.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6781.67,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Otitis Media And Uri With Mcc","code_information":[{"code":"152","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9858.53,"maximum":25642.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":17396.07},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9858.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10055.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18611.37},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9858.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9858.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9957.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9858.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10154.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":25642.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":9858.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9858.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9858.53,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Epistaxis Without Mcc","code_information":[{"code":"151","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6752.56,"maximum":17563.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":10800.81},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6752.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6887.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11555.36},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6752.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6752.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6820.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6752.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6955.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17563.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":6752.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6752.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6752.56,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Epistaxis With Mcc","code_information":[{"code":"150","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10893.16,"maximum":28333.11,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":19593.02},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10893.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11111.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20961.8},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10893.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10893.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11002.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10893.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11219.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":28333.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":10893.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10893.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10893.16,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Dysequilibrium","code_information":[{"code":"149","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6874.53,"maximum":17880.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":11059.79},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6874.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7012.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11832.44},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6874.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6874.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6943.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6874.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7080.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17880.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":6874.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6874.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6874.53,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ear, Nose, Mouth And Throat Malignancy Without Cc/Mcc","code_information":[{"code":"148","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7189.84,"maximum":18700.77,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":11729.33},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7189.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7333.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12548.75},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7189.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7189.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7261.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7189.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7405.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":18700.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":7189.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7189.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7189.84,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ear, Nose, Mouth And Throat Malignancy With Cc","code_information":[{"code":"147","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10477.37,"maximum":27251.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":18710.12},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10477.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10686.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20017.22},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10477.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10477.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10582.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10477.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10791.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":27251.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":10477.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10477.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10477.37,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ear, Nose, Mouth And Throat Malignancy With Mcc","code_information":[{"code":"146","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16339.34,"maximum":42498.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":31157.54},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16339.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16666.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33334.23},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16339.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16339.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16502.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16339.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16829.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":42498.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":16339.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16339.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16339.34,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Ear, Nose, Mouth And Throat O.R. Procedures Without Cc/Mcc","code_information":[{"code":"145","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9997.82,"maximum":26004.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":17691.84},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9997.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10197.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18927.81},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9997.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9997.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10097.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9997.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10297.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":26004.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":9997.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9997.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9997.82,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Ear, Nose, Mouth And Throat O.R. Procedures With Cc","code_information":[{"code":"144","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13674.81,"maximum":35568.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":25499.62},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13674.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13948.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27281.04},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13674.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13674.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13811.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13674.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14085.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":35568.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":13674.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13674.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13674.81,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"1 through 10","median_amount":30331.83,"10th_percentile":30331.83,"90th_percentile":30331.83},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Ear, Nose, Mouth And Throat O.R. Procedures With Mcc","code_information":[{"code":"143","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":27629.48,"maximum":71864.28,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":55131.22},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27629.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28182.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":58982.72},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27629.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27629.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27905.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27629.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28458.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":71864.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":27629.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27629.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27629.48,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Head And Neck Procedures Without Cc/Mcc","code_information":[{"code":"142","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12728.88,"maximum":33107.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":23491.03},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12728.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12983.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25132.13},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12728.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12728.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12856.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12728.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13110.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":33107.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":12728.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12728.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12728.88,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Head And Neck Procedures With Cc","code_information":[{"code":"141","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16780.78,"maximum":43646.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":32094.89},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16780.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17116.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34337.06},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16780.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16780.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16948.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16780.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17284.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":43646.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":16780.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16780.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16780.78,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Head And Neck Procedures With Mcc","code_information":[{"code":"140","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":31224.01,"maximum":81213.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":62763.89},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":31224.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31848.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":67148.62},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31224.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31224.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31536.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31224.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":32160.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":81213.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":31224.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31224.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":31224.01,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Salivary Gland Procedures","code_information":[{"code":"139","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10229.28,"maximum":26606.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":18183.33},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10229.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10433.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19453.63},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10229.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10229.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10331.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10229.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10536.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":26606.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":10229.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10229.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10229.28,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Mouth Procedures Without Cc/Mcc","code_information":[{"code":"138","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7807.29,"maximum":20306.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":13040.43},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7807.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7963.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13951.45},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7807.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7807.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7885.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7807.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8041.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":20306.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":7807.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7807.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7807.29,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Mouth Procedures With Cc/Mcc","code_information":[{"code":"137","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12013.72,"maximum":31247.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":21972.44},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12013.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12253.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23507.45},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12013.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12013.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12133.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12013.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12374.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":31247.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":12013.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12013.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12013.72,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Sinus And Mastoid Procedures Without Cc/Mcc","code_information":[{"code":"136","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8701.94,"maximum":22633.75,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":14940.14},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8701.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8875.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15983.87},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8701.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8701.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8788.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8701.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8963.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":22633.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":8701.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8701.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8701.94,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Sinus And Mastoid Procedures With Cc/Mcc","code_information":[{"code":"135","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16703.85,"maximum":43446.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":31931.55},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16703.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17037.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34162.31},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16703.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16703.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16870.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16703.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17204.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":43446.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":16703.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16703.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16703.85,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders Of The Eye Without Mcc","code_information":[{"code":"125","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6986.79,"maximum":18172.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":11298.18},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6986.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7126.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12087.48},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6986.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6986.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7056.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6986.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7196.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":18172.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":6986.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6986.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6986.79,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders Of The Eye With Mcc Or Thrombolytic Agent","code_information":[{"code":"124","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10834.95,"maximum":28181.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":19469.42},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10834.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11051.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20829.56},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10834.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10834.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10943.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10834.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11160.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":28181.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":10834.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10834.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10834.95,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Neurological Eye Disorders","code_information":[{"code":"123","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7200.23,"maximum":18727.80,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":11751.4},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7200.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7344.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12572.36},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7200.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7200.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7272.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7200.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7416.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":18727.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":7200.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7200.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7200.23,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Major Eye Infections Without Cc/Mcc","code_information":[{"code":"122","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7111.53,"maximum":18497.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":11563.05},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7111.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7253.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12370.85},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7111.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7111.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7182.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7111.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7324.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":18497.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":7111.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7111.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7111.53,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Major Eye Infections With Cc/Mcc","code_information":[{"code":"121","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9727.56,"maximum":25301.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":17117.96},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9727.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9922.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18313.83},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9727.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9727.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9824.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9727.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10019.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":25301.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":9727.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9727.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9727.56,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intraocular Procedures Without Cc/Mcc","code_information":[{"code":"117","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9184.25,"maximum":23888.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":15964.3},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9184.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9367.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17079.58},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9184.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9184.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9276.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9184.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9459.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":23888.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":9184.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9184.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9184.25,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intraocular Procedures With Cc/Mcc","code_information":[{"code":"116","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14195.93,"maximum":36923.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":26606.19},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14195.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14479.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28464.92},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14195.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14195.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14337.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14195.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14621.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":36923.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":14195.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14195.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14195.93,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extraocular Procedures Except Orbit","code_information":[{"code":"115","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12302.69,"maximum":31999.30,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":22586.05},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12302.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12548.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24163.93},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12302.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12302.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12425.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12302.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12671.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":31999.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":12302.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12302.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12302.69,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Orbital Procedures Without Cc/Mcc","code_information":[{"code":"114","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11042.15,"maximum":28720.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":19909.4},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11042.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11262.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21300.28},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11042.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11042.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11152.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11042.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11373.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":28720.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":11042.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11042.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11042.15,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Orbital Procedures With Cc/Mcc","code_information":[{"code":"113","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17958.85,"maximum":46710.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":34596.44},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17958.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18318.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37013.37},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17958.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17958.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18138.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17958.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18497.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":46710.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":17958.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17958.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17958.85,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Headaches Without Mcc","code_information":[{"code":"103","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7461.49,"maximum":19407.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":12306.15},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7461.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7610.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13165.87},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7461.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7461.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7536.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7461.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7685.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":19407.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":7461.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7461.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7461.49,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Headaches With Mcc","code_information":[{"code":"102","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9433.73,"maximum":24537.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":16494.04},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9433.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9622.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17646.33},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9433.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9433.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9528.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9433.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9716.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":24537.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":9433.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9433.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9433.73,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Seizures Without Mcc","code_information":[{"code":"101","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7920.94,"maximum":20602.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":13281.76},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7920.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8079.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14209.63},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7920.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7920.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8000.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7920.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8158.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":20602.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":7920.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7920.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7920.94,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"1 through 10","median_amount":11820.0,"10th_percentile":11820.0,"90th_percentile":11820.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Seizures With Mcc","code_information":[{"code":"100","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15087.81,"maximum":39243.39,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":28500.01},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15087.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15389.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30491.04},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15087.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15087.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15238.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15087.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15540.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":39243.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":15087.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15087.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15087.81,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/Mcc","code_information":[{"code":"099","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11107.29,"maximum":28890.06,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":20047.72},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11107.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11329.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21448.26},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11107.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11107.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11218.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11107.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11440.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":28890.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":11107.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11107.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11107.29,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc","code_information":[{"code":"098","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17569.39,"maximum":45697.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":33769.45},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17569.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17920.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36128.61},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17569.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17569.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17745.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17569.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18096.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":45697.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":17569.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17569.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17569.39,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Mcc","code_information":[{"code":"097","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":26695.34,"maximum":69434.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":53147.64},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26695.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27229.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":56860.57},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26695.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26695.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26962.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26695.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27496.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":69434.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":26695.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26695.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26695.34,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bacterial And Tuberculous Infections Of Nervous System Without Cc/Mcc","code_information":[{"code":"096","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19539.56,"maximum":50822.40,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":37952.93},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19539.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19930.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":40604.35},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19539.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19539.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19734.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19539.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20125.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":50822.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":19539.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19539.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19539.56,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bacterial And Tuberculous Infections Of Nervous System With Cc","code_information":[{"code":"095","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19539.56,"maximum":50822.40,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":37952.93},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19539.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19930.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":40604.35},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19539.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19539.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19734.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19539.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20125.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":50822.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":19539.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19539.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19539.56,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bacterial And Tuberculous Infections Of Nervous System With Mcc","code_information":[{"code":"094","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":26055.02,"maximum":67769.11,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":51787.97},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26055.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26576.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":55405.91},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26055.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26055.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26315.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26055.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26836.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":67769.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":26055.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26055.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26055.02,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders Of Nervous System Without Cc/Mcc","code_information":[{"code":"093","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7184.29,"maximum":18686.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":11717.55},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7184.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7327.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12536.15},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7184.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7184.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7256.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7184.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7399.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":18686.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":7184.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7184.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7184.29,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders Of Nervous System With Cc","code_information":[{"code":"092","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8755.3,"maximum":22772.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":15053.45},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8755.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8930.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16105.09},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8755.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8755.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8842.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8755.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9017.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":22772.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":8755.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8755.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8755.3,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":3272.06,"10th_percentile":3272.06,"90th_percentile":3272.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders Of Nervous System With Mcc","code_information":[{"code":"091","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13836.27,"maximum":35988.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":25842.48},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13836.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14113.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27647.86},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13836.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13836.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13974.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13836.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14251.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":35988.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":13836.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13836.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13836.27,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Concussion Without Cc/Mcc","code_information":[{"code":"090","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7370.71,"maximum":19171.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":12113.39},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7370.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7518.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12959.64},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7370.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7370.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7444.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7370.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7591.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":19171.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":7370.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7370.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7370.71,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Concussion With Cc","code_information":[{"code":"089","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9279.19,"maximum":24135.17,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":16165.9},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9279.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9464.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17295.26},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9279.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9279.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9371.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9279.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9557.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":24135.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":9279.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9279.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9279.19,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Concussion With Mcc","code_information":[{"code":"088","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11033.84,"maximum":28699.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":19891.74},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11033.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11254.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21281.39},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11033.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11033.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11144.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11033.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11364.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":28699.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":11033.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11033.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11033.84,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Stupor And Coma <1 Hour Without Cc/Mcc","code_information":[{"code":"087","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8004.79,"maximum":20820.46,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":13459.81},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8004.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8164.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14400.12},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8004.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8004.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8084.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8004.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8244.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":20820.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":8004.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8004.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8004.79,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Stupor And Coma <1 Hour With Cc","code_information":[{"code":"086","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10693.58,"maximum":27814.00,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":19169.23},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10693.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10907.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20508.41},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10693.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10693.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10800.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10693.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11014.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":27814.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":10693.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10693.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10693.58,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Stupor And Coma <1 Hour With Mcc","code_information":[{"code":"085","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17410.01,"maximum":45283.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":33431.01},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17410.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17758.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35766.52},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17410.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17410.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17584.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17410.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17932.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":45283.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":17410.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17410.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17410.01,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Stupor And Coma >1 Hour Without Cc/Mcc","code_information":[{"code":"084","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8289.61,"maximum":21561.28,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":14064.6},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8289.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8455.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15047.16},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8289.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8289.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8372.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8289.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8538.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":21561.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":8289.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8289.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8289.61,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Stupor And Coma >1 Hour With Cc","code_information":[{"code":"083","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11338.75,"maximum":29492.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":20539.2},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11338.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11565.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21974.08},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11338.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11338.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11452.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11338.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11678.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":29492.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":11338.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11338.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11338.75,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Stupor And Coma >1 Hour With Mcc","code_information":[{"code":"082","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17504.95,"maximum":45530.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":33632.6},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17504.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17855.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35982.2},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17504.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17504.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17680.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17504.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18030.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":45530.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":17504.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17504.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17504.95,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Nontraumatic Stupor And Coma Without Mcc","code_information":[{"code":"081","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7872.43,"maximum":20476.19,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":13178.75},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7872.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8029.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14099.43},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7872.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7872.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7951.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7872.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8108.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":20476.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":7872.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7872.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7872.43,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Nontraumatic Stupor And Coma With Mcc","code_information":[{"code":"080","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14209.1,"maximum":36957.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":26634.15},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14209.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14493.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28494.83},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14209.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14209.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14351.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14209.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14635.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":36957.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":14209.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14209.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14209.1,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Viral Meningitis Without Cc/Mcc","code_information":[{"code":"076","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7384.57,"maximum":19207.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":12142.82},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7384.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7532.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12991.12},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7384.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7384.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7458.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7384.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7606.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":19207.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":7384.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7384.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7384.57,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Viral Meningitis With Cc/Mcc","code_information":[{"code":"075","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14954.06,"maximum":38895.51,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":28216.01},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14954.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15253.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30187.2},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14954.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14954.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15103.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14954.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15402.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":38895.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":14954.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14954.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14954.06,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cranial And Peripheral Nerve Disorders Without Mcc","code_information":[{"code":"074","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8809.35,"maximum":22913.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":15168.22},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8809.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8985.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16227.88},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8809.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8809.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8897.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8809.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9073.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":22913.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":8809.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8809.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8809.35,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8846.88,"10th_percentile":8846.88,"90th_percentile":8846.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cranial And Peripheral Nerve Disorders With Mcc","code_information":[{"code":"073","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12783.63,"maximum":33250.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":23607.27},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12783.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13039.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25256.49},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12783.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12783.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12911.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12783.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13167.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":33250.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":12783.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12783.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12783.63,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Cerebrovascular Disorders Without Cc/Mcc","code_information":[{"code":"072","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6906.41,"maximum":17963.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":11127.48},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6906.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7044.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11904.86},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6906.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6906.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6975.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6906.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7113.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17963.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":6906.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6906.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6906.41,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Cerebrovascular Disorders With Cc","code_information":[{"code":"071","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8776.08,"maximum":22826.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":15097.59},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8776.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8951.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16152.32},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8776.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8776.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8863.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8776.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9039.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":22826.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":8776.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8776.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8776.08,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Cerebrovascular Disorders With Mcc","code_information":[{"code":"070","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13202.88,"maximum":34340.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":24497.53},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13202.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13466.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26208.95},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13202.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13202.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13334.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13202.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13598.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":34340.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":13202.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13202.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13202.88,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Transient Ischemia Without Thrombolytic","code_information":[{"code":"069","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7201.62,"maximum":18731.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":11754.34},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7201.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7345.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12575.51},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7201.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7201.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7273.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7201.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7417.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":18731.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":7201.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7201.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7201.62,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"1 through 10","median_amount":16798.46,"10th_percentile":16798.46,"90th_percentile":16798.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Precerebral Occlusion Without Infarction Without Mcc","code_information":[{"code":"068","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7656.22,"maximum":19913.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":12719.65},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7656.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7809.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13608.25},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7656.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7656.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7732.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7656.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7885.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":19913.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":7656.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7656.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7656.22,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Precerebral Occlusion Without Infarction With Mcc","code_information":[{"code":"067","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11843.94,"maximum":30806.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":21611.92},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11843.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12080.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23121.74},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11843.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11843.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11962.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11843.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12199.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":30806.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":11843.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11843.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11843.94,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intracranial Hemorrhage Or Cerebral Infarction Without Cc/Mcc","code_information":[{"code":"066","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6408.84,"maximum":16669.39,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":10070.95},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6408.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6537.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10774.51},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6408.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6408.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6472.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6408.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6601.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":16669.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":6408.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6408.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6408.84,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours","code_information":[{"code":"065","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8667.29,"maximum":22543.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":14866.56},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8667.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8840.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15905.15},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8667.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8667.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8753.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8667.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8927.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":22543.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":8667.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8667.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8667.29,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"1 through 10","median_amount":14454.01,"10th_percentile":14454.01,"90th_percentile":14454.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"1 through 10","median_amount":7382.15,"10th_percentile":7382.15,"90th_percentile":7382.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"1 through 10","median_amount":8681.33,"10th_percentile":8681.33,"90th_percentile":8681.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intracranial Hemorrhage Or Cerebral Infarction With Mcc","code_information":[{"code":"064","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15602.01,"maximum":40580.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":29591.87},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15602.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15914.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31659.17},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15602.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15602.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15758.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15602.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16070.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":40580.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":15602.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15602.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15602.01,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15696.09,"10th_percentile":15696.09,"90th_percentile":15696.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15490.42,"10th_percentile":15490.42,"90th_percentile":15490.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/Mcc","code_information":[{"code":"063","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11394.19,"maximum":29636.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":20656.92},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11394.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11622.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22100.02},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11394.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11394.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11508.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11394.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11736.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":29636.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":11394.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11394.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11394.19,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc","code_information":[{"code":"062","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13843.2,"maximum":36006.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":25857.2},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13843.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14120.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27663.6},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13843.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13843.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13981.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13843.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14258.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":36006.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":13843.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13843.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13843.2,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"1 through 10","median_amount":11414.1,"10th_percentile":11414.1,"90th_percentile":11414.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Mcc","code_information":[{"code":"061","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20772.38,"maximum":54028.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":40570.73},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20772.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21187.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":43405.03},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20772.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20772.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20980.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20772.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21395.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":54028.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":20772.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20772.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20772.38,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Multiple Sclerosis And Cerebellar Ataxia Without Cc/Mcc","code_information":[{"code":"060","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8040.13,"maximum":20912.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":13534.86},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8040.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8200.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14480.41},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8040.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8040.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8120.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8040.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8281.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":20912.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":8040.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8040.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8040.13,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"1 through 10","median_amount":18420.44,"10th_percentile":18420.44,"90th_percentile":18420.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Multiple Sclerosis And Cerebellar Ataxia With Cc","code_information":[{"code":"059","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10265.31,"maximum":26700.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":18259.84},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10265.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10470.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19535.49},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10265.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10265.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10367.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10265.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10573.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":26700.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":10265.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10265.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10265.31,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Multiple Sclerosis And Cerebellar Ataxia With Mcc","code_information":[{"code":"058","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13512.65,"maximum":35146.40,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":25155.29},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13512.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13782.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26912.66},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13512.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13512.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13647.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13512.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13918.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":35146.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":13512.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13512.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13512.65,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Degenerative Nervous System Disorders Without Mcc","code_information":[{"code":"057","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10644.38,"maximum":27686.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":19064.75},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10644.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10857.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20396.63},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10644.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10644.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10750.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10644.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10963.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":27686.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":10644.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10644.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10644.38,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"1 through 10","median_amount":10686.6,"10th_percentile":10686.6,"90th_percentile":10686.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Degenerative Nervous System Disorders With Mcc","code_information":[{"code":"056","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17764.82,"maximum":46206.30,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":34184.42},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17764.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18120.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36572.56},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17764.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17764.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17942.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17764.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18297.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":46206.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":17764.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17764.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17764.82,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Nervous System Neoplasms Without Mcc","code_information":[{"code":"055","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8731.73,"maximum":22711.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":15003.41},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8731.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8906.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16051.56},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8731.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8731.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8819.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8731.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8993.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":22711.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":8731.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8731.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8731.73,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":7033.19,"10th_percentile":7033.19,"90th_percentile":7033.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Nervous System Neoplasms With Mcc","code_information":[{"code":"054","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12247.26,"maximum":31855.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":22468.33},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12247.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12492.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24037.99},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12247.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12247.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12369.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12247.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12614.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":31855.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":12247.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12247.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12247.26,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Disorders And Injuries Without Cc/Mcc","code_information":[{"code":"053","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8451.77,"maximum":21983.05,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":14408.93},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8451.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8620.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15415.55},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8451.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8451.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8536.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8451.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8705.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":21983.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":8451.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8451.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8451.77,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Disorders And Injuries With Cc/Mcc","code_information":[{"code":"052","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14218.11,"maximum":36981.30,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":26653.28},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14218.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14502.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28515.3},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14218.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14218.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14360.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14218.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14644.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":36981.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":14218.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14218.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14218.11,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/Mcc","code_information":[{"code":"042","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13638.77,"maximum":35474.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":25423.11},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13638.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13911.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27199.18},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13638.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13638.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13775.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13638.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14047.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":35474.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":13638.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13638.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13638.77,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator","code_information":[{"code":"041","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16902.74,"maximum":43964.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":32353.87},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16902.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17240.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34614.13},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16902.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16902.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17071.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16902.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17409.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":43964.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":16902.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16902.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16902.74,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peripheral, Cranial Nerve And Other Nervous System Procedures With Mcc","code_information":[{"code":"040","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":28423.65,"maximum":73929.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":56817.56},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28423.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28992.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":60786.87},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28423.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28423.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28707.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28423.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29276.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":73929.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":28423.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28423.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28423.65,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extracranial Procedures Without Cc/Mcc","code_information":[{"code":"039","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9812.1,"maximum":25521.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":17297.48},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9812.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10008.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18505.9},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9812.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9812.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9910.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9812.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10106.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":25521.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":9812.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9812.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9812.1,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extracranial Procedures With Cc","code_information":[{"code":"038","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12910.44,"maximum":33580.05,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":23876.56},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12910.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13168.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25544.59},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12910.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12910.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13039.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12910.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13297.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":33580.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":12910.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12910.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12910.44,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extracranial Procedures With Mcc","code_information":[{"code":"037","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24479.86,"maximum":63672.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":48443.25},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24479.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24969.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":51827.53},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24479.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24479.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24724.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24479.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25214.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":63672.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":24479.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24479.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24479.86,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Carotid Artery Stent Procedures Without Cc/Mcc","code_information":[{"code":"036","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15129.39,"maximum":39351.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":28588.3},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15129.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15431.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30585.5},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15129.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15129.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15280.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15129.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15583.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":39351.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":15129.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15129.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15129.39,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Carotid Artery Stent Procedures With Cc","code_information":[{"code":"035","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18231.89,"maximum":47421.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":35176.21},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18231.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18596.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37633.64},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18231.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18231.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18414.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18231.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18778.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":47421.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":18231.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18231.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18231.89,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Carotid Artery Stent Procedures With Mcc","code_information":[{"code":"034","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":28489.48,"maximum":74101.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":56957.35},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28489.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29059.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":60936.43},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28489.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28489.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28774.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28489.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29344.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":74101.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":28489.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28489.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28489.48,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ventricular Shunt Procedures Without Cc/Mcc","code_information":[{"code":"033","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13189.72,"maximum":34306.46,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":24469.57},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13189.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13453.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26179.03},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13189.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13189.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13321.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13189.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13585.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":34306.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":13189.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13189.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13189.72,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ventricular Shunt Procedures With Cc","code_information":[{"code":"032","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16433.59,"maximum":42743.77,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":31357.67},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16433.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16762.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33548.33},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16433.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16433.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16597.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16433.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16926.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":42743.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":16433.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16433.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16433.59,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ventricular Shunt Procedures With Mcc","code_information":[{"code":"031","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":32715.32,"maximum":85092.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":65930.56},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":32715.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33369.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":70536.51},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32715.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32715.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33042.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32715.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":33696.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":85092.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":32715.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32715.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":32715.32,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Procedures Without Cc/Mcc","code_information":[{"code":"030","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16878.49,"maximum":43900.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":32302.37},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16878.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17216.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34559.03},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16878.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16878.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17047.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16878.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17384.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":43900.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":16878.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16878.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16878.49,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Procedures With Cc Or Spinal Neurostimulators","code_information":[{"code":"029","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":25307.98,"maximum":65826.06,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":50201.69},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25307.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25814.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":53708.82},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25307.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25307.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25561.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25307.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26067.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":65826.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":25307.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25307.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25307.98,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Procedures With Mcc","code_information":[{"code":"028","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":43302.77,"maximum":112630.50,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":88412.13},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":43302.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":44168.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":94588.67},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":43302.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43302.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":43735.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43302.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":44601.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":112630.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":43302.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":43302.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":43302.77,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Craniotomy And Endovascular Intracranial Procedures Without Cc/Mcc","code_information":[{"code":"027","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19149.4,"maximum":49807.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":37124.47},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19149.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19532.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39718.01},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19149.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19149.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19340.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19149.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19723.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":49807.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":19149.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19149.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19149.4,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Craniotomy And Endovascular Intracranial Procedures With Cc","code_information":[{"code":"026","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23212.39,"maximum":60375.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":45751.88},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23212.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23676.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":48948.14},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23212.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23212.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23444.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23212.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23908.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":60375.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":23212.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23212.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23212.39,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Craniotomy And Endovascular Intracranial Procedures With Mcc","code_information":[{"code":"025","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":33174.07,"maximum":86285.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":66904.69},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":33174.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33837.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":71578.7},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33174.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33174.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33505.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33174.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":34169.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":86285.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":33174.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33174.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":33174.07,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without Mcc","code_information":[{"code":"024","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":28774.99,"maximum":74843.75,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":57563.61},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28774.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29350.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":61585.04},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28774.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28774.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29062.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28774.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29638.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":74843.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":28774.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28774.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28774.99,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With Mcc Or Antineopla","code_information":[{"code":"023","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":41376.26,"maximum":107619.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":84321.36},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":41376.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":42203.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":90212.11},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":41376.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41376.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":41790.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41376.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":42617.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":107619.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":41376.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":41376.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":41376.26,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage Without Cc/Mcc","code_information":[{"code":"022","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23685.0,"maximum":61604.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":46755.44},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23685.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24158.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":50021.81},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23685.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23685.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23921.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23685.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24395.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":61604.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":23685.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23685.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23685.0,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Cc","code_information":[{"code":"021","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":38351.38,"maximum":99751.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":77898.27},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":38351.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39118.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":83340.29},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38351.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38351.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38734.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38351.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":39501.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":99751.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":38351.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38351.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":38351.38,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc","code_information":[{"code":"020","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":56195.79,"maximum":146165.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":115789.39},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":56195.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":57319.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":123878.52},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":56195.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":56195.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":56757.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":56195.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":57881.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":146165.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":56195.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":56195.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":56195.79,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Simultaneous Pancreas And Kidney Transplant With Hemodialysis","code_information":[{"code":"019","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":51107.88,"maximum":132931.60,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":104985.64},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":51107.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":52130.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":112320.01},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":51107.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51107.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":51618.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51107.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":52641.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":132931.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":51107.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":51107.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":51107.88,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chimeric Antigen Receptor (Car) T-Cell And Other Immunotherapies","code_information":[{"code":"018","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":300917.16,"maximum":782685.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":635434.9},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":300917.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":306935.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":679826.82},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":300917.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":300917.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":303926.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":300917.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":309944.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":782685.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":300917.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":300917.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":300917.16,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Autologous Bone Marrow Transplant Without Cc/Mcc","code_information":[{"code":"017","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":39311.16,"maximum":102248.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":79936.29},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":39311.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":40097.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":85520.7},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39311.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39311.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39704.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39311.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":40490.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":102248.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":39311.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39311.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":39311.16,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Autologous Bone Marrow Transplant With Cc/Mcc","code_information":[{"code":"016","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":42758.08,"maximum":111213.77,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":87255.54},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":42758.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":43613.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":93351.27},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":42758.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42758.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":43185.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42758.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":44040.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":111213.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":42758.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":42758.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":42758.08,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Allogeneic Bone Marrow Transplant","code_information":[{"code":"014","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":84948.5,"maximum":220951.05,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":176843.4},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":84948.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":86647.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":189197.8},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84948.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":84948.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":85797.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":84948.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":87496.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":220951.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":84948.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84948.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":84948.5,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy Without Cc/Mcc","code_information":[{"code":"013","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21636.53,"maximum":56276.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":42405.69},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21636.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22069.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":45368.18},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21636.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21636.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21852.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21636.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22285.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":56276.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":21636.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21636.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21636.53,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Cc","code_information":[{"code":"012","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":30882.36,"maximum":80325.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":62038.44},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30882.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31500.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":66372.49},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30882.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30882.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31191.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30882.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":31808.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":80325.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":30882.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30882.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30882.36,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Mcc","code_information":[{"code":"011","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":39462.24,"maximum":102641.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":80257.08},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":39462.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":40251.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":85863.9},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39462.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39462.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39856.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39462.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":40646.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":102641.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":39462.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39462.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":39462.24,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pancreas Transplant","code_information":[{"code":"010","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":51392.7,"maximum":133672.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":105590.43},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":51392.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":52420.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":112967.05},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":51392.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51392.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":51906.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51392.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":52934.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":133672.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":51392.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":51392.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":51392.7,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Simultaneous Pancreas And Kidney Transplant","code_information":[{"code":"008","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":40505.18,"maximum":105353.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":82471.69},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":40505.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":41315.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":88233.22},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":40505.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40505.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":40910.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40505.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":41720.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":105353.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":40505.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":40505.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":40505.18,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lung Transplant","code_information":[{"code":"007","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":91409.22,"maximum":237755.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":190562.19},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":91409.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":93237.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":203875.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":91409.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":91409.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":92323.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":91409.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":94151.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":237755.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":91409.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":91409.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":91409.22,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Liver Transplant Without Mcc","code_information":[{"code":"006","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":33799.84,"maximum":87913.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":68233.46},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":33799.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34475.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":73000.29},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33799.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33799.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34137.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33799.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":34813.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":87913.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":33799.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33799.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":33799.84,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Liver Transplant With Mcc Or Intestinal Transplant","code_information":[{"code":"005","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":73116.45,"maximum":190175.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":151719.01},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":73116.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":74578.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":162318.2},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":73116.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":73116.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":73847.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":73116.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":75309.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":190175.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":73116.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":73116.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":73116.45,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R.","code_information":[{"code":"004","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":97654.42,"maximum":253999.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":203823.35},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":97654.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":99607.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":218062.59},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":97654.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":97654.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":98630.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":97654.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":100584.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":253999.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":97654.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":97654.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":97654.42,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major","code_information":[{"code":"003","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":148753.88,"maximum":386908.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":312328.82},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":148753.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":151728.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":334148.32},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":148753.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":148753.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":150241.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":148753.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":153216.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":386908.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":148753.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":148753.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":148753.88,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Heart Transplant Or Implant Of Heart Assist System Without Mcc","code_information":[{"code":"002","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":80193.92,"maximum":208584.39,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":166747.44},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":80193.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":81797.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":178396.53},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":80193.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":80193.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":80995.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":80193.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":82599.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":208584.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":80193.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":80193.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":80193.92,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Heart Transplant Or Implant Of Heart Assist System With Mcc","code_information":[{"code":"001","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":195867.98,"maximum":509452.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":412371.69},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":195867.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":199785.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":441180.26},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":195867.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":195867.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":197826.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":195867.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":201744.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":509452.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":195867.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":195867.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":195867.98,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inflammatory Bowel Disease With Mcc","code_information":[{"code":"385","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12631.17,"maximum":32853.67,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":23283.54},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12631.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12883.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24910.15},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12631.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12631.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12757.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12631.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13010.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":32853.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":12631.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12631.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12631.17,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10454.65,"10th_percentile":10454.65,"90th_percentile":10454.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Inflammatory Bowel Disease With Cc","code_information":[{"code":"386","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8431.67,"maximum":21930.77,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":14366.25},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8431.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8600.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15369.89},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8431.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8431.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8515.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8431.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8684.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":21930.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":8431.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8431.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8431.67,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inflammatory Bowel Disease Without Cc/Mcc","code_information":[{"code":"387","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6387.36,"maximum":16613.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":10025.33},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6387.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6515.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10725.71},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6387.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6387.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6451.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6387.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6578.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":16613.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":6387.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6387.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6387.36,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Gastrointestinal Obstruction With Mcc","code_information":[{"code":"388","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11900.07,"maximum":30952.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":21731.11},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11900.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12138.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23249.26},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11900.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11900.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12019.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11900.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12257.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":30952.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":11900.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11900.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11900.07,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"1 through 10","median_amount":7152.85,"10th_percentile":7152.85,"90th_percentile":7152.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Gastrointestinal Obstruction With Cc","code_information":[{"code":"389","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7139.25,"maximum":18569.19,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":11621.91},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7139.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7282.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12433.82},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7139.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7139.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7210.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7139.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7353.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":18569.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":7139.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7139.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7139.25,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"1 through 10","median_amount":5458.92,"10th_percentile":5458.92,"90th_percentile":5458.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Gastrointestinal Obstruction Without Cc/Mcc","code_information":[{"code":"390","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5435.89,"maximum":14138.75,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":8004.96},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5435.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5544.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8564.19},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5435.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5435.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5490.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5435.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5598.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14138.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":5435.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5435.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5435.89,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With Mcc","code_information":[{"code":"391","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10455.19,"maximum":27193.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":18663.03},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10455.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10664.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19966.85},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10455.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10455.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10559.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10455.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10768.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":27193.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":10455.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10455.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10455.19,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"1 through 10","median_amount":18375.07,"10th_percentile":18375.07,"90th_percentile":18375.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"1 through 10","median_amount":10512.98,"10th_percentile":10512.98,"90th_percentile":10512.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10385.79,"10th_percentile":10385.79,"90th_percentile":10385.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without Mcc","code_information":[{"code":"392","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7068.57,"maximum":18385.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":11471.81},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7068.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7209.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12273.24},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7068.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7068.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7139.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7068.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7280.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":18385.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":7068.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7068.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7068.57,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"1 through 10","median_amount":13665.9,"10th_percentile":13665.9,"90th_percentile":13665.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"1 through 10","median_amount":5988.35,"10th_percentile":5988.35,"90th_percentile":5988.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Digestive System Diagnoses With Mcc","code_information":[{"code":"393","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12748.98,"maximum":33160.10,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":23533.7},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12748.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13003.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25177.78},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12748.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12748.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12876.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12748.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13131.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":33160.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":12748.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12748.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12748.98,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"1 through 10","median_amount":8472.3,"10th_percentile":8472.3,"90th_percentile":8472.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11212.3,"10th_percentile":11212.3,"90th_percentile":11212.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Digestive System Diagnoses With Cc","code_information":[{"code":"394","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8150.32,"maximum":21198.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":13768.83},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8150.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8313.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14730.73},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8150.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8150.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8231.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8150.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8394.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":21198.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":8150.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8150.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8150.32,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Digestive System Diagnoses Without Cc/Mcc","code_information":[{"code":"395","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6163.52,"maximum":16031.32,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":9550.04},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6163.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6286.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10217.21},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6163.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6163.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6225.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6163.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6348.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":16031.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":6163.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6163.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6163.52,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendix Procedures With Mcc","code_information":[{"code":"397","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18262.38,"maximum":47500.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":35240.95},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18262.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18627.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37702.91},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18262.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18262.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18445.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18262.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18810.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":47500.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":18262.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18262.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18262.38,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendix Procedures With Cc","code_information":[{"code":"398","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12155.09,"maximum":31615.39,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":22272.62},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12155.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12398.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23828.6},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12155.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12155.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12276.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12155.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12519.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":31615.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":12155.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12155.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12155.09,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"1 through 10","median_amount":27984.49,"10th_percentile":27984.49,"90th_percentile":27984.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendix Procedures Without Cc/Mcc","code_information":[{"code":"399","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9598.66,"maximum":24966.11,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":16844.26},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9598.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9790.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18021.01},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9598.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9598.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9694.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9598.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9886.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":24966.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":9598.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9598.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9598.66,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":8399.59,"10th_percentile":8399.59,"90th_percentile":8399.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"1 through 10","median_amount":24893.78,"10th_percentile":24893.78,"90th_percentile":24893.78},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Single Level Combined Anterior And Posterior Spinal Fusion Except Cervical","code_information":[{"code":"402","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":29527.58,"maximum":76801.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":59161.66},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29527.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30118.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":63294.73},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29527.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29527.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29822.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29527.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30413.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":76801.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":29527.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29527.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29527.58,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pancreas, Liver And Shunt Procedures With Mcc","code_information":[{"code":"405","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":39575.88,"maximum":102936.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":80498.41},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":39575.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":40367.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":86122.08},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39575.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39575.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39971.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39575.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":40763.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":102936.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":39575.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39575.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":39575.88,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pancreas, Liver And Shunt Procedures With Cc","code_information":[{"code":"406","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21764.04,"maximum":56608.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":42676.44},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21764.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22199.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":45657.85},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21764.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21764.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21981.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21764.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22416.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":56608.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":21764.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21764.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21764.04,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pancreas, Liver And Shunt Procedures Without Cc/Mcc","code_information":[{"code":"407","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17047.58,"maximum":44340.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":32661.41},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17047.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17388.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34943.16},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17047.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17047.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17218.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17047.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17559.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":44340.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":17047.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17047.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17047.58,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Mcc","code_information":[{"code":"408","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":26375.18,"maximum":68601.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":52467.8},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26375.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26902.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":56133.24},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26375.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26375.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26638.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26375.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27166.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":68601.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":26375.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26375.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26375.18,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc","code_information":[{"code":"409","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16754.44,"maximum":43578.30,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":32038.97},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16754.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17089.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34277.23},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16754.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16754.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16921.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16754.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17257.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":43578.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":16754.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16754.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16754.44,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/Mcc","code_information":[{"code":"410","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12668.59,"maximum":32951.00,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":23363.01},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12668.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12921.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24995.16},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12668.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12668.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12795.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12668.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13048.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":32951.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":12668.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12668.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12668.59,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cholecystectomy With C.D.E. With Mcc","code_information":[{"code":"411","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24557.47,"maximum":63873.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":48608.06},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24557.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25048.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":52003.85},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24557.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24557.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24803.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24557.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25294.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":63873.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":24557.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24557.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24557.47,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cholecystectomy With C.D.E. With Cc","code_information":[{"code":"412","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16236.09,"maximum":42230.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":30938.29},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16236.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16560.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33099.66},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16236.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16236.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16398.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16236.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16723.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":42230.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":16236.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16236.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16236.09,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cholecystectomy With C.D.E. Without Cc/Mcc","code_information":[{"code":"413","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13173.09,"maximum":34263.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":24434.26},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13173.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13436.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26141.25},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13173.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13173.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13304.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13173.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13568.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":34263.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":13173.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13173.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13173.09,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cholecystectomy Except By Laparoscope Without C.D.E. With Mcc","code_information":[{"code":"414","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":26354.39,"maximum":68547.77,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":52423.66},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26354.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26881.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":56086.01},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26354.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26354.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26617.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26354.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27145.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":68547.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":26354.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26354.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26354.39,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cholecystectomy Except By Laparoscope Without C.D.E. With Cc","code_information":[{"code":"415","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15988.0,"maximum":41584.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":30411.49},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15988.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16307.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32536.06},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15988.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15988.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16147.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15988.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16467.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":41584.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":15988.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15988.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15988.0,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/Mcc","code_information":[{"code":"416","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11113.53,"maximum":28906.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":20060.96},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11113.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11335.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21462.43},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11113.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11113.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11224.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11113.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11446.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":28906.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":11113.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11113.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11113.53,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Menstrual And Other Female Reproductive System Disorders Without Cc/Mcc","code_information":[{"code":"761","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5619.53,"maximum":14616.40,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":8394.91},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5619.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5731.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8981.38},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5619.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5619.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5675.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5619.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5788.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14616.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":5619.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5619.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5619.53,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C","code_information":[{"code":"768","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9092.09,"maximum":23648.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":15768.59},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9092.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9273.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16870.2},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9092.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9092.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9183.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9092.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9364.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":23648.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":9092.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9092.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9092.09,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"1 through 10","median_amount":9737.94,"10th_percentile":9737.94,"90th_percentile":9737.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Postpartum And Post Abortion Diagnoses With O.R. Procedures","code_information":[{"code":"769","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13376.13,"maximum":34791.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":24865.41},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13376.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13643.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26602.52},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13376.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13376.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13509.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13376.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13777.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":34791.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":13376.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13376.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13376.13,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":12072.13,"10th_percentile":12072.13,"90th_percentile":12072.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Abortion With D&C, Aspiration Curettage Or Hysterotomy","code_information":[{"code":"770","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8614.62,"maximum":22406.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":14754.73},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8614.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8786.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15785.51},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8614.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8614.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8700.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8614.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8873.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":22406.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":8614.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8614.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8614.62,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Postpartum And Post Abortion Diagnoses Without O.R. Procedures","code_information":[{"code":"776","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6203.02,"maximum":16134.06,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":9633.91},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6203.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6327.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10306.94},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6203.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6203.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6265.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6203.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6389.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":16134.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":6203.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6203.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6203.02,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Abortion Without D&C","code_information":[{"code":"779","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7496.14,"maximum":19497.46,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":12379.73},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7496.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7646.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13244.59},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7496.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7496.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7571.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7496.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7721.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":19497.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":7496.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7496.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7496.14,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cesarean Section With Sterilization With Mcc","code_information":[{"code":"783","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18679.56,"maximum":48585.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":36126.8},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18679.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19053.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38650.64},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18679.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18679.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18866.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18679.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19239.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":48585.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":18679.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18679.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18679.56,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cesarean Section With Sterilization With Cc","code_information":[{"code":"784","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9012.39,"maximum":23441.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":15599.37},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9012.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9192.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16689.15},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9012.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9012.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9102.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9012.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9282.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":23441.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":9012.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9012.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9012.39,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"1 through 10","median_amount":6957.0,"10th_percentile":6957.0,"90th_percentile":6957.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cesarean Section With Sterilization Without Cc/Mcc","code_information":[{"code":"785","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8303.47,"maximum":21597.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":14094.03},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8303.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8469.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15078.65},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8303.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8303.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8386.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8303.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8552.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":21597.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":8303.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8303.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8303.47,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"1 through 10","median_amount":4622.29,"10th_percentile":4622.29,"90th_percentile":4622.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cesarean Section Without Sterilization With Mcc","code_information":[{"code":"786","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13096.86,"maximum":34064.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":24272.39},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13096.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13358.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25968.08},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13096.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13096.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13227.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13096.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13489.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":34064.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":13096.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13096.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13096.86,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cesarean Section Without Sterilization With Cc","code_information":[{"code":"787","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9405.32,"maximum":24463.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":16433.71},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9405.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9593.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17581.78},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9405.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9405.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9499.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9405.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9687.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":24463.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":9405.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9405.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9405.32,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":8267.88,"10th_percentile":8267.88,"90th_percentile":8267.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"1 through 10","median_amount":6957.0,"10th_percentile":6957.0,"90th_percentile":6957.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"1 through 10","median_amount":17068.9,"10th_percentile":17068.9,"90th_percentile":17068.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"1 through 10","median_amount":16514.7,"10th_percentile":16514.7,"90th_percentile":16514.7},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":8267.88,"10th_percentile":8267.88,"90th_percentile":8267.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cesarean Section Without Sterilization Without Cc/Mcc","code_information":[{"code":"788","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8310.4,"maximum":21615.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":14108.74},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8310.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8476.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15094.39},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8310.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8310.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8393.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8310.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8559.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":21615.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":8310.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8310.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8310.4,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"1 through 10","median_amount":23586.29,"10th_percentile":23586.29,"90th_percentile":23586.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"1 through 10","median_amount":6957.0,"10th_percentile":6957.0,"90th_percentile":6957.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"1 through 10","median_amount":17774.3,"10th_percentile":16742.58,"90th_percentile":30048.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":7567.3,"10th_percentile":7567.3,"90th_percentile":7567.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Neonates, Died Or Transferred To Another Acute Care Facility","code_information":[{"code":"789","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14155.05,"maximum":36817.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":26519.37},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14155.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14438.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28372.03},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14155.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14155.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14296.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14155.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14579.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":36817.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":14155.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14155.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14155.05,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extreme Immaturity Or Respiratory Distress Syndrome, Neonate","code_information":[{"code":"790","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":42853.71,"maximum":111462.50,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":87458.6},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":42853.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":43710.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":93568.52},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":42853.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42853.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":43282.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42853.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":44139.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":111462.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":42853.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":42853.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":42853.71,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Prematurity With Major Problems","code_information":[{"code":"791","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":29794.38,"maximum":77495.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":59728.19},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29794.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30390.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":63900.84},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29794.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29794.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30092.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29794.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30688.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":77495.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":29794.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29794.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29794.38,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Prematurity Without Major Problems","code_information":[{"code":"792","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18638.67,"maximum":48479.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":36039.98},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18638.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19011.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38557.76},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18638.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18638.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18825.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18638.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19197.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":48479.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":18638.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18638.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18638.67,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"1 through 10","median_amount":5452.0,"10th_percentile":5452.0,"90th_percentile":5452.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":8061.83,"10th_percentile":8061.83,"90th_percentile":8061.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Full Term Neonate With Major Problems","code_information":[{"code":"793","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":30560.82,"maximum":79488.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":61355.66},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30560.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31172.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":65642.01},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30560.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30560.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30866.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30560.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":31477.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":79488.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":30560.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30560.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30560.82,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":9677.91,"10th_percentile":9677.91,"90th_percentile":9677.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":9677.91,"10th_percentile":9677.91,"90th_percentile":9677.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Neonate With Other Significant Problems","code_information":[{"code":"794","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11893.83,"maximum":30935.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":21717.87},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11893.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12131.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23235.09},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11893.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11893.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12012.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11893.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12250.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":30935.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":11893.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11893.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11893.83,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":2592.82,"10th_percentile":2592.82,"90th_percentile":2592.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":2567.15,"10th_percentile":2567.15,"90th_percentile":2567.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":2567.15,"10th_percentile":2567.15,"90th_percentile":2567.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Normal Newborn","code_information":[{"code":"795","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":2940.06,"maximum":7934.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":2940.06},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3050.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3111.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3145.45},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3050.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3050.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3081.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3050.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3142.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7934.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":3050.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3050.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3050.63,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":2160.0,"10th_percentile":2160.0,"90th_percentile":2160.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":1895.66,"10th_percentile":1895.66,"90th_percentile":1895.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"1 through 10","median_amount":1363.0,"10th_percentile":1363.0,"90th_percentile":1363.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":1895.66,"10th_percentile":1895.66,"90th_percentile":1895.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery With Sterilization And/Or D&C With Mcc","code_information":[{"code":"796","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9753.2,"maximum":25368.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":17172.41},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9753.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9948.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18372.08},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9753.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9753.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9850.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9753.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10045.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":25368.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":9753.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9753.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9753.2,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery With Sterilization And/Or D&C With Cc","code_information":[{"code":"797","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8598.68,"maximum":22365.17,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":14720.89},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8598.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8770.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15749.3},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8598.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8598.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8684.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8598.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8856.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":22365.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":8598.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8598.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8598.68,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery With Sterilization And/Or D&C Without Cc/Mcc","code_information":[{"code":"798","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8298.62,"maximum":21584.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":14083.73},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8298.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8464.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15067.63},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8298.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8298.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8381.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8298.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8547.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":21584.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":8298.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8298.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8298.62,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Splenic Procedures With Mcc","code_information":[{"code":"799","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":33050.72,"maximum":85964.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":66642.76},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":33050.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33711.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":71298.47},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33050.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33050.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33381.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33050.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":34042.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":85964.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":33050.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33050.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":33050.72,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Splenic Procedures With Cc","code_information":[{"code":"800","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21134.81,"maximum":54971.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":41340.32},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21134.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21557.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":44228.38},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21134.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21134.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21346.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21134.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21768.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":54971.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":21134.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21134.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21134.81,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Laparoscopic Cholecystectomy Without C.D.E. With Mcc","code_information":[{"code":"417","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18203.48,"maximum":47347.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":35115.88},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18203.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18567.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37569.1},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18203.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18203.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18385.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18203.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18749.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":47347.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":18203.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18203.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18203.48,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18065.68,"10th_percentile":18065.68,"90th_percentile":18065.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Laparoscopic Cholecystectomy Without C.D.E. With Cc","code_information":[{"code":"418","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13388.61,"maximum":34823.77,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":24891.89},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13388.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13656.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26630.86},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13388.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13388.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13522.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13388.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13790.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":34823.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":13388.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13388.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13388.61,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"1 through 10","median_amount":13420.79,"10th_percentile":13420.79,"90th_percentile":13420.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":42247.81,"10th_percentile":42247.81,"90th_percentile":42247.81},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Laparoscopic Cholecystectomy Without C.D.E. Without Cc/Mcc","code_information":[{"code":"419","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11130.85,"maximum":28951.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":20097.75},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11130.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11353.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21501.79},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11130.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11130.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11242.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11130.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11464.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":28951.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":11130.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11130.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11130.85,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"1 through 10","median_amount":100995.92,"10th_percentile":100995.92,"90th_percentile":100995.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hepatobiliary Diagnostic Procedures With Mcc","code_information":[{"code":"420","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":25276.79,"maximum":65744.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":50135.48},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25276.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25782.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":53637.98},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25276.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25276.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25529.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25276.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26035.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":65744.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":25276.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25276.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25276.79,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hepatobiliary Diagnostic Procedures With Cc","code_information":[{"code":"421","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13706.69,"maximum":35651.10,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":25567.31},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13706.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13980.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27353.46},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13706.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13706.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13843.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13706.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14117.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":35651.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":13706.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13706.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13706.69,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hepatobiliary Diagnostic Procedures Without Cc/Mcc","code_information":[{"code":"422","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11364.39,"maximum":29558.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":20593.64},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11364.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11591.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22032.33},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11364.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11364.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11478.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11364.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11705.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":29558.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":11364.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11364.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11364.39,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Hepatobiliary Or Pancreas O.R. Procedures With Mcc","code_information":[{"code":"423","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":30445.78,"maximum":79189.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":61111.4},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30445.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31054.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":65380.68},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30445.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30445.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30750.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30445.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":31359.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":79189.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":30445.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30445.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30445.78,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Hepatobiliary Or Pancreas O.R. Procedures With Cc","code_information":[{"code":"424","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16827.9,"maximum":43769.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":32194.95},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16827.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17164.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34444.11},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16827.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16827.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16996.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16827.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17332.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":43769.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":16827.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16827.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16827.9,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/Mcc","code_information":[{"code":"425","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12062.92,"maximum":31375.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":22076.91},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12062.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12304.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23619.22},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12062.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12062.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12183.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12062.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12424.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":31375.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":12062.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12062.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12062.92,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical With Mcc Or Custom-Made","code_information":[{"code":"426","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":78041.51,"maximum":202985.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":162176.96},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":78041.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":79602.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":173506.75},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":78041.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":78041.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":78821.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":78041.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":80382.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":202985.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":78041.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":78041.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":78041.51,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical With Cc","code_information":[{"code":"427","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":51689.99,"maximum":134445.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":106221.7},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":51689.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":52723.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":113642.42},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":51689.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51689.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":52206.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51689.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":53240.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":134445.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":51689.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":51689.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":51689.99,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Without Cc/Mcc","code_information":[{"code":"428","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":40625.76,"maximum":105667.60,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":82727.73},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":40625.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":41438.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":88507.15},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":40625.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40625.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":41032.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40625.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":41844.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":105667.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":40625.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":40625.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":40625.76,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Combined Anterior And Posterior Cervical Spinal Fusion With Mcc","code_information":[{"code":"429","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":64101.38,"maximum":166727.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":132576.26},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":64101.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":65383.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":141838.13},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":64101.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":64101.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":64742.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":64101.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":66024.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":166727.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":64101.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":64101.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":64101.38,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Combined Anterior And Posterior Cervical Spinal Fusion Without Mcc","code_information":[{"code":"430","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":41631.28,"maximum":108282.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":84862.88},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":41631.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":42463.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":90791.46},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":41631.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41631.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":42047.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41631.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":42880.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":108282.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":41631.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":41631.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":41631.28,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cirrhosis And Alcoholic Hepatitis With Mcc","code_information":[{"code":"432","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15305.41,"maximum":39809.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":28962.06},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15305.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15611.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30985.37},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15305.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15305.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15458.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15305.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15764.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":39809.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":15305.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15305.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15305.41,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cirrhosis And Alcoholic Hepatitis With Cc","code_information":[{"code":"433","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8985.37,"maximum":23370.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":15541.98},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8985.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9165.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16627.76},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8985.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8985.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9075.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8985.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9254.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":23370.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":8985.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8985.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8985.37,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":9654.47,"10th_percentile":9654.47,"90th_percentile":9654.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cirrhosis And Alcoholic Hepatitis Without Cc/Mcc","code_information":[{"code":"434","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6603.57,"maximum":17175.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":10484.44},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6603.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6735.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11216.89},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6603.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6603.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6669.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6603.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6801.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17175.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":6603.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6603.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6603.57,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy Of Hepatobiliary System Or Pancreas With Mcc","code_information":[{"code":"435","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14394.13,"maximum":37439.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":27027.04},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14394.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14682.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28915.17},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14394.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14394.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14538.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14394.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14825.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":37439.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":14394.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14394.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14394.13,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"1 through 10","median_amount":14028.89,"10th_percentile":14028.89,"90th_percentile":14028.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy Of Hepatobiliary System Or Pancreas With Cc","code_information":[{"code":"436","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9504.41,"maximum":24720.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":16644.14},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9504.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9694.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17806.91},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9504.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9504.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9599.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9504.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9789.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":24720.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":9504.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9504.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9504.41,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy Of Hepatobiliary System Or Pancreas Without Cc/Mcc","code_information":[{"code":"437","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7579.3,"maximum":19713.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":12556.31},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7579.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7730.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13433.5},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7579.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7579.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7655.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7579.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7806.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":19713.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":7579.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7579.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7579.3,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of Pancreas Except Malignancy With Mcc","code_information":[{"code":"438","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12963.11,"maximum":33717.05,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":23988.39},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12963.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13222.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25664.24},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12963.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12963.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13092.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12963.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13352.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":33717.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":12963.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12963.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12963.11,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of Pancreas Except Malignancy With Cc","code_information":[{"code":"439","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7495.45,"maximum":19495.67,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":12378.26},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7495.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7645.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13243.01},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7495.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7495.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7570.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7495.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7720.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":19495.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":7495.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7495.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7495.45,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"1 through 10","median_amount":8663.61,"10th_percentile":8663.61,"90th_percentile":8663.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":8165.25,"10th_percentile":8165.25,"90th_percentile":8165.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of Pancreas Except Malignancy Without Cc/Mcc","code_information":[{"code":"440","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5972.26,"maximum":15533.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":9143.9},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5972.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6091.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9782.7},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5972.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5972.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6031.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5972.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6151.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":15533.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":5972.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5972.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5972.26,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Mcc","code_information":[{"code":"441","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14103.07,"maximum":36682.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":26409.01},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14103.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14385.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28253.96},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14103.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14103.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14244.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14103.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14526.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":36682.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":14103.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14103.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14103.07,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc","code_information":[{"code":"442","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8355.44,"maximum":21732.50,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":14204.39},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8355.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8522.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15196.72},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8355.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8355.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8438.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8355.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8606.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":21732.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":8355.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8355.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8355.44,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/Mcc","code_information":[{"code":"443","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6514.87,"maximum":16945.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":10296.09},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6514.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6645.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11015.38},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6514.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6514.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6580.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6514.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6710.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":16945.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":6514.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6514.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6514.87,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of The Biliary Tract With Mcc","code_information":[{"code":"444","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13245.16,"maximum":34450.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":24587.29},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13245.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13510.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26304.98},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13245.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13245.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13377.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13245.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13642.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":34450.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":13245.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13245.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13245.16,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of The Biliary Tract With Cc","code_information":[{"code":"445","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9250.09,"maximum":24059.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":16104.1},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9250.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9435.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17229.14},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9250.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9250.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9342.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9250.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9527.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":24059.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":9250.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9250.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9250.09,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of The Biliary Tract Without Cc/Mcc","code_information":[{"code":"446","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7399.12,"maximum":19245.11,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":12173.72},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7399.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7547.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13024.18},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7399.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7399.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7473.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7399.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7621.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":19245.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":7399.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7399.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7399.12,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Multiple Level Spinal Fusion Except Cervical With Mcc Or Custom-Made Anatomically Designed Interbody","code_information":[{"code":"447","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":47968.65,"maximum":124766.46,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":98319.74},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":47968.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":48928.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":105188.43},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":47968.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47968.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":48448.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47968.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":49407.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":124766.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":47968.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":47968.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":47968.65,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Multiple Level Spinal Fusion Except Cervical Without Mcc","code_information":[{"code":"448","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":31054.23,"maximum":80772.05,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":62403.37},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":31054.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31675.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":66762.91},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31054.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31054.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31364.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31054.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":31985.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":80772.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":31054.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31054.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":31054.23,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Single Level Spinal Fusion Except Cervical With Mcc Or Custom-Made Anatomically Designed Interbody F","code_information":[{"code":"450","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":38599.47,"maximum":100397.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":78425.06},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":38599.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39371.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":83903.89},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38599.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38599.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38985.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38599.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":39757.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":100397.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":38599.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38599.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":38599.47,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Single Level Spinal Fusion Except Cervical Without Mcc","code_information":[{"code":"451","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24052.29,"maximum":62560.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":47535.34},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24052.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24533.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":50856.19},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24052.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24052.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24292.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24052.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24773.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":62560.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":24052.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24052.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24052.29,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With","code_information":[{"code":"456","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":59900.5,"maximum":155801.20,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":123656.03},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":59900.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":61098.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":132294.73},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":59900.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59900.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":60499.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59900.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":61697.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":155801.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":59900.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":59900.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":59900.5,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With","code_information":[{"code":"457","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":42989.54,"maximum":111815.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":87747.02},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":42989.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":43849.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":93877.08},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":42989.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42989.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":43419.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42989.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":44279.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":111815.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":42989.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":42989.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":42989.54,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With","code_information":[{"code":"458","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":30581.61,"maximum":79542.77,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":61399.81},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30581.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31193.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":65689.24},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30581.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30581.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30887.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30581.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":31499.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":79542.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":30581.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30581.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30581.61,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With Mcc","code_information":[{"code":"461","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":39939.7,"maximum":103883.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":81270.95},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":39939.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":40738.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":86948.59},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39939.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39939.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":40339.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39939.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":41137.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":103883.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":39939.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39939.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":39939.7,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without Mcc","code_information":[{"code":"462","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20099.49,"maximum":52278.77,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":39141.9},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20099.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20501.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":41876.38},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20099.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20099.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20300.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20099.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20702.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":52278.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":20099.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20099.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20099.49,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit","code_information":[{"code":"463","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":41162.82,"maximum":107064.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":83868.14},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":41162.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":41986.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":89727.23},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":41162.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41162.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":41574.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41162.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":42397.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":107064.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":41162.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":41162.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":41162.82,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit","code_information":[{"code":"464","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23250.5,"maximum":60474.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":45832.81},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23250.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23715.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":49034.72},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23250.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23250.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23483.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23250.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23948.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":60474.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":23250.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23250.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23250.5,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit","code_information":[{"code":"465","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14304.04,"maximum":37204.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":26835.75},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14304.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14590.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28710.51},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14304.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14304.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14447.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14304.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14733.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":37204.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":14304.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14304.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14304.04,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Revision Of Hip Or Knee Replacement With Mcc","code_information":[{"code":"466","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":37738.78,"maximum":98158.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":76597.46},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":37738.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38493.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":81948.61},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37738.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37738.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38116.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37738.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":38870.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":98158.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":37738.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37738.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":37738.78,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Revision Of Hip Or Knee Replacement With Cc","code_information":[{"code":"467","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":26104.91,"maximum":67898.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":51893.92},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26104.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26627.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":55519.26},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26104.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26104.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26365.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26104.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26888.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":67898.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":26104.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26104.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26104.91,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":25489.7,"10th_percentile":25489.7,"90th_percentile":25489.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Revision Of Hip Or Knee Replacement Without Cc/Mcc","code_information":[{"code":"468","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20709.32,"maximum":53864.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":40436.82},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20709.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21123.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":43261.76},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20709.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20709.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20916.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20709.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21330.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":53864.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":20709.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20709.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20709.32,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20946.98,"10th_percentile":20946.98,"90th_percentile":20946.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"1 through 10","median_amount":21012.1,"10th_percentile":21012.1,"90th_percentile":21012.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With Mcc Or Total Ankle Repl","code_information":[{"code":"469","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":22685.72,"maximum":59005.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":44633.54},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22685.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23139.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":47751.67},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22685.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22685.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22912.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22685.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23366.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":59005.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":22685.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22685.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22685.72,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without Mcc","code_information":[{"code":"470","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15033.06,"maximum":39100.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":28383.76},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15033.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15333.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30366.67},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15033.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15033.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15183.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15033.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15484.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":39100.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":15033.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15033.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15033.06,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"1 through 10","median_amount":1341.6,"10th_percentile":1341.6,"90th_percentile":1341.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"1 through 10","median_amount":15060.85,"10th_percentile":15060.85,"90th_percentile":15060.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14927.19,"10th_percentile":14927.19,"90th_percentile":14927.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cervical Spinal Fusion With Mcc","code_information":[{"code":"471","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":35128.3,"maximum":91368.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":71054.32},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35128.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35830.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":76018.22},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35128.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35128.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35479.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35128.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36182.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":91368.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":35128.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35128.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35128.3,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cervical Spinal Fusion With Cc","code_information":[{"code":"472","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":22082.13,"maximum":57435.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":43351.86},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22082.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22523.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":46380.45},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22082.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22082.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22302.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22082.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22744.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":57435.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":22082.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22082.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22082.13,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cervical Spinal Fusion Without Cc/Mcc","code_information":[{"code":"473","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18583.93,"maximum":48336.80,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":35923.73},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18583.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18955.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38433.39},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18583.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18583.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18769.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18583.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19141.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":48336.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":18583.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18583.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18583.93,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18425.66,"10th_percentile":18425.66,"90th_percentile":18425.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation For Musculoskeletal System And Connective Tissue Disorders With Mcc","code_information":[{"code":"474","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":31415.27,"maximum":81711.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":63170.02},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":31415.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32043.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":67583.12},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31415.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31415.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31729.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31415.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":32357.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":81711.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":31415.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31415.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":31415.27,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc","code_information":[{"code":"475","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17436.34,"maximum":45351.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":33486.93},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17436.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17785.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35826.35},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17436.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17436.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17610.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17436.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17959.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":45351.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":17436.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17436.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17436.34,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/Mcc","code_information":[{"code":"476","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9844.67,"maximum":25605.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":17366.64},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9844.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10041.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18579.89},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9844.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9844.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9943.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9844.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10140.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":25605.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":9844.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9844.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9844.67,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"1 through 10","median_amount":35789.37,"10th_percentile":35789.37,"90th_percentile":35789.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Biopsies Of Musculoskeletal System And Connective Tissue With Mcc","code_information":[{"code":"477","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":25605.96,"maximum":66601.10,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":50834.44},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25605.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26118.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":54385.77},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25605.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25605.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25862.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25605.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26374.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":66601.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":25605.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25605.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25605.96,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Biopsies Of Musculoskeletal System And Connective Tissue With Cc","code_information":[{"code":"478","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18707.97,"maximum":48659.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":36187.13},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18707.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19082.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38715.19},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18707.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18707.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18895.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18707.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19269.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":48659.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":18707.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18707.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18707.97,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18150.25,"10th_percentile":18150.25,"90th_percentile":18150.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/Mcc","code_information":[{"code":"479","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14547.97,"maximum":37839.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":27353.71},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14547.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14838.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29264.66},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14547.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14547.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14693.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14547.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14984.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":37839.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":14547.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14547.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14547.97,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hip And Femur Procedures Except Major Joint With Mcc","code_information":[{"code":"480","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21847.9,"maximum":56826.39,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":42854.49},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21847.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22284.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":45848.34},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21847.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21847.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22066.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21847.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22503.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":56826.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":21847.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21847.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21847.9,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hip And Femur Procedures Except Major Joint With Cc","code_information":[{"code":"481","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16180.65,"maximum":42085.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":30820.57},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16180.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16504.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32973.71},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16180.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16180.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16342.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16180.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16666.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":42085.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":16180.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16180.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16180.65,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":27215.74,"10th_percentile":27215.74,"90th_percentile":27215.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hip And Femur Procedures Except Major Joint Without Cc/Mcc","code_information":[{"code":"482","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12968.66,"maximum":33731.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":24000.17},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12968.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13228.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25676.83},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12968.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12968.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13098.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12968.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13357.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":33731.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":12968.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12968.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12968.66,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Joint Or Limb Reattachment Procedures Of Upper Extremities","code_information":[{"code":"483","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20874.94,"maximum":54295.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":40788.51},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20874.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21292.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":43638.02},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20874.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20874.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21083.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20874.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21501.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":54295.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":20874.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20874.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20874.94,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20975.09,"10th_percentile":20975.09,"90th_percentile":20975.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"1 through 10","median_amount":20907.28,"10th_percentile":20907.28,"90th_percentile":20907.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":28002.84,"10th_percentile":28002.84,"90th_percentile":28002.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Knee Procedures With Principal Diagnosis Of Infection With Mcc","code_information":[{"code":"485","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24029.42,"maximum":62500.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":47486.78},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24029.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24510.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":50804.24},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24029.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24029.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24269.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24029.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24750.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":62500.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":24029.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24029.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24029.42,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Knee Procedures With Principal Diagnosis Of Infection With Cc","code_information":[{"code":"486","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16157.09,"maximum":42024.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":30770.54},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16157.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16480.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32920.19},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16157.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16157.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16318.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16157.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16641.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":42024.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":16157.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16157.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16157.09,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Knee Procedures With Principal Diagnosis Of Infection Without Cc/Mcc","code_information":[{"code":"487","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12519.6,"maximum":32563.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":23046.63},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12519.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12769.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24656.69},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12519.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12519.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12644.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12519.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12895.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":32563.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":12519.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12519.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12519.6,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Knee Procedures Without Principal Diagnosis Of Infection With Cc/Mcc","code_information":[{"code":"488","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13924.28,"maximum":36217.05,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":26029.36},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13924.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14202.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27847.79},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13924.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13924.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14063.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13924.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14342.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":36217.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":13924.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13924.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13924.28,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Knee Procedures Without Principal Diagnosis Of Infection Without Cc/Mcc","code_information":[{"code":"489","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9405.32,"maximum":24463.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":16433.71},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9405.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9593.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17581.78},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9405.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9405.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9499.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9405.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9687.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":24463.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":9405.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9405.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9405.32,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"1 through 10","median_amount":9404.99,"10th_percentile":9404.99,"90th_percentile":9404.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Mcc","code_information":[{"code":"492","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":27109.74,"maximum":70512.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":54027.59},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27109.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27651.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":57802.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27109.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27109.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27380.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27109.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27923.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":70512.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":27109.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27109.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27109.74,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc","code_information":[{"code":"493","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19240.88,"maximum":50045.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":37318.71},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19240.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19625.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39925.82},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19240.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19240.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19433.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19240.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19818.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":50045.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":19240.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19240.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19240.88,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/Mcc","code_information":[{"code":"494","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15570.82,"maximum":40499.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":29525.65},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15570.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15882.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31588.33},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15570.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15570.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15726.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15570.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16037.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":40499.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":15570.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15570.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15570.82,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"1 through 10","median_amount":15590.14,"10th_percentile":15590.14,"90th_percentile":15590.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Mcc","code_information":[{"code":"495","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":26791.66,"maximum":69685.11,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":53352.18},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26791.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27327.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":57079.4},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26791.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26791.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27059.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26791.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27595.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":69685.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":26791.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26791.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26791.66,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc","code_information":[{"code":"496","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14166.83,"maximum":36847.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":26544.39},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14166.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14450.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28398.8},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14166.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14166.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14308.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14166.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14591.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":36847.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":14166.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14166.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14166.83,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"1 through 10","median_amount":14189.55,"10th_percentile":14189.55,"90th_percentile":14189.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/Mcc","code_information":[{"code":"497","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10039.4,"maximum":26112.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":17780.13},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10039.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10240.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19022.27},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10039.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10039.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10139.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10039.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10340.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":26112.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":10039.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10039.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10039.4,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/Mcc","code_information":[{"code":"498","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":22572.07,"maximum":58709.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":44392.21},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22572.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23023.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":47493.48},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22572.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22572.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22797.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22572.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23249.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":58709.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":22572.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22572.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22572.07,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/Mcc","code_information":[{"code":"499","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15628.34,"maximum":40649.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":29647.78},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15628.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15940.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31719.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15628.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15628.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15784.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15628.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16097.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":40649.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":15628.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15628.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15628.34,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Soft Tissue Procedures With Mcc","code_information":[{"code":"500","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23597.69,"maximum":61377.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":46570.03},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23597.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24069.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":49823.45},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23597.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23597.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23833.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23597.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24305.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":61377.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":23597.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23597.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23597.69,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Soft Tissue Procedures With Cc","code_information":[{"code":"501","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13780.14,"maximum":35842.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":25723.29},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13780.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14055.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27520.34},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13780.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13780.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13917.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13780.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14193.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":35842.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":13780.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13780.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13780.14,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Soft Tissue Procedures Without Cc/Mcc","code_information":[{"code":"502","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10992.95,"maximum":28592.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":19804.92},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10992.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11212.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21188.5},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10992.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10992.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11102.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10992.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11322.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":28592.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":10992.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10992.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10992.95,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Foot Procedures With Mcc","code_information":[{"code":"503","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21008.0,"maximum":54641.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":41071.04},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21008.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21428.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":43940.29},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21008.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21008.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21218.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21008.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21638.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":54641.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":21008.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21008.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21008.0,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Foot Procedures With Cc","code_information":[{"code":"504","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14619.35,"maximum":38024.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":27505.28},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14619.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14911.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29426.82},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14619.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14619.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14765.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14619.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15057.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":38024.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":14619.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14619.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14619.35,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Foot Procedures Without Cc/Mcc","code_information":[{"code":"505","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14089.91,"maximum":36647.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":26381.05},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14089.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14371.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28224.05},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14089.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14089.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14230.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14089.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14512.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":36647.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":14089.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14089.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14089.91,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Thumb Or Joint Procedures","code_information":[{"code":"506","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11015.82,"maximum":28652.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":19853.48},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11015.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11236.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21240.46},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11015.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11015.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11125.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11015.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11346.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":28652.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":11015.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11015.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11015.82,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Shoulder Or Elbow Joint Procedures With Cc/Mcc","code_information":[{"code":"507","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14184.15,"maximum":36892.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":26581.18},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14184.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14467.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28438.16},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14184.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14184.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14325.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14184.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14609.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":36892.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":14184.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14184.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14184.15,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Shoulder Or Elbow Joint Procedures Without Cc/Mcc","code_information":[{"code":"508","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12160.63,"maximum":31629.80,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":22284.4},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12160.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12403.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23841.2},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12160.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12160.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12282.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12160.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12525.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":31629.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":12160.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12160.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12160.63,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Mcc","code_information":[{"code":"510","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":22597.71,"maximum":58776.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":44446.66},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22597.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23049.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":47551.73},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22597.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22597.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22823.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22597.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23275.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":58776.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":22597.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22597.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22597.71,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc","code_information":[{"code":"511","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16076.01,"maximum":41813.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":30598.37},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16076.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16397.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32735.99},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16076.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16076.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16236.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16076.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16558.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":41813.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":16076.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16076.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16076.01,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/Mcc","code_information":[{"code":"512","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13137.74,"maximum":34171.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":24359.21},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13137.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13400.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26060.96},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13137.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13137.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13269.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13137.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13531.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":34171.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":13137.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13137.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13137.74,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/Mcc","code_information":[{"code":"513","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12575.73,"maximum":32709.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":23165.82},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12575.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12827.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24784.2},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12575.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12575.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12701.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12575.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12953.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":32709.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":12575.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12575.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12575.73,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/Mcc","code_information":[{"code":"514","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8750.44,"maximum":22759.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":15043.14},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8750.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8925.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16094.07},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8750.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8750.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8837.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8750.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9012.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":22759.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":8750.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8750.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8750.44,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Musculoskeletal System And Connective Tissue O.R. Procedures With Mcc","code_information":[{"code":"515","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23750.84,"maximum":61775.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":46895.23},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23750.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24225.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":50171.37},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23750.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23750.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23988.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23750.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24463.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":61775.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":23750.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23750.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23750.84,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc","code_information":[{"code":"516","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16067.0,"maximum":41790.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":30579.24},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16067.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16388.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32715.53},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16067.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16067.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16227.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16067.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16549.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":41790.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":16067.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16067.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16067.0,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15959.3,"10th_percentile":15959.3,"90th_percentile":15959.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/Mcc","code_information":[{"code":"517","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12315.17,"maximum":32031.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":22612.54},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12315.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12561.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24192.27},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12315.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12315.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12438.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12315.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12684.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":32031.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":12315.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12315.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12315.17,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Back And Neck Procedures Except Spinal Fusion With Mcc Or Disc Device Or Neurostimulator","code_information":[{"code":"518","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":27565.04,"maximum":71696.67,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":54994.37},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27565.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28116.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":58836.31},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27565.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27565.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27840.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27565.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28391.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":71696.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":27565.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27565.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27565.04,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Back And Neck Procedures Except Spinal Fusion With Cc","code_information":[{"code":"519","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15527.16,"maximum":40386.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":29432.94},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15527.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15837.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31489.15},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15527.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15527.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15682.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15527.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15992.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":40386.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":15527.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15527.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15527.16,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Back And Neck Procedures Except Spinal Fusion Without Cc/Mcc","code_information":[{"code":"520","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12018.57,"maximum":31260.30,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":21982.74},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12018.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12258.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23518.47},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12018.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12018.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12138.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12018.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12379.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":31260.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":12018.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12018.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12018.57,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hip Replacement With Principal Diagnosis Of Hip Fracture With Mcc","code_information":[{"code":"521","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21556.15,"maximum":56067.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":42234.99},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21556.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21987.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":45185.56},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21556.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21556.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21771.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21556.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22202.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":56067.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":21556.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21556.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21556.15,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21368.3,"10th_percentile":21368.3,"90th_percentile":21368.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hip Replacement With Principal Diagnosis Of Hip Fracture Without Mcc","code_information":[{"code":"522","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16341.42,"maximum":42504.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":31161.96},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16341.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16668.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33338.95},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16341.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16341.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16504.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16341.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16831.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":42504.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":16341.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16341.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16341.42,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15900.07,"10th_percentile":15900.07,"90th_percentile":15900.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"1 through 10","median_amount":19293.72,"10th_percentile":19293.72,"90th_percentile":19293.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Fractures Of Femur With Mcc","code_information":[{"code":"533","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12529.99,"maximum":32590.50,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":23068.71},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12529.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12780.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24680.3},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12529.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12529.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12655.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12529.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12905.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":32590.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":12529.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12529.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12529.99,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Fractures Of Femur Without Mcc","code_information":[{"code":"534","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7252.21,"maximum":18863.00,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":11861.76},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7252.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7397.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12690.43},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7252.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7252.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7324.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7252.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7469.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":18863.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":7252.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7252.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7252.21,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Fractures Of Hip And Pelvis With Mcc","code_information":[{"code":"535","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10550.13,"maximum":27440.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":18864.63},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10550.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10761.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20182.53},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10550.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10550.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10655.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10550.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10866.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":27440.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":10550.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10550.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10550.13,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Fractures Of Hip And Pelvis Without Mcc","code_information":[{"code":"536","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7262.6,"maximum":18890.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":11883.83},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7262.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7407.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12714.05},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7262.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7262.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7335.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7262.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7480.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":18890.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":7262.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7262.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7262.6,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7218.02,"10th_percentile":7218.02,"90th_percentile":7218.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/Mcc","code_information":[{"code":"537","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8279.21,"maximum":21534.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":14042.52},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8279.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8444.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15023.54},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8279.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8279.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8362.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8279.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8527.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":21534.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":8279.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8279.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8279.21,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/Mcc","code_information":[{"code":"538","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6657.62,"maximum":17316.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":10599.21},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6657.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6790.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11339.68},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6657.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6657.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6724.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6657.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6857.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17316.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":6657.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6657.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6657.62,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Osteomyelitis With Mcc","code_information":[{"code":"539","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15315.8,"maximum":39836.40,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":28984.14},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15315.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15622.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31008.99},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15315.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15315.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15468.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15315.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15775.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":39836.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":15315.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15315.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15315.8,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Osteomyelitis With Cc","code_information":[{"code":"540","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10649.23,"maximum":27698.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":19075.05},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10649.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10862.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20407.65},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10649.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10649.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10755.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10649.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10968.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":27698.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":10649.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10649.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10649.23,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Osteomyelitis Without Cc/Mcc","code_information":[{"code":"541","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7122.62,"maximum":18525.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":11586.59},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7122.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7265.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12396.04},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7122.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7122.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7193.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7122.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7336.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":18525.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":7122.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7122.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7122.62,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Mcc","code_information":[{"code":"542","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13907.65,"maximum":36173.80,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":25994.05},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13907.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14185.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27810.01},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13907.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13907.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14046.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13907.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14324.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":36173.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":13907.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13907.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13907.65,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc","code_information":[{"code":"543","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8789.94,"maximum":22862.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":15127.02},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8789.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8965.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16183.8},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8789.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8789.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8877.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8789.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9053.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":22862.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":8789.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8789.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8789.94,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/Mcc","code_information":[{"code":"544","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6895.32,"maximum":17934.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":11103.94},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6895.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7033.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11879.67},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6895.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6895.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6964.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6895.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7102.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17934.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":6895.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6895.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6895.32,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Connective Tissue Disorders With Mcc","code_information":[{"code":"545","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18863.89,"maximum":49064.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":36518.22},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18863.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19241.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39069.4},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18863.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18863.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19052.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18863.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19429.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":49064.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":18863.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18863.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18863.89,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Connective Tissue Disorders With Cc","code_information":[{"code":"546","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9658.95,"maximum":25122.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":16972.28},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9658.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9852.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18157.98},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9658.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9658.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9755.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9658.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9948.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":25122.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":9658.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9658.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9658.95,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Connective Tissue Disorders Without Cc/Mcc","code_information":[{"code":"547","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7460.8,"maximum":19405.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":12304.68},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7460.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7610.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13164.3},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7460.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7460.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7535.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7460.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7684.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":19405.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":7460.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7460.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7460.8,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Septic Arthritis With Mcc","code_information":[{"code":"548","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15046.92,"maximum":39137.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":28413.19},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15046.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15347.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30398.16},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15046.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15046.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15197.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15046.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15498.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":39137.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":15046.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15046.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15046.92,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Septic Arthritis With Cc","code_information":[{"code":"549","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10031.78,"maximum":26092.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":17763.95},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10031.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10232.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19004.95},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10031.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10031.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10132.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10031.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10332.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":26092.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":10031.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10031.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10031.78,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Septic Arthritis Without Cc/Mcc","code_information":[{"code":"550","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7723.44,"maximum":20088.67,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":12862.38},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7723.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7877.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13760.96},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7723.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7723.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7800.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7723.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7955.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":20088.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":7723.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7723.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7723.44,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Medical Back Problems With Mcc","code_information":[{"code":"551","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13281.19,"maximum":34544.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":24663.81},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13281.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13546.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26386.84},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13281.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13281.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13414.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13281.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13679.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":34544.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":13281.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13281.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13281.19,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Medical Back Problems Without Mcc","code_information":[{"code":"552","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8327.72,"maximum":21660.40,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":14145.53},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8327.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8494.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15133.75},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8327.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8327.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8411.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8327.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8577.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":21660.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":8327.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8327.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8327.72,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bone Diseases And Arthropathies With Mcc","code_information":[{"code":"553","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10649.23,"maximum":27698.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":19075.05},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10649.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10862.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20407.65},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10649.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10649.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10755.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10649.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10968.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":27698.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":10649.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10649.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10649.23,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bone Diseases And Arthropathies Without Mcc","code_information":[{"code":"554","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7418.52,"maximum":19295.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":12214.92},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7418.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7566.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13068.26},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7418.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7418.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7492.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7418.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7641.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":19295.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":7418.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7418.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7418.52,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5635.31,"10th_percentile":5635.31,"90th_percentile":5635.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Signs And Symptoms Of Musculoskeletal System And Connective Tissue With Mcc","code_information":[{"code":"555","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10825.94,"maximum":28158.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":19450.29},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10825.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11042.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20809.1},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10825.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10825.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10934.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10825.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11150.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":28158.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":10825.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10825.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10825.94,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without Mcc","code_information":[{"code":"556","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7421.99,"maximum":19304.60,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":12222.28},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7421.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7570.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13076.14},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7421.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7421.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7496.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7421.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7644.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":19304.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":7421.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7421.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7421.99,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Tendonitis, Myositis And Bursitis With Mcc","code_information":[{"code":"557","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11970.06,"maximum":31134.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":21879.73},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11970.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12209.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23408.27},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11970.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11970.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12089.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11970.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12329.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":31134.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":11970.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11970.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11970.06,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Tendonitis, Myositis And Bursitis Without Mcc","code_information":[{"code":"558","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7855.8,"maximum":20432.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":13143.44},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7855.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8012.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14061.65},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7855.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7855.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7934.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7855.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8091.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":20432.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":7855.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7855.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7855.8,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"1 through 10","median_amount":19673.76,"10th_percentile":19673.76,"90th_percentile":19673.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aftercare, Musculoskeletal System And Connective Tissue With Mcc","code_information":[{"code":"559","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14589.55,"maximum":37947.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":27442.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14589.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14881.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29359.12},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14589.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14589.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14735.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14589.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15027.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":37947.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":14589.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14589.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14589.55,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aftercare, Musculoskeletal System And Connective Tissue With Cc","code_information":[{"code":"560","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9469.76,"maximum":24630.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":16570.56},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9469.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9659.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17728.19},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9469.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9469.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9564.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9469.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9753.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":24630.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":9469.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9469.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9469.76,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aftercare, Musculoskeletal System And Connective Tissue Without Cc/Mcc","code_information":[{"code":"561","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7236.96,"maximum":18823.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":11829.39},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7236.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7381.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12655.8},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7236.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7236.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7309.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7236.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7454.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":18823.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":7236.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7236.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7236.96,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7387.94,"10th_percentile":7387.94,"90th_percentile":7387.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With Mcc","code_information":[{"code":"562","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11539.72,"maximum":30014.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":20965.93},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11539.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11770.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22430.63},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11539.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11539.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11655.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11539.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11885.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":30014.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":11539.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11539.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11539.72,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without Mcc","code_information":[{"code":"563","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7871.74,"maximum":20474.40,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":13177.28},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7871.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8029.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14097.86},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7871.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7871.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7950.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7871.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8107.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":20474.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":7871.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7871.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7871.74,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Musculoskeletal System And Connective Tissue Diagnoses With Mcc","code_information":[{"code":"564","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12362.98,"maximum":32156.11,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":22714.07},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12362.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12610.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24300.89},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12362.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12362.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12486.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12362.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12733.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":32156.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":12362.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12362.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12362.98,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Musculoskeletal System And Connective Tissue Diagnoses With Cc","code_information":[{"code":"565","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8418.5,"maximum":21896.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":14338.3},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8418.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8586.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15339.98},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8418.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8418.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8502.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8418.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8671.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":21896.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":8418.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8418.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8418.5,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/Mcc","code_information":[{"code":"566","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6858.59,"maximum":17839.19,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":11025.95},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6858.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6995.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11796.23},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6858.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6858.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6927.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6858.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7064.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17839.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":6858.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6858.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6858.59,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Debridement With Mcc","code_information":[{"code":"570","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":22047.48,"maximum":57345.50,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":43278.29},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22047.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22488.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":46301.74},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22047.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22047.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22267.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22047.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22708.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":57345.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":22047.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22047.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22047.48,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Debridement With Cc","code_information":[{"code":"571","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13374.05,"maximum":34785.90,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":24860.99},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13374.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13641.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26597.8},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13374.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13374.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13507.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13374.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13775.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":34785.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":13374.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13374.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13374.05,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Debridement Without Cc/Mcc","code_information":[{"code":"572","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9609.75,"maximum":24994.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":16867.8},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9609.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9801.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18046.2},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9609.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9609.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9705.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9609.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9898.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":24994.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":9609.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9609.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9609.75,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Graft For Skin Ulcer Or Cellulitis With Mcc","code_information":[{"code":"573","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":47066.38,"maximum":122419.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":96403.85},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":47066.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":48007.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":103138.69},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":47066.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47066.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":47537.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47066.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":48478.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":122419.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":47066.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":47066.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":47066.38,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Graft For Skin Ulcer Or Cellulitis With Cc","code_information":[{"code":"574","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":25722.39,"maximum":66903.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":51081.65},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25722.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26236.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":54650.25},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25722.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25722.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25979.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25722.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26494.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":66903.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":25722.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25722.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25722.39,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Graft For Skin Ulcer Or Cellulitis Without Cc/Mcc","code_information":[{"code":"575","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14119.01,"maximum":36723.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":26442.86},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14119.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14401.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28290.17},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14119.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14119.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14260.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14119.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14542.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":36723.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":14119.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14119.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14119.01,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Graft Except For Skin Ulcer Or Cellulitis With Mcc","code_information":[{"code":"576","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":35630.71,"maximum":92675.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":72121.16},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35630.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36343.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":77159.59},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35630.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35630.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35987.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35630.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36699.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":92675.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":35630.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35630.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35630.71,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Graft Except For Skin Ulcer Or Cellulitis With Cc","code_information":[{"code":"577","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20035.04,"maximum":52111.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":39005.05},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20035.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20435.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":41729.97},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20035.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20035.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20235.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20035.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20636.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":52111.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":20035.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20035.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20035.04,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/Mcc","code_information":[{"code":"578","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12798.18,"maximum":33288.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":23638.18},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12798.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13054.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25289.56},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12798.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12798.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12926.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12798.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13182.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":33288.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":12798.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12798.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12798.18,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Skin, Subcutaneous Tissue And Breast Procedures With Mcc","code_information":[{"code":"579","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24108.42,"maximum":62706.00,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":47654.53},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24108.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24590.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":50983.71},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24108.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24108.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24349.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24108.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24831.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":62706.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":24108.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24108.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24108.42,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Skin, Subcutaneous Tissue And Breast Procedures With Cc","code_information":[{"code":"580","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13640.85,"maximum":35479.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":25427.52},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13640.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13913.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27203.9},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13640.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13640.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13777.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13640.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14050.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":35479.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":13640.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13640.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13640.85,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11935.3,"10th_percentile":11935.3,"90th_percentile":11935.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/Mcc","code_information":[{"code":"581","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11666.53,"maximum":30344.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":21235.22},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11666.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11899.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22718.72},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11666.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11666.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11783.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11666.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12016.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":30344.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":11666.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11666.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11666.53,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Mastectomy For Malignancy With Cc/Mcc","code_information":[{"code":"582","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15017.12,"maximum":39059.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":28349.92},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15017.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15317.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30330.46},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15017.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15017.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15167.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15017.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15467.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":39059.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":15017.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15017.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15017.12,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Mastectomy For Malignancy Without Cc/Mcc","code_information":[{"code":"583","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13615.9,"maximum":35414.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":25374.55},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13615.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13888.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27147.23},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13615.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13615.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13752.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13615.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14024.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":35414.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":13615.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13615.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13615.9,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Breast Biopsy, Local Excision And Other Breast Procedures With Cc/Mcc","code_information":[{"code":"584","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16500.81,"maximum":42918.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":31500.4},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16500.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16830.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33701.04},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16500.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16500.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16665.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16500.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16995.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":42918.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":16500.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16500.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16500.81,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/Mcc","code_information":[{"code":"585","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15034.45,"maximum":39104.60,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":28386.71},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15034.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15335.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30369.82},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15034.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15034.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15184.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15034.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15485.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":39104.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":15034.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15034.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15034.45,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Ulcers With Mcc","code_information":[{"code":"592","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15077.41,"maximum":39216.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":28477.94},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15077.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15378.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30467.43},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15077.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15077.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15228.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15077.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15529.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":39216.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":15077.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15077.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15077.41,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Ulcers With Cc","code_information":[{"code":"593","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9886.94,"maximum":25715.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":17456.4},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9886.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10084.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18675.92},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9886.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9886.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9985.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9886.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10183.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":25715.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":9886.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9886.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9886.94,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Ulcers Without Cc/Mcc","code_information":[{"code":"594","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7672.85,"maximum":19957.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":12754.96},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7672.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7826.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13646.03},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7672.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7672.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7749.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7672.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7903.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":19957.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":7672.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7672.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7672.85,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Skin Disorders With Mcc","code_information":[{"code":"595","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16362.21,"maximum":42558.11,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":31206.1},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16362.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16689.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33386.18},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16362.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16362.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16525.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16362.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16853.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":42558.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":16362.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16362.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16362.21,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Skin Disorders Without Mcc","code_information":[{"code":"596","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9167.62,"maximum":23844.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":15928.99},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9167.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9350.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17041.8},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9167.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9167.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9259.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9167.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9442.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":23844.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":9167.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9167.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9167.62,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignant Breast Disorders With Mcc","code_information":[{"code":"597","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13218.82,"maximum":34382.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":24531.38},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13218.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13483.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26245.16},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13218.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13218.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13351.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13218.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13615.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":34382.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":13218.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13218.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13218.82,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignant Breast Disorders With Cc","code_information":[{"code":"598","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9505.8,"maximum":24724.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":16647.08},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9505.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9695.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17810.06},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9505.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9505.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9600.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9505.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9790.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":24724.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":9505.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9505.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9505.8,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignant Breast Disorders Without Cc/Mcc","code_information":[{"code":"599","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6997.88,"maximum":18201.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":11321.72},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6997.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7137.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12112.66},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6997.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6997.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7067.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6997.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7207.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":18201.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":6997.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6997.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6997.88,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Malignant Breast Disorders With Cc/Mcc","code_information":[{"code":"600","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8884.19,"maximum":23107.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":15327.14},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8884.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9061.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16397.91},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8884.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8884.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8973.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8884.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9150.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":23107.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":8884.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8884.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8884.19,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Malignant Breast Disorders Without Cc/Mcc","code_information":[{"code":"601","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5858.61,"maximum":15238.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":8902.58},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5858.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5975.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9524.52},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5858.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5858.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5917.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5858.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6034.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":15238.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":5858.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5858.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5858.61,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cellulitis With Mcc","code_information":[{"code":"602","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11515.46,"maximum":29951.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":20914.43},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11515.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11745.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22375.53},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11515.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11515.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11630.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11515.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11860.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":29951.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":11515.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11515.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11515.46,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cellulitis Without Mcc","code_information":[{"code":"603","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7701.26,"maximum":20030.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":12815.29},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7701.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7855.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13710.58},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7701.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7701.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7778.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7701.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7932.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":20030.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":7701.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7701.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7701.26,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Trauma To The Skin, Subcutaneous Tissue And Breast With Mcc","code_information":[{"code":"604","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11867.5,"maximum":30867.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":21661.95},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11867.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12104.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23175.27},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11867.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11867.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11986.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11867.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12223.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":30867.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":11867.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11867.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11867.5,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Trauma To The Skin, Subcutaneous Tissue And Breast Without Mcc","code_information":[{"code":"605","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8013.8,"maximum":20843.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":13478.94},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8013.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8174.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14420.59},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8013.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8013.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8093.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8013.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8254.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":20843.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":8013.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8013.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8013.8,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Minor Skin Disorders With Mcc","code_information":[{"code":"606","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12152.32,"maximum":31608.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":22266.74},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12152.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12395.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23822.31},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12152.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12152.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12273.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12152.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12516.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":31608.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":12152.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12152.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12152.32,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Minor Skin Disorders Without Mcc","code_information":[{"code":"607","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7947.27,"maximum":20670.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":13337.68},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7947.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8106.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14269.46},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7947.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7947.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8026.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7947.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8185.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":20670.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":7947.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7947.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7947.27,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Adrenal And Pituitary Procedures With Cc/Mcc","code_information":[{"code":"614","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16854.93,"maximum":43839.67,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":32252.34},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16854.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17192.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34505.51},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16854.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16854.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17023.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16854.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17360.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":43839.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":16854.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16854.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16854.93,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Adrenal And Pituitary Procedures Without Cc/Mcc","code_information":[{"code":"615","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11363.0,"maximum":29555.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":20590.7},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11363.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11590.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22029.18},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11363.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11363.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11476.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11363.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11703.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":29555.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":11363.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11363.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11363.0,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Mcc","code_information":[{"code":"616","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":25833.26,"maximum":67192.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":51317.09},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25833.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26349.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":54902.14},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25833.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25833.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26091.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25833.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26608.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":67192.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":25833.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25833.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25833.26,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc","code_information":[{"code":"617","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14626.97,"maximum":38044.75,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":27521.46},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14626.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14919.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29444.13},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14626.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14626.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14773.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14626.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15065.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":38044.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":14626.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14626.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14626.97,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders Without Cc/Mcc","code_information":[{"code":"618","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11494.67,"maximum":29897.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":20870.28},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11494.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11724.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22328.3},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11494.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11494.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11609.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11494.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11839.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":29897.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":11494.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11494.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11494.67,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"O.R. Procedures For Obesity With Mcc","code_information":[{"code":"619","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21675.34,"maximum":56377.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":42488.09},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21675.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22108.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":45456.34},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21675.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21675.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21892.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21675.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22325.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":56377.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":21675.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21675.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21675.34,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"O.R. Procedures For Obesity With Cc","code_information":[{"code":"620","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12755.91,"maximum":33178.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":23548.41},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12755.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13011.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25193.52},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12755.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12755.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12883.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12755.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13138.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":33178.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":12755.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12755.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12755.91,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"O.R. Procedures For Obesity Without Cc/Mcc","code_information":[{"code":"621","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12119.05,"maximum":31521.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":22196.11},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12119.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12361.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23746.74},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12119.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12119.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12240.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12119.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12482.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":31521.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":12119.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12119.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12119.05,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Mcc","code_information":[{"code":"622","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":26330.83,"maximum":68486.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":52373.63},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26330.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26857.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":56032.49},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26330.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26330.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26594.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26330.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27120.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":68486.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":26330.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26330.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26330.83,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc","code_information":[{"code":"623","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14097.53,"maximum":36667.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":26397.24},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14097.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14379.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28241.37},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14097.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14097.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14238.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14097.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14520.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":36667.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":14097.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14097.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14097.53,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"1 through 10","median_amount":27426.37,"10th_percentile":27426.37,"90th_percentile":27426.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/Mcc","code_information":[{"code":"624","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10341.54,"maximum":26898.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":18421.71},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10341.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10548.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19708.66},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10341.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10341.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10444.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10341.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10651.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":26898.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":10341.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10341.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10341.54,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Thyroid, Parathyroid And Thyroglossal Procedures With Mcc","code_information":[{"code":"625","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":22594.94,"maximum":58769.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":44440.77},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22594.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23046.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":47545.43},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22594.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22594.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22820.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22594.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23272.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":58769.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":22594.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22594.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22594.94,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Thyroid, Parathyroid And Thyroglossal Procedures With Cc","code_information":[{"code":"626","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12056.68,"maximum":31359.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":22063.67},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12056.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12297.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23605.05},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12056.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12056.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12177.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12056.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12418.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":31359.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":12056.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12056.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12056.68,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/Mcc","code_information":[{"code":"627","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10870.98,"maximum":28275.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":19545.93},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10870.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11088.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20911.43},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10870.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10870.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10979.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10870.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11197.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":28275.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":10870.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10870.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10870.98,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Endocrine, Nutritional And Metabolic O.R. Procedures With Mcc","code_information":[{"code":"628","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":27492.27,"maximum":71507.39,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":54839.86},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27492.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28042.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":58671.01},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27492.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27492.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27767.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27492.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28317.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":71507.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":27492.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27492.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27492.27,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc","code_information":[{"code":"629","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16764.84,"maximum":43605.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":32061.04},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16764.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17100.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34300.85},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16764.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16764.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16932.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16764.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17267.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":43605.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":16764.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16764.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16764.84,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"1 through 10","median_amount":17240.27,"10th_percentile":17240.27,"90th_percentile":17240.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Endocrine, Nutritional And Metabolic O.R. Procedures Without Cc/Mcc","code_information":[{"code":"630","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11780.18,"maximum":30640.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":21476.54},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11780.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12015.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22976.91},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11780.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11780.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11897.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11780.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12133.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":30640.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":11780.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11780.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11780.18,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Diabetes With Mcc","code_information":[{"code":"637","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11622.18,"maximum":30229.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":21141.04},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11622.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11854.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22617.97},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11622.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11622.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11738.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11622.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11970.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":30229.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":11622.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11622.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11622.18,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Diabetes With Cc","code_information":[{"code":"638","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7876.59,"maximum":20487.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":13187.58},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7876.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8034.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14108.88},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7876.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7876.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7955.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7876.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8112.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":20487.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":7876.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7876.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7876.59,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6099.1,"10th_percentile":6099.1,"90th_percentile":6099.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Diabetes Without Cc/Mcc","code_information":[{"code":"639","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5970.87,"maximum":15530.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":9140.96},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5970.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6090.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9779.55},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5970.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5970.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6030.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5970.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6150.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":15530.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":5970.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5970.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5970.87,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With Mcc","code_information":[{"code":"640","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10921.57,"maximum":28407.00,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":19653.35},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10921.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11140.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21026.35},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10921.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10921.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11030.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10921.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11249.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":28407.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":10921.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10921.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10921.57,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"1 through 10","median_amount":7059.88,"10th_percentile":7059.88,"90th_percentile":7059.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without Mcc","code_information":[{"code":"641","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7058.86,"maximum":18360.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":11451.21},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7058.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7200.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12251.2},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7058.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7058.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7129.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7058.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7270.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":18360.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":7058.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7058.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7058.86,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7009.65,"10th_percentile":7009.65,"90th_percentile":7009.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inborn And Other Disorders Of Metabolism","code_information":[{"code":"642","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11521.01,"maximum":29966.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":20926.2},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11521.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11751.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22388.12},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11521.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11521.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11636.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11521.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11866.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":29966.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":11521.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11521.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11521.01,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Endocrine Disorders With Mcc","code_information":[{"code":"643","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13073.3,"maximum":34003.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":24222.36},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13073.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13334.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25914.55},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13073.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13073.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13204.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13073.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13465.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":34003.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":13073.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13073.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13073.3,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12951.35,"10th_percentile":12951.35,"90th_percentile":12951.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Endocrine Disorders With Cc","code_information":[{"code":"644","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8769.16,"maximum":22808.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":15082.88},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8769.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8944.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16136.58},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8769.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8769.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8856.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8769.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9032.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":22808.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":8769.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8769.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8769.16,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Endocrine Disorders Without Cc/Mcc","code_information":[{"code":"645","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6990.26,"maximum":18181.67,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":11305.53},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6990.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7130.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12095.35},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6990.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6990.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7060.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6990.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7199.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":18181.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":6990.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6990.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6990.26,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney Transplant With Hemodialysis With Mcc","code_information":[{"code":"650","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":34246.12,"maximum":89074.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":69181.1},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":34246.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34931.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":74014.14},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34246.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34246.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34588.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34246.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35273.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":89074.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":34246.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34246.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":34246.12,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney Transplant With Hemodialysis Without Mcc","code_information":[{"code":"651","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":27346.75,"maximum":71128.90,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":54530.85},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27346.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27893.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":58340.41},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27346.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27346.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27620.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27346.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28167.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":71128.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":27346.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27346.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27346.75,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney Transplant","code_information":[{"code":"652","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24046.05,"maximum":62543.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":47522.09},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24046.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24526.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":50842.02},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24046.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24046.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24286.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24046.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24767.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":62543.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":24046.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24046.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24046.05,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Bladder Procedures With Mcc","code_information":[{"code":"653","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":37676.41,"maximum":97996.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":76465.03},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":37676.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38429.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":81806.93},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37676.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37676.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38053.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37676.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":38806.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":97996.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":37676.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37676.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":37676.41,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Bladder Procedures With Cc","code_information":[{"code":"654","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21064.82,"maximum":54789.60,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":41191.7},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21064.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21486.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":44069.38},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21064.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21064.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21275.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21064.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21696.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":54789.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":21064.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21064.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21064.82,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Bladder Procedures Without Cc/Mcc","code_information":[{"code":"655","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16333.8,"maximum":42484.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":31145.77},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16333.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16660.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33321.63},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16333.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16333.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16497.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16333.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16823.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":42484.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":16333.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16333.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16333.8,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Ureter Procedures For Neoplasm With Mcc","code_information":[{"code":"656","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23729.35,"maximum":61720.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":46849.62},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23729.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24203.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":50122.56},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23729.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23729.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23966.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23729.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24441.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":61720.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":23729.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23729.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23729.35,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Ureter Procedures For Neoplasm With Cc","code_information":[{"code":"657","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14347.7,"maximum":37318.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":26928.45},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14347.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14634.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28809.69},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14347.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14347.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14491.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14347.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14778.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":37318.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":14347.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14347.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14347.7,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Ureter Procedures For Neoplasm Without Cc/Mcc","code_information":[{"code":"658","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12419.81,"maximum":32303.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":22834.74},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12419.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12668.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24429.99},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12419.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12419.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12544.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12419.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12792.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":32303.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":12419.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12419.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12419.81,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Ureter Procedures For Non-Neoplasm With Mcc","code_information":[{"code":"659","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19274.14,"maximum":50132.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":37389.34},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19274.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19659.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":40001.39},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19274.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19274.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19466.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19274.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19852.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":50132.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":19274.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19274.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19274.14,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":20787.66,"10th_percentile":20787.66,"90th_percentile":20787.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Ureter Procedures For Non-Neoplasm With Cc","code_information":[{"code":"660","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10825.25,"maximum":28156.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":19448.82},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10825.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11041.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20807.52},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10825.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10825.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10933.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10825.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11150.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":28156.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":10825.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10825.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10825.25,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Ureter Procedures For Non-Neoplasm Without Cc/Mcc","code_information":[{"code":"661","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8841.23,"maximum":22996.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":15235.91},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8841.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9018.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16300.3},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8841.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8841.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8929.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8841.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9106.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":22996.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":8841.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8841.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8841.23,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8765.97,"10th_percentile":8765.97,"90th_percentile":8765.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Minor Bladder Procedures With Mcc","code_information":[{"code":"662","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":22881.83,"maximum":59515.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":45049.97},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22881.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23339.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":48197.19},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22881.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22881.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23110.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22881.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23568.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":59515.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":22881.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22881.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22881.83,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Minor Bladder Procedures With Cc","code_information":[{"code":"663","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12200.83,"maximum":31734.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":22369.74},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12200.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12444.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23932.51},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12200.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12200.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12322.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12200.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12566.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":31734.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":12200.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12200.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12200.83,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Minor Bladder Procedures Without Cc/Mcc","code_information":[{"code":"664","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8920.92,"maximum":23203.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":15405.13},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8920.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9099.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16481.35},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8920.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8920.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9010.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8920.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9188.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":23203.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":8920.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8920.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8920.92,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Prostatectomy With Mcc","code_information":[{"code":"665","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23295.55,"maximum":60591.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":45928.46},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23295.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23761.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":49137.05},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23295.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23295.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23528.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23295.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23994.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":60591.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":23295.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23295.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23295.55,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Prostatectomy With Cc","code_information":[{"code":"666","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13788.46,"maximum":35863.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":25740.95},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13788.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14064.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27539.23},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13788.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13788.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13926.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13788.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14202.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":35863.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":13788.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13788.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13788.46,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Prostatectomy Without Cc/Mcc","code_information":[{"code":"667","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9331.86,"maximum":24272.17,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":16277.73},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9331.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9518.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17414.91},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9331.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9331.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9425.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9331.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9611.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":24272.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":9331.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9331.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9331.86,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Transurethral Procedures With Mcc","code_information":[{"code":"668","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21901.26,"maximum":56965.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":42967.8},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21901.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22339.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":45969.56},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21901.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21901.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22120.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21901.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22558.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":56965.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":21901.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21901.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21901.26,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Transurethral Procedures With Cc","code_information":[{"code":"669","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12421.2,"maximum":32307.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":22837.68},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12421.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12669.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24433.14},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12421.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12421.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12545.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12421.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12793.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":32307.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":12421.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12421.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12421.2,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12464.42,"10th_percentile":12464.42,"90th_percentile":12464.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Transurethral Procedures Without Cc/Mcc","code_information":[{"code":"670","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8438.6,"maximum":21948.80,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":14380.97},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8438.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8607.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15385.63},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8438.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8438.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8522.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8438.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8691.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":21948.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":8438.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8438.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8438.6,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Urethral Procedures With Cc/Mcc","code_information":[{"code":"671","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14105.15,"maximum":36687.50,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":26413.43},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14105.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14387.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28258.69},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14105.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14105.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14246.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14105.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14528.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":36687.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":14105.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14105.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14105.15,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Urethral Procedures Without Cc/Mcc","code_information":[{"code":"672","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9146.83,"maximum":23790.90,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":15884.84},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9146.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9329.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16994.57},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9146.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9146.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9238.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9146.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9421.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":23790.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":9146.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9146.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9146.83,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Kidney And Urinary Tract Procedures With Mcc","code_information":[{"code":"673","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":30782.57,"maximum":80065.46,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":61826.54},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30782.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31398.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":66145.79},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30782.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30782.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31090.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30782.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":31706.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":80065.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":30782.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30782.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30782.57,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Kidney And Urinary Tract Procedures With Cc","code_information":[{"code":"674","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17872.23,"maximum":46485.67,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":34412.5},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17872.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18229.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36816.58},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17872.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17872.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18050.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17872.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18408.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":46485.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":17872.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17872.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17872.23,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Kidney And Urinary Tract Procedures Without Cc/Mcc","code_information":[{"code":"675","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13040.73,"maximum":33918.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":24153.2},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13040.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13301.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25840.56},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13040.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13040.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13171.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13040.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13431.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":33918.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":13040.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13040.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13040.73,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Renal Failure With Mcc","code_information":[{"code":"682","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11929.18,"maximum":31027.80,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":21792.92},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11929.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12167.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23315.38},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11929.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11929.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12048.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11929.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12287.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":31027.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":11929.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11929.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11929.18,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"1 through 10","median_amount":11934.28,"10th_percentile":5252.92,"90th_percentile":11946.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Renal Failure With Cc","code_information":[{"code":"683","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7735.22,"maximum":20119.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":12887.4},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7735.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7889.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13787.72},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7735.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7735.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7812.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7735.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7967.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":20119.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":7735.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7735.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7735.22,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"1 through 10","median_amount":12298.55,"10th_percentile":12298.55,"90th_percentile":12298.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"1 through 10","median_amount":7740.9,"10th_percentile":7740.9,"90th_percentile":7740.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6999.45,"10th_percentile":6999.45,"90th_percentile":6999.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Renal Failure Without Cc/Mcc","code_information":[{"code":"684","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5826.04,"maximum":15153.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":8833.41},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5826.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5942.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9450.52},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5826.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5826.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5884.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5826.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6000.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":15153.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":5826.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5826.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5826.04,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"1 through 10","median_amount":8832.21,"10th_percentile":8832.21,"90th_percentile":8832.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Urinary Tract Neoplasms With Mcc","code_information":[{"code":"686","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14165.44,"maximum":36844.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":26541.45},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14165.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14448.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28395.65},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14165.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14165.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14307.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14165.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14590.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":36844.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":14165.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14165.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14165.44,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Urinary Tract Neoplasms With Cc","code_information":[{"code":"687","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8927.16,"maximum":23219.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":15418.38},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8927.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9105.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16495.52},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8927.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8927.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9016.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8927.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9194.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":23219.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":8927.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8927.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8927.16,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Urinary Tract Neoplasms Without Cc/Mcc","code_information":[{"code":"688","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7142.71,"maximum":18578.19,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":11629.26},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7142.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7285.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12441.69},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7142.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7142.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7214.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7142.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7356.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":18578.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":7142.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7142.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7142.71,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Urinary Tract Infections With Mcc","code_information":[{"code":"689","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9706.77,"maximum":25247.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":17073.81},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9706.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9900.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18266.6},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9706.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9706.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9803.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9706.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9997.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":25247.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":9706.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9706.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9706.77,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Urinary Tract Infections Without Mcc","code_information":[{"code":"690","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7275.77,"maximum":18924.28,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":11911.79},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7275.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7421.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12743.96},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7275.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7275.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7348.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7275.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7494.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":18924.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":7275.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7275.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7275.77,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"1 through 10","median_amount":7270.86,"10th_percentile":7270.86,"90th_percentile":7270.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7226.47,"10th_percentile":7226.47,"90th_percentile":7226.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Urinary Stones With Mcc","code_information":[{"code":"693","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10983.25,"maximum":28567.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":19784.32},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10983.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11202.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21166.46},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10983.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10983.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11093.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10983.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11312.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":28567.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":10983.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10983.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10983.25,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Urinary Stones Without Mcc","code_information":[{"code":"694","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7083.12,"maximum":18423.20,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":11502.72},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7083.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7224.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12306.3},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7083.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7083.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7153.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7083.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7295.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":18423.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":7083.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7083.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7083.12,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"1 through 10","median_amount":7096.2,"10th_percentile":7096.2,"90th_percentile":7096.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Urinary Tract Signs And Symptoms With Mcc","code_information":[{"code":"695","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9592.42,"maximum":24949.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":16831.02},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9592.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9784.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18006.84},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9592.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9592.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9688.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9592.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9880.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":24949.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":9592.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9592.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9592.42,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Urinary Tract Signs And Symptoms Without Mcc","code_information":[{"code":"696","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6440.72,"maximum":16752.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":10138.64},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6440.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6569.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10846.93},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6440.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6440.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6505.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6440.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6633.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":16752.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":6440.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6440.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6440.72,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Urethral Stricture","code_information":[{"code":"697","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9135.05,"maximum":23760.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":15859.83},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9135.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9317.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16967.81},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9135.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9135.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9226.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9135.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9409.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":23760.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":9135.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9135.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9135.05,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Kidney And Urinary Tract Diagnoses With Mcc","code_information":[{"code":"698","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13130.81,"maximum":34153.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":24344.5},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13130.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13393.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26045.22},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13130.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13130.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13262.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13130.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13524.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":34153.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":13130.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13130.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13130.81,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Kidney And Urinary Tract Diagnoses With Cc","code_information":[{"code":"699","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8699.86,"maximum":22628.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":14935.73},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8699.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8873.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15979.15},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8699.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8699.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8786.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8699.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8960.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":22628.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":8699.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8699.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8699.86,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Kidney And Urinary Tract Diagnoses Without Cc/Mcc","code_information":[{"code":"700","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6446.96,"maximum":16768.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":10151.88},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6446.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6575.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10861.1},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6446.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6446.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6511.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6446.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6640.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":16768.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":6446.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6446.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6446.96,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Male Pelvic Procedures With Cc/Mcc","code_information":[{"code":"707","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15527.86,"maximum":40387.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":29434.41},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15527.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15838.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31490.72},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15527.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15527.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15683.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15527.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15993.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":40387.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":15527.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15527.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15527.86,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Male Pelvic Procedures Without Cc/Mcc","code_information":[{"code":"708","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12297.84,"maximum":31986.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":22575.75},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12297.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12543.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24152.91},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12297.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12297.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12420.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12297.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12666.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":31986.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":12297.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12297.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12297.84,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Penis Procedures With Cc/Mcc","code_information":[{"code":"709","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17792.54,"maximum":46278.40,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":34243.28},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17792.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18148.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36635.54},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17792.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17792.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17970.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17792.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18326.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":46278.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":17792.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17792.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17792.54,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Penis Procedures Without Cc/Mcc","code_information":[{"code":"710","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11376.17,"maximum":29589.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":20618.66},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11376.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11603.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22059.09},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11376.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11376.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11489.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11376.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11717.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":29589.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":11376.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11376.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11376.17,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Testes Procedures With Cc/Mcc","code_information":[{"code":"711","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16106.5,"maximum":41893.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":30663.12},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16106.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16428.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32805.26},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16106.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16106.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16267.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16106.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16589.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":41893.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":16106.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16106.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16106.5,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Testes Procedures Without Cc/Mcc","code_information":[{"code":"712","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9286.82,"maximum":24155.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":16182.09},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9286.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9472.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17312.58},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9286.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9286.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9379.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9286.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9565.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":24155.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":9286.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9286.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9286.82,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Transurethral Prostatectomy With Cc/Mcc","code_information":[{"code":"713","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12084.4,"maximum":31431.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":22122.53},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12084.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12326.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23668.03},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12084.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12084.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12205.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12084.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12446.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":31431.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":12084.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12084.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12084.4,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Transurethral Prostatectomy Without Cc/Mcc","code_information":[{"code":"714","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8993.68,"maximum":23392.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":15559.64},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8993.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9173.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16646.65},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8993.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8993.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9083.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8993.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9263.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":23392.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":8993.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8993.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8993.68,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Male Reproductive System O.R. Procedures For Malignancy With Cc/Mcc","code_information":[{"code":"715","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17170.23,"maximum":44659.77,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":32921.87},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17170.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17513.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35221.81},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17170.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17170.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17341.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17170.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17685.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":44659.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":17170.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17170.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17170.23,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/Mcc","code_information":[{"code":"716","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11859.88,"maximum":30847.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":21645.77},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11859.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12097.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23157.95},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11859.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11859.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11978.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11859.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12215.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":30847.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":11859.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11859.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11859.88,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/Mcc","code_information":[{"code":"717","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14766.96,"maximum":38408.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":27818.71},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14766.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15062.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29762.14},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14766.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14766.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14914.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14766.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15209.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":38408.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":14766.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14766.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14766.96,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/Mcc","code_information":[{"code":"718","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10973.55,"maximum":28542.20,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":19763.72},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10973.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11193.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21144.42},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10973.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10973.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11083.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10973.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11302.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":28542.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":10973.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10973.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10973.55,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":6865.92,"10th_percentile":6865.92,"90th_percentile":6865.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy, Male Reproductive System With Mcc","code_information":[{"code":"722","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14207.02,"maximum":36952.46,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":26629.74},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14207.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14491.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28490.11},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14207.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14207.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14349.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14207.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14633.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":36952.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":14207.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14207.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14207.02,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy, Male Reproductive System With Cc","code_information":[{"code":"723","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9584.8,"maximum":24930.06,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":16814.83},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9584.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9776.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17989.53},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9584.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9584.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9680.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9584.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9872.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":24930.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":9584.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9584.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9584.8,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy, Male Reproductive System Without Cc/Mcc","code_information":[{"code":"724","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6209.95,"maximum":16152.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":9648.63},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6209.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6334.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10322.69},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6209.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6209.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6272.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6209.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6396.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":16152.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":6209.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6209.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6209.95,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Benign Prostatic Hypertrophy With Mcc","code_information":[{"code":"725","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9775.37,"maximum":25425.74,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":17219.49},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9775.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9970.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18422.46},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9775.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9775.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9873.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9775.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10068.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":25425.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":9775.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9775.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9775.37,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Benign Prostatic Hypertrophy Without Mcc","code_information":[{"code":"726","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6669.4,"maximum":17347.11,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":10624.23},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6669.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6802.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11366.45},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6669.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6669.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6736.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6669.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6869.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17347.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":6669.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6669.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6669.4,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inflammation Of The Male Reproductive System With Mcc","code_information":[{"code":"727","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11942.34,"maximum":31062.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":21820.87},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11942.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12181.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23345.29},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11942.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11942.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12061.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11942.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12300.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":31062.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":11942.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11942.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11942.34,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inflammation Of The Male Reproductive System Without Mcc","code_information":[{"code":"728","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7287.55,"maximum":18954.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":11936.81},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7287.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7433.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12770.72},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7287.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7287.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7360.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7287.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7506.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":18954.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":7287.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7287.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7287.55,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Male Reproductive System Diagnoses With Cc/Mcc","code_information":[{"code":"729","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9002.69,"maximum":23416.00,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":15578.77},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9002.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9182.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16667.11},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9002.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9002.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9092.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9002.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9272.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":23416.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":9002.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9002.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9002.69,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Male Reproductive System Diagnoses Without Cc/Mcc","code_information":[{"code":"730","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6322.91,"maximum":16445.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":9888.48},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6322.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6449.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10579.3},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6322.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6322.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6386.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6322.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6512.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":16445.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":6322.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6322.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6322.91,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/Mcc","code_information":[{"code":"734","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16426.66,"maximum":42725.74,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":31342.95},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16426.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16755.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33532.59},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16426.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16426.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16590.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16426.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16919.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":42725.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":16426.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16426.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16426.66,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/Mcc","code_information":[{"code":"735","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10990.18,"maximum":28585.46,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":19799.03},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10990.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11209.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21182.21},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10990.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10990.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11100.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10990.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11319.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":28585.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":10990.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10990.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10990.18,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Mcc","code_information":[{"code":"736","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":26436.85,"maximum":68762.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":52598.77},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26436.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26965.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":56273.35},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26436.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26436.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26701.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26436.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27229.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":68762.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":26436.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26436.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26436.85,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc","code_information":[{"code":"737","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15945.73,"maximum":41474.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":30321.73},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15945.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16264.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32440.03},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15945.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15945.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16105.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15945.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16424.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":41474.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":15945.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15945.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15945.73,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"1 through 10","median_amount":15999.37,"10th_percentile":15999.37,"90th_percentile":15999.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/Mcc","code_information":[{"code":"738","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11842.55,"maximum":30802.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":21608.98},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11842.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12079.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23118.6},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11842.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11842.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11960.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11842.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12197.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":30802.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":11842.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11842.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11842.55,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Mcc","code_information":[{"code":"739","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":26494.37,"maximum":68911.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":52720.9},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26494.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27024.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":56404.02},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26494.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26494.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26759.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26494.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27289.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":68911.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":26494.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26494.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26494.37,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc","code_information":[{"code":"740","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14206.33,"maximum":36950.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":26628.26},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14206.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14490.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28488.53},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14206.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14206.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14348.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14206.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14632.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":36950.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":14206.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14206.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14206.33,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/Mcc","code_information":[{"code":"741","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11548.73,"maximum":30038.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":20985.06},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11548.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11779.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22451.09},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11548.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11548.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11664.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11548.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11895.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":30038.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":11548.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11548.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11548.73,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uterine And Adnexa Procedures For Non-Malignancy With Cc/Mcc","code_information":[{"code":"742","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14380.96,"maximum":37404.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":26999.08},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14380.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14668.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28885.26},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14380.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14380.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14524.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14380.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14812.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":37404.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":14380.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14380.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14380.96,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uterine And Adnexa Procedures For Non-Malignancy Without Cc/Mcc","code_information":[{"code":"743","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10263.93,"maximum":26696.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":18256.9},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10263.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10469.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19532.34},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10263.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10263.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10366.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10263.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10571.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":26696.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":10263.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10263.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10263.93,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"1 through 10","median_amount":10274.64,"10th_percentile":10274.64,"90th_percentile":10274.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"D&C, Conization, Laparoscopy And Tubal Interruption With Cc/Mcc","code_information":[{"code":"744","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15866.03,"maximum":41267.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":30152.51},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15866.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16183.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32258.98},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15866.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15866.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16024.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15866.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16342.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":41267.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":15866.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15866.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15866.03,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/Mcc","code_information":[{"code":"745","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9548.77,"maximum":24836.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":16738.31},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9548.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9739.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17907.66},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9548.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9548.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9644.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9548.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9835.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":24836.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":9548.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9548.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9548.77,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vagina, Cervix And Vulva Procedures With Cc/Mcc","code_information":[{"code":"746","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13703.91,"maximum":35643.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":25561.43},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13703.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13977.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27347.17},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13703.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13703.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13840.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13703.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14115.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":35643.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":13703.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13703.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13703.91,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"1 through 10","median_amount":13720.81,"10th_percentile":13720.81,"90th_percentile":13720.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vagina, Cervix And Vulva Procedures Without Cc/Mcc","code_information":[{"code":"747","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7623.65,"maximum":19829.11,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":12650.49},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7623.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7776.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13534.26},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7623.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7623.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7699.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7623.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7852.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":19829.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":7623.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7623.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7623.65,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Female Reproductive System Reconstructive Procedures","code_information":[{"code":"748","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11279.85,"maximum":29338.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":20414.12},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11279.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11505.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21840.26},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11279.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11279.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11392.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11279.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11618.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":29338.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":11279.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11279.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11279.85,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Female Reproductive System O.R. Procedures With Cc/Mcc","code_information":[{"code":"749","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19459.17,"maximum":50613.30,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":37782.23},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19459.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19848.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":40421.73},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19459.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19459.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19653.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19459.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20042.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":50613.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":19459.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19459.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19459.17,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Female Reproductive System O.R. Procedures Without Cc/Mcc","code_information":[{"code":"750","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11893.14,"maximum":30934.06,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":21716.4},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11893.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12131.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23233.52},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11893.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11893.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12012.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11893.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12249.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":30934.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":11893.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11893.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11893.14,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy, Female Reproductive System With Mcc","code_information":[{"code":"754","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14428.78,"maximum":37529.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":27100.62},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14428.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14717.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28993.88},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14428.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14428.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14573.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14428.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14861.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":37529.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":14428.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14428.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14428.78,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy, Female Reproductive System With Cc","code_information":[{"code":"755","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9204.35,"maximum":23940.51,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":16006.98},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9204.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9388.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17125.24},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9204.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9204.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9296.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9204.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9480.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":23940.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":9204.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9204.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9204.35,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy, Female Reproductive System Without Cc/Mcc","code_information":[{"code":"756","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8322.18,"maximum":21645.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":14133.76},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8322.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8488.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15121.15},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8322.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8322.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8405.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8322.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8571.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":21645.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":8322.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8322.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8322.18,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Infections, Female Reproductive System With Mcc","code_information":[{"code":"757","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11588.92,"maximum":30142.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":21070.41},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11588.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11820.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22542.4},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11588.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11588.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11704.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11588.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11936.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":30142.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":11588.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11588.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11588.92,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Infections, Female Reproductive System With Cc","code_information":[{"code":"758","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8450.38,"maximum":21979.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":14405.99},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8450.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8619.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15412.4},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8450.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8450.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8534.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8450.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8703.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":21979.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":8450.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8450.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8450.38,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Infections, Female Reproductive System Without Cc/Mcc","code_information":[{"code":"759","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6264.7,"maximum":16294.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":9764.87},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6264.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6389.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10447.05},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6264.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6264.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6327.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6264.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6452.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":16294.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":6264.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6264.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6264.7,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Menstrual And Other Female Reproductive System Disorders With Cc/Mcc","code_information":[{"code":"760","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8647.88,"maximum":22493.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":14825.36},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8647.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8820.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15861.07},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8647.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8647.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8734.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8647.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8907.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":22493.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":8647.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8647.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8647.88,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/Mcc","code_information":[{"code":"804","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11062.94,"maximum":28774.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":19953.54},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11062.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11284.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21347.51},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11062.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11062.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11173.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11062.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11394.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":28774.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":11062.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11062.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11062.94,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery Without Sterilization Or D&C With Mcc","code_information":[{"code":"805","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9144.75,"maximum":23785.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":15880.43},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9144.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9327.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16989.85},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9144.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9144.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9236.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9144.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9419.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":23785.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":9144.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9144.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9144.75,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":6753.61,"10th_percentile":6753.61,"90th_percentile":6753.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery Without Sterilization Or D&C With Cc","code_information":[{"code":"806","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6891.16,"maximum":17923.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":11095.11},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6891.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7028.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11870.22},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6891.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6891.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6960.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6891.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7097.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17923.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":6891.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6891.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6891.16,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"1 through 10","median_amount":9827.54,"10th_percentile":9827.54,"90th_percentile":13331.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":5888.19,"10th_percentile":5888.19,"90th_percentile":5888.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"1 through 10","median_amount":6957.0,"10th_percentile":6957.0,"90th_percentile":6957.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":5888.19,"10th_percentile":5888.19,"90th_percentile":5888.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery Without Sterilization Or D&C Without Cc/Mcc","code_information":[{"code":"807","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6338.16,"maximum":16485.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":9920.85},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6338.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6464.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10613.93},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6338.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6338.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6401.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6338.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6528.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":16485.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":6338.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6338.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6338.16,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"1 through 10","median_amount":9920.85,"10th_percentile":7947.64,"90th_percentile":10524.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":5422.76,"10th_percentile":5422.76,"90th_percentile":5422.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"1 through 10","median_amount":6957.0,"10th_percentile":6957.0,"90th_percentile":18076.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"1 through 10","median_amount":8941.5,"10th_percentile":8941.5,"90th_percentile":8941.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":5422.76,"10th_percentile":5422.76,"90th_percentile":6056.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"1 through 10","median_amount":9255.16,"10th_percentile":9255.16,"90th_percentile":9255.16},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":5422.76,"10th_percentile":5422.76,"90th_percentile":5422.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ","code_information":[{"code":"808","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16966.5,"maximum":44129.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":32489.25},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16966.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17305.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34758.97},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16966.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16966.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17136.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16966.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17475.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":44129.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":16966.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16966.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16966.5,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ","code_information":[{"code":"809","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10438.56,"maximum":27150.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":18627.72},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10438.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10647.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19929.06},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10438.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10438.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10542.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10438.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10751.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":27150.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":10438.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10438.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10438.56,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":10786.54,"10th_percentile":10786.54,"90th_percentile":10786.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ","code_information":[{"code":"810","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8918.84,"maximum":23197.90,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":15400.72},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8918.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9097.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16476.62},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8918.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8918.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9008.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8918.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9186.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":23197.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":8918.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8918.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8918.84,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Red Blood Cell Disorders With Mcc","code_information":[{"code":"811","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11397.65,"maximum":29645.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":20664.27},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11397.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11625.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22107.89},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11397.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11397.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11511.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11397.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11739.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":29645.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":11397.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11397.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11397.65,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Red Blood Cell Disorders Without Mcc","code_information":[{"code":"812","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8029.05,"maximum":20883.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":13511.31},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8029.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8189.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14455.22},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8029.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8029.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8109.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8029.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8269.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":20883.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":8029.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8029.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8029.05,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8073.66,"10th_percentile":8073.66,"90th_percentile":8073.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coagulation Disorders","code_information":[{"code":"813","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12236.17,"maximum":31826.28,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":22444.79},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12236.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12480.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24012.8},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12236.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12236.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12358.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12236.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12603.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":31826.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":12236.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12236.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12236.17,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Reticuloendothelial And Immunity Disorders With Mcc","code_information":[{"code":"814","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16403.79,"maximum":42666.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":31294.39},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16403.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16731.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33480.64},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16403.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16403.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16567.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16403.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16895.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":42666.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":16403.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16403.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16403.79,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Reticuloendothelial And Immunity Disorders With Cc","code_information":[{"code":"815","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8692.93,"maximum":22610.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":14921.01},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8692.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8866.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15963.4},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8692.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8692.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8779.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8692.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8953.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":22610.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":8692.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8692.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8692.93,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Reticuloendothelial And Immunity Disorders Without Cc/Mcc","code_information":[{"code":"816","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6045.72,"maximum":15724.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":9299.88},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6045.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6166.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9949.58},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6045.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6045.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6106.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6045.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6227.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":15724.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":6045.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6045.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6045.72,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Antepartum Diagnoses With O.R. Procedures With Mcc","code_information":[{"code":"817","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17477.23,"maximum":45458.28,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":33573.74},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17477.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17826.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35919.23},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17477.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17477.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17652.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17477.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18001.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":45458.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":17477.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17477.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17477.23,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Antepartum Diagnoses With O.R. Procedures With Cc","code_information":[{"code":"818","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9699.14,"maximum":25227.46,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":17057.63},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9699.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9893.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18249.29},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9699.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9699.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9796.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9699.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9990.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":25227.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":9699.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9699.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9699.14,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Antepartum Diagnoses With O.R. Procedures Without Cc/Mcc","code_information":[{"code":"819","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7625.03,"maximum":19832.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":12653.43},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7625.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7777.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13537.41},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7625.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7625.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7701.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7625.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7853.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":19832.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":7625.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7625.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7625.03,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma And Leukemia With Major O.R. Procedures With Mcc","code_information":[{"code":"820","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":42308.33,"maximum":110043.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":86300.53},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":42308.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":43154.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":92329.55},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":42308.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42308.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":42731.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42308.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":43577.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":110043.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":42308.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":42308.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":42308.33,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma And Leukemia With Major O.R. Procedures With Cc","code_information":[{"code":"821","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17179.24,"maximum":44683.20,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":32941.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17179.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17522.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35242.28},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17179.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17179.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17351.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17179.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17694.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":44683.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":17179.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17179.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17179.24,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma And Leukemia With Major O.R. Procedures Without Cc/Mcc","code_information":[{"code":"822","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10009.6,"maximum":26034.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":17716.86},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10009.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10209.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18954.57},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10009.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10009.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10109.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10009.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10309.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":26034.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":10009.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10009.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10009.6,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma And Non-Acute Leukemia With Other Procedures With Mcc","code_information":[{"code":"823","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":33438.1,"maximum":86972.50,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":67465.33},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":33438.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34106.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":72178.51},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33438.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33438.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33772.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33438.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":34441.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":86972.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":33438.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33438.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":33438.1,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma And Non-Acute Leukemia With Other Procedures With Cc","code_information":[{"code":"824","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17366.35,"maximum":45169.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":33338.3},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17366.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17713.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35667.34},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17366.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17366.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17540.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17366.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17887.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":45169.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":17366.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17366.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17366.35,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/Mcc","code_information":[{"code":"825","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11017.2,"maximum":28655.74,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":19856.42},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11017.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11237.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21243.6},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11017.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11017.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11127.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11017.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11347.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":28655.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":11017.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11017.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11017.2,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Mcc","code_information":[{"code":"826","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":34082.58,"maximum":88648.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":68833.83},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":34082.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34764.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":73642.61},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34082.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34082.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34423.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34082.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35105.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":88648.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":34082.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34082.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":34082.58,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc","code_information":[{"code":"827","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17682.35,"maximum":45991.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":34009.31},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17682.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18036.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36385.22},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17682.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17682.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17859.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17682.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18212.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":45991.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":17682.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17682.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17682.35,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Splenic Procedures Without Cc/Mcc","code_information":[{"code":"801","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14894.47,"maximum":38740.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":28089.46},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14894.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15192.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30051.81},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14894.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14894.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15043.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14894.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15341.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":38740.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":14894.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14894.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14894.47,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other O.R. Procedures Of The Blood And Blood Forming Organs With Mcc","code_information":[{"code":"802","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":29275.33,"maximum":76145.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":58626.03},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29275.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29860.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":62721.69},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29275.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29275.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29568.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29275.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30153.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":76145.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":29275.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29275.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29275.33,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc","code_information":[{"code":"803","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14547.97,"maximum":37839.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":27353.71},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14547.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14838.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29264.66},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14547.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14547.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14693.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14547.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14984.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":37839.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":14547.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14547.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14547.97,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without C","code_information":[{"code":"828","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13473.15,"maximum":35043.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":25071.42},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13473.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13742.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26822.92},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13473.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13473.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13607.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13473.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13877.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":35043.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":13473.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13473.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13473.15,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/Mcc","code_information":[{"code":"829","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23564.42,"maximum":61291.06,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":46499.4},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23564.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24035.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":49747.88},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23564.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23564.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23800.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23564.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24271.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":61291.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":23564.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23564.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23564.42,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/Mcc","code_information":[{"code":"830","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12095.49,"maximum":31460.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":22146.08},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12095.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12337.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23693.22},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12095.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12095.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12216.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12095.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12458.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":31460.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":12095.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12095.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12095.49,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Antepartum Diagnoses Without O.R. Procedures With Mcc","code_information":[{"code":"831","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9999.21,"maximum":26007.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":17694.79},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9999.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10199.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18930.96},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9999.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9999.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10099.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9999.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10299.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":26007.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":9999.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9999.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9999.21,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Antepartum Diagnoses Without O.R. Procedures With Cc","code_information":[{"code":"832","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6666.63,"maximum":17339.90,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":10618.34},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6666.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6799.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11360.15},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6666.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6666.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6733.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6666.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6866.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17339.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":6666.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6666.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6666.63,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Antepartum Diagnoses Without O.R. Procedures Without Cc/Mcc","code_information":[{"code":"833","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5289.67,"maximum":13758.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":7694.47},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5289.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5395.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8232.01},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5289.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5289.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5342.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5289.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5448.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":13758.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":5289.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5289.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5289.67,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"1 through 10","median_amount":323.11,"10th_percentile":323.11,"90th_percentile":323.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":4464.43,"10th_percentile":4464.43,"90th_percentile":4464.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Leukemia With Mcc","code_information":[{"code":"834","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":39710.32,"maximum":103286.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":80783.88},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":39710.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":40504.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":86427.5},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39710.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39710.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":40107.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39710.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":40901.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":103286.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":39710.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39710.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":39710.32,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Leukemia With Cc","code_information":[{"code":"835","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16120.36,"maximum":41929.06,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":30692.55},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16120.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16442.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32836.75},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16120.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16120.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16281.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16120.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16603.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":41929.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":16120.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16120.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16120.36,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Leukemia Without Cc/Mcc","code_information":[{"code":"836","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10117.01,"maximum":26314.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":17944.94},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10117.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10319.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19198.59},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10117.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10117.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10218.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10117.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10420.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":26314.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":10117.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10117.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10117.01,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chemotherapy With Acute Leukemia As Secondary Diagnosis Or With High Dose Chemotherapy Agent With Mc","code_information":[{"code":"837","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":34959.21,"maximum":90928.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":70695.27},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":34959.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35658.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":75634.09},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34959.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34959.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35308.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34959.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36007.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":90928.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":34959.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34959.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":34959.21,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chemotherapy With Acute Leukemia As Secondary Diagnosis With Cc Or High Dose Chemotherapy Agent","code_information":[{"code":"838","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16131.45,"maximum":41957.90,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":30716.09},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16131.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16454.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32861.94},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16131.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16131.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16292.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16131.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16615.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":41957.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":16131.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16131.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16131.45,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chemotherapy With Acute Leukemia As Secondary Diagnosis Without Cc/Mcc","code_information":[{"code":"839","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11672.08,"maximum":30359.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":21246.99},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11672.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11905.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22731.32},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11672.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11672.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11788.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11672.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12022.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":30359.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":11672.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11672.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11672.08,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma And Non-Acute Leukemia With Mcc","code_information":[{"code":"840","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24083.47,"maximum":62641.11,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":47601.55},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24083.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24565.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":50927.03},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24083.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24083.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24324.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24083.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24805.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":62641.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":24083.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24083.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24083.47,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma And Non-Acute Leukemia With Cc","code_information":[{"code":"841","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12971.43,"maximum":33738.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":24006.05},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12971.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13230.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25683.13},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12971.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12971.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13101.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12971.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13360.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":33738.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":12971.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12971.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12971.43,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma And Non-Acute Leukemia Without Cc/Mcc","code_information":[{"code":"842","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8667.98,"maximum":22545.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":14868.04},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8667.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8841.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15906.73},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8667.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8667.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8754.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8667.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8928.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":22545.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":8667.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8667.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8667.98,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Mcc","code_information":[{"code":"843","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15489.74,"maximum":40288.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":29353.48},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15489.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15799.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31404.14},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15489.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15489.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15644.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15489.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15954.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":40288.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":15489.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15489.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15489.74,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Cc","code_information":[{"code":"844","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10102.46,"maximum":26276.50,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":17914.04},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10102.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10304.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19165.53},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10102.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10102.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10203.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10102.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10405.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":26276.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":10102.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10102.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10102.46,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses Without Cc/Mcc","code_information":[{"code":"845","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7567.52,"maximum":19683.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":12531.29},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7567.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7718.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13406.74},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7567.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7567.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7643.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7567.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7794.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":19683.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":7567.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7567.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7567.52,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Mcc","code_information":[{"code":"846","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19631.72,"maximum":51062.10,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":38148.64},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19631.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20024.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":40813.73},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19631.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19631.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19828.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19631.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20220.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":51062.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":19631.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19631.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19631.72,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc","code_information":[{"code":"847","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10731.69,"maximum":27913.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":19250.16},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10731.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10946.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20594.99},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10731.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10731.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10839.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10731.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11053.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":27913.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":10731.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10731.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10731.69,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/Mcc","code_information":[{"code":"848","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7552.27,"maximum":19643.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":12498.92},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7552.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7703.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13372.1},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7552.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7552.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7627.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7552.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7778.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":19643.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":7552.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7552.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7552.27,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Radiotherapy","code_information":[{"code":"849","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20442.52,"maximum":53170.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":39870.29},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20442.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20851.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":42655.66},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20442.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20442.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20646.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20442.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21055.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":53170.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":20442.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20442.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20442.52,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Leukemia With Other Procedures","code_information":[{"code":"850","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":61675.24,"maximum":160417.30,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":127424.54},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":61675.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":62908.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":136326.51},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":61675.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":61675.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":62291.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":61675.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":63525.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":160417.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":61675.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":61675.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":61675.24,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Infectious And Parasitic Diseases With O.R. Procedures With Mcc","code_information":[{"code":"853","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":35889.89,"maximum":93349.60,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":72671.5},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35889.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36607.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":77748.38},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35889.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35889.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36248.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35889.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36966.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":93349.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":35889.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35889.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35889.89,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"1 through 10","median_amount":33742.86,"10th_percentile":33742.86,"90th_percentile":33742.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Infectious And Parasitic Diseases With O.R. Procedures With Cc","code_information":[{"code":"854","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15512.61,"maximum":40348.30,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":29402.04},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15512.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15822.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31456.09},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15512.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15512.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15667.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15512.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15977.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":40348.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":15512.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15512.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15512.61,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"1 through 10","median_amount":28712.33,"10th_percentile":28712.33,"90th_percentile":28712.33},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Infectious And Parasitic Diseases With O.R. Procedures Without Cc/Mcc","code_information":[{"code":"855","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12041.44,"maximum":31319.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":22031.3},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12041.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12282.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23570.42},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12041.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12041.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12161.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12041.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12402.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":31319.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":12041.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12041.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12041.44,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Postoperative Or Post-Traumatic Infections With O.R. Procedures With Mcc","code_information":[{"code":"856","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":33187.93,"maximum":86321.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":66934.12},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":33187.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33851.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":71610.18},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33187.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33187.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33519.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33187.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":34183.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":86321.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":33187.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33187.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":33187.93,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc","code_information":[{"code":"857","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16506.35,"maximum":42933.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":31512.17},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16506.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16836.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33713.63},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16506.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16506.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16671.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16506.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17001.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":42933.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":16506.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16506.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16506.35,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/Mcc","code_information":[{"code":"858","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11318.65,"maximum":29439.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":20496.52},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11318.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11545.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21928.42},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11318.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11318.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11431.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11318.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11658.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":29439.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":11318.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11318.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11318.65,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Postoperative And Post-Traumatic Infections With Mcc","code_information":[{"code":"862","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14304.04,"maximum":37204.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":26835.75},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14304.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14590.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28710.51},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14304.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14304.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14447.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14304.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14733.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":37204.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":14304.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14304.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14304.04,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Postoperative And Post-Traumatic Infections Without Mcc","code_information":[{"code":"863","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8581.36,"maximum":22320.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":14684.1},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8581.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8752.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15709.94},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8581.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8581.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8667.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8581.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8838.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":22320.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":8581.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8581.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8581.36,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Fever And Inflammatory Conditions","code_information":[{"code":"864","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7817.68,"maximum":20333.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":13062.51},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7817.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7974.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13975.06},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7817.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7817.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7895.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7817.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8052.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":20333.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":7817.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7817.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7817.68,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Viral Illness With Mcc","code_information":[{"code":"865","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12049.06,"maximum":31339.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":22047.48},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12049.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12290.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23587.74},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12049.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12049.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12169.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12049.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12410.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":31339.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":12049.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12049.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12049.06,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Viral Illness Without Mcc","code_information":[{"code":"866","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7692.25,"maximum":20007.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":12796.16},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7692.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7846.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13690.11},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7692.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7692.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7769.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7692.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7923.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":20007.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":7692.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7692.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7692.25,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Infectious And Parasitic Diseases Diagnoses With Mcc","code_information":[{"code":"867","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16171.64,"maximum":42062.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":30801.44},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16171.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16495.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32953.25},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16171.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16171.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16333.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16171.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16656.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":42062.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":16171.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16171.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16171.64,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Infectious And Parasitic Diseases Diagnoses With Cc","code_information":[{"code":"868","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8811.43,"maximum":22918.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":15172.64},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8811.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8987.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16232.61},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8811.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8811.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8899.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8811.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9075.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":22918.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":8811.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8811.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8811.43,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Infectious And Parasitic Diseases Diagnoses Without Cc/Mcc","code_information":[{"code":"869","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6722.76,"maximum":17485.90,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":10737.54},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6722.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6857.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11487.67},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6722.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6722.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6789.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6722.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6924.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17485.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":6722.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6722.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6722.76,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Septicemia Or Severe Sepsis With Mv >96 Hours","code_information":[{"code":"870","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":49563.9,"maximum":128915.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":101707.14},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":49563.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":50555.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":108812.47},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":49563.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49563.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":50059.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49563.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":51050.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":128915.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":49563.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":49563.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":49563.9,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc","code_information":[{"code":"871","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15127.31,"maximum":39346.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":28583.89},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15127.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15429.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30580.78},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15127.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15127.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15278.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15127.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15581.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":39346.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":15127.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15127.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15127.31,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":16501.81,"10th_percentile":16501.81,"90th_percentile":16501.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"1 through 10","median_amount":28580.0,"10th_percentile":28580.0,"90th_percentile":28580.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14332.8,"10th_percentile":14332.8,"90th_percentile":14332.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"1 through 10","median_amount":10801.22,"10th_percentile":10352.52,"90th_percentile":15178.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":16501.81,"10th_percentile":16501.81,"90th_percentile":16501.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14989.41,"10th_percentile":14989.41,"90th_percentile":14989.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":16501.81,"10th_percentile":16501.81,"90th_percentile":16501.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8018.48,"10th_percentile":8018.48,"90th_percentile":8018.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Septicemia Or Severe Sepsis Without Mv >96 Hours Without Mcc","code_information":[{"code":"872","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8757.37,"maximum":22777.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":15057.86},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8757.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8932.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16109.81},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8757.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8757.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8844.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8757.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9020.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":22777.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":8757.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8757.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8757.37,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"1 through 10","median_amount":337.0,"10th_percentile":337.0,"90th_percentile":337.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":8308.28,"10th_percentile":8308.28,"90th_percentile":8308.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"1 through 10","median_amount":14586.13,"10th_percentile":14586.13,"90th_percentile":14586.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"1 through 10","median_amount":7935.88,"10th_percentile":7935.88,"90th_percentile":7935.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8668.97,"10th_percentile":8668.97,"90th_percentile":8668.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"O.R. Procedures With Principal Diagnosis Of Mental Illness","code_information":[{"code":"876","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":28449.29,"maximum":73996.60,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":56872.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28449.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29018.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":60845.12},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28449.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28449.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28733.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28449.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29302.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":73996.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":28449.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28449.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28449.29,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Adjustment Reaction And Psychosocial Dysfunction","code_information":[{"code":"880","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8320.1,"maximum":21640.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":14129.34},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8320.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8486.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15116.43},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8320.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8320.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8403.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8320.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8569.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":21640.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":8320.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8320.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8320.1,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Depressive Neuroses","code_information":[{"code":"881","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8186.35,"maximum":21292.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":13845.34},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8186.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8350.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14812.59},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8186.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8186.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8268.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8186.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8431.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":21292.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":8186.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8186.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8186.35,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":5698.91,"10th_percentile":5698.91,"90th_percentile":5698.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":4119.9,"10th_percentile":4119.9,"90th_percentile":4119.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"1 through 10","median_amount":13552.0,"10th_percentile":13552.0,"90th_percentile":13552.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"1 through 10","median_amount":8136.0,"10th_percentile":8136.0,"90th_percentile":8136.0},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":3295.92,"10th_percentile":2471.94,"90th_percentile":8239.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Neuroses Except Depressive","code_information":[{"code":"882","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9107.33,"maximum":23688.17,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":15800.97},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9107.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9289.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16904.83},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9107.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9107.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9198.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9107.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9380.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":23688.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":9107.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9107.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9107.33,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of Personality And Impulse Control","code_information":[{"code":"883","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15292.24,"maximum":39775.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":28934.1},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15292.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15598.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30955.46},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15292.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15292.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15445.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15292.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15751.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":39775.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":15292.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15292.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15292.24,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":27191.34,"10th_percentile":27191.34,"90th_percentile":27191.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Organic Disturbances And Intellectual Disability","code_information":[{"code":"884","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12815.51,"maximum":33333.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":23674.96},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12815.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13071.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25328.91},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12815.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12815.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12943.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12815.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13199.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":33333.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":12815.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12815.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12815.51,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12725.56,"10th_percentile":12725.56,"90th_percentile":12725.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Psychoses","code_information":[{"code":"885","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11345.68,"maximum":29510.11,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":20553.91},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11345.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11572.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21989.82},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11345.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11345.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11459.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11345.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11686.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":29510.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":11345.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11345.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11345.68,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"1 through 10","median_amount":4855.0,"10th_percentile":4855.0,"90th_percentile":4855.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10877.29,"10th_percentile":8671.31,"90th_percentile":14719.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":3295.92,"10th_percentile":3295.92,"90th_percentile":3295.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"1 through 10","median_amount":5808.0,"10th_percentile":1936.0,"90th_percentile":13552.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10208.14,"10th_percentile":10208.14,"90th_percentile":10208.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"1 through 10","median_amount":11798.99,"10th_percentile":11798.99,"90th_percentile":11988.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":4119.9,"10th_percentile":3295.92,"90th_percentile":10711.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"22","median_amount":5767.86,"10th_percentile":3582.52,"90th_percentile":15225.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Behavioral And Developmental Disorders","code_information":[{"code":"886","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16047.6,"maximum":41739.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":30538.04},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16047.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16368.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32671.45},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16047.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16047.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16208.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16047.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16529.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":41739.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":16047.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16047.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16047.6,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Mental Disorder Diagnoses","code_information":[{"code":"887","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9087.24,"maximum":23635.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":15758.29},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9087.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9268.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16859.18},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9087.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9087.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9178.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9087.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9359.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":23635.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":9087.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9087.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9087.24,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Alcohol, Drug Abuse Or Dependence, Left Ama","code_information":[{"code":"894","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5941.08,"maximum":15452.75,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":9077.68},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5941.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6059.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9711.86},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5941.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5941.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6000.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5941.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6119.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":15452.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":5941.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5941.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5941.08,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Alcohol, Drug Abuse Or Dependence With Rehabilitation Therapy","code_information":[{"code":"895","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11475.96,"maximum":29848.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":20830.55},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11475.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11705.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22285.79},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11475.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11475.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11590.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11475.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11820.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":29848.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":11475.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11475.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11475.96,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With Mcc","code_information":[{"code":"896","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13759.35,"maximum":35788.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":25679.15},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13759.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14034.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27473.11},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13759.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13759.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13896.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13759.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14172.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":35788.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":13759.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13759.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13759.35,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":1647.96,"10th_percentile":1647.96,"90th_percentile":1647.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without Mcc","code_information":[{"code":"897","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7783.73,"maximum":20245.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":12990.4},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7783.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7939.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13897.92},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7783.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7783.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7861.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7783.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8017.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":20245.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":7783.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7783.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7783.73,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"1 through 10","median_amount":11616.0,"10th_percentile":11616.0,"90th_percentile":11616.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":3295.92,"10th_percentile":3295.92,"90th_percentile":14831.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Wound Debridements For Injuries With Mcc","code_information":[{"code":"901","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":30747.93,"maximum":79975.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":61752.97},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30747.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31362.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":66067.07},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30747.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30747.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31055.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30747.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":31670.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":79975.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":30747.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30747.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30747.93,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Wound Debridements For Injuries With Cc","code_information":[{"code":"902","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14933.27,"maximum":38841.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":28171.87},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14933.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15231.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30139.97},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14933.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14933.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15082.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14933.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15381.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":38841.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":14933.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14933.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14933.27,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Wound Debridements For Injuries Without Cc/Mcc","code_information":[{"code":"903","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9771.21,"maximum":25414.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":17210.66},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9771.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9966.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18413.01},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9771.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9771.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9868.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9771.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10064.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":25414.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":9771.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9771.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9771.21,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Grafts For Injuries With Cc/Mcc","code_information":[{"code":"904","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":27120.14,"maximum":70539.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":54049.67},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27120.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27662.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":57825.61},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27120.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27120.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27391.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27120.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27933.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":70539.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":27120.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27120.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27120.14,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Grafts For Injuries Without Cc/Mcc","code_information":[{"code":"905","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11945.81,"maximum":31071.05,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":21828.23},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11945.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12184.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23353.17},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11945.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11945.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12065.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11945.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12304.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":31071.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":11945.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11945.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11945.81,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hand Procedures For Injuries","code_information":[{"code":"906","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15278.38,"maximum":39739.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":28904.67},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15278.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15583.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30923.97},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15278.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15278.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15431.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15278.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15736.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":39739.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":15278.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15278.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15278.38,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other O.R. Procedures For Injuries With Mcc","code_information":[{"code":"907","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":28271.88,"maximum":73535.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":56495.3},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28271.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28837.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":60442.1},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28271.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28271.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28554.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28271.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29120.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":73535.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":28271.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28271.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28271.88,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other O.R. Procedures For Injuries With Cc","code_information":[{"code":"908","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15492.51,"maximum":40296.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":29359.37},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15492.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15802.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31410.43},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15492.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15492.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15647.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15492.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15957.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":40296.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":15492.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15492.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15492.51,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other O.R. Procedures For Injuries Without Cc/Mcc","code_information":[{"code":"909","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10762.88,"maximum":27994.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":19316.38},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10762.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10978.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20665.84},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10762.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10762.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10870.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10762.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11085.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":27994.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":10762.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10762.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10762.88,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Injury With Mcc","code_information":[{"code":"913","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12993.6,"maximum":33796.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":24053.14},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12993.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13253.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25733.51},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12993.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12993.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13123.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12993.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13383.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":33796.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":12993.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12993.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12993.6,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Injury Without Mcc","code_information":[{"code":"914","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7802.44,"maximum":20294.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":13030.13},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7802.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7958.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13940.43},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7802.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7802.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7880.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7802.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8036.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":20294.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":7802.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7802.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7802.44,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Allergic Reactions With Mcc","code_information":[{"code":"915","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13319.31,"maximum":34643.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":24744.74},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13319.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13585.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26473.43},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13319.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13319.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13452.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13319.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13718.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":34643.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":13319.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13319.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13319.31,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Allergic Reactions Without Mcc","code_information":[{"code":"916","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6283.41,"maximum":16343.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":9804.6},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6283.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6409.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10489.56},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6283.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6283.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6346.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6283.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6471.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":16343.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":6283.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6283.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6283.41,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Poisoning And Toxic Effects Of Drugs With Mcc","code_information":[{"code":"917","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12534.85,"maximum":32603.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":23079.01},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12534.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12785.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24691.32},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12534.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12534.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12660.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12534.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12910.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":32603.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":12534.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12534.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12534.85,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Poisoning And Toxic Effects Of Drugs Without Mcc","code_information":[{"code":"918","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7605.63,"maximum":19782.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":12612.23},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7605.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7757.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13493.33},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7605.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7605.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7681.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7605.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7833.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":19782.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":7605.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7605.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7605.63,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"1 through 10","median_amount":15946.62,"10th_percentile":15946.62,"90th_percentile":15946.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complications Of Treatment With Mcc","code_information":[{"code":"919","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14353.24,"maximum":37332.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":26940.22},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14353.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14640.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28822.28},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14353.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14353.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14496.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14353.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14783.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":37332.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":14353.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14353.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14353.24,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"1 through 10","median_amount":11441.04,"10th_percentile":11441.04,"90th_percentile":11441.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":13243.79,"10th_percentile":13243.79,"90th_percentile":13243.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complications Of Treatment With Cc","code_information":[{"code":"920","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8611.85,"maximum":22399.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":14748.84},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8611.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8784.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15779.21},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8611.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8611.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8697.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8611.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8870.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":22399.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":8611.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8611.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8611.85,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complications Of Treatment Without Cc/Mcc","code_information":[{"code":"921","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6436.56,"maximum":16741.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":10129.81},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6436.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6565.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10837.48},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6436.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6436.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6500.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6436.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6629.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":16741.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":6436.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6436.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6436.56,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Injury, Poisoning And Toxic Effect Diagnoses With Mcc","code_information":[{"code":"922","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13789.15,"maximum":35865.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":25742.42},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13789.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14064.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27540.8},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13789.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13789.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13927.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13789.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14202.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":35865.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":13789.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13789.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13789.15,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Injury, Poisoning And Toxic Effect Diagnoses Without Mcc","code_information":[{"code":"923","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8718.57,"maximum":22677.00,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":14975.46},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8718.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8892.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16021.65},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8718.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8718.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8805.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8718.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8980.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":22677.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":8718.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8718.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8718.57,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft","code_information":[{"code":"927","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":149622.19,"maximum":389167.32,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":314172.61},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":149622.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":152614.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":336120.92},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":149622.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":149622.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":151118.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":149622.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":154110.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":389167.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":149622.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":149622.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":149622.19,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Full Thickness Burn With Skin Graft Or Inhalation Injury With Cc/Mcc","code_information":[{"code":"928","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":51371.91,"maximum":133618.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":105546.28},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":51371.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":52399.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":112919.82},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":51371.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51371.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":51885.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51371.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":52913.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":133618.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":51371.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":51371.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":51371.91,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Full Thickness Burn With Skin Graft Or Inhalation Injury Without Cc/Mcc","code_information":[{"code":"929","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23985.76,"maximum":62386.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":47394.07},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23985.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24465.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":50705.05},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23985.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23985.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24225.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23985.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24705.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":62386.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":23985.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23985.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23985.76,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft","code_information":[{"code":"933","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":28652.33,"maximum":74524.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":57303.15},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28652.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29225.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":61306.39},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28652.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28652.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28938.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28652.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29511.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":74524.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":28652.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28652.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28652.33,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Full Thickness Burn Without Skin Graft Or Inhalation Injury","code_information":[{"code":"934","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16985.21,"maximum":44178.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":32528.98},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16985.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17324.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34801.48},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16985.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16985.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17155.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16985.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17494.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":44178.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":16985.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16985.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16985.21,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Extensive Burns","code_information":[{"code":"935","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15941.57,"maximum":41464.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":30312.9},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15941.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16260.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32430.58},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15941.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15941.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16100.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15941.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16419.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":41464.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":15941.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15941.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15941.57,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"O.R. Procedures With Diagnoses Of Other Contact With Health Services With Mcc","code_information":[{"code":"939","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":26811.07,"maximum":69735.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":53393.38},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26811.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27347.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":57123.48},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26811.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26811.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27079.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26811.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27615.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":69735.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":26811.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26811.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26811.07,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc","code_information":[{"code":"940","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17860.45,"maximum":46455.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":34387.48},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17860.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18217.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36789.82},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17860.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17860.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18039.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17860.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18396.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":46455.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":17860.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17860.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17860.45,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"1 through 10","median_amount":17925.33,"10th_percentile":17925.33,"90th_percentile":17925.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/Mcc","code_information":[{"code":"941","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15717.73,"maximum":40881.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":29837.61},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15717.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16032.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31922.08},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15717.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15717.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15874.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15717.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16189.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":40881.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":15717.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15717.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15717.73,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Rehabilitation With Cc/Mcc","code_information":[{"code":"945","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12397.63,"maximum":32246.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":22787.65},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12397.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12645.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24379.61},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12397.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12397.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12521.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12397.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12769.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":32246.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":12397.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12397.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12397.63,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Rehabilitation Without Cc/Mcc","code_information":[{"code":"946","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9613.21,"maximum":25003.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":16875.16},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9613.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9805.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18054.07},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9613.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9613.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9709.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9613.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9901.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":25003.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":9613.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9613.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9613.21,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Signs And Symptoms With Mcc","code_information":[{"code":"947","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10462.81,"maximum":27213.77,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":18679.22},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10462.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10672.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19984.16},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10462.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10462.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10567.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10462.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10776.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":27213.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":10462.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10462.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10462.81,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Signs And Symptoms Without Mcc","code_information":[{"code":"948","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7213.4,"maximum":18762.05,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":11779.36},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7213.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7357.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12602.27},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7213.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7213.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7285.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7213.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7429.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":18762.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":7213.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7213.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7213.4,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"1 through 10","median_amount":7218.03,"10th_percentile":7218.03,"90th_percentile":7218.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aftercare With Cc/Mcc","code_information":[{"code":"949","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9910.5,"maximum":25777.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":17506.44},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9910.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10108.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18729.45},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9910.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9910.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10009.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9910.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10207.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":25777.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":9910.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9910.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9910.5,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aftercare Without Cc/Mcc","code_information":[{"code":"950","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6015.92,"maximum":15647.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":9236.61},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6015.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6136.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9881.88},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6015.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6015.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6076.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6015.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6196.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":15647.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":6015.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6015.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6015.92,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Factors Influencing Health Status","code_information":[{"code":"951","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5519.05,"maximum":14355.05,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":8181.54},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5519.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5629.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8753.11},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5519.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5519.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5574.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5519.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5684.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14355.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":5519.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5519.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5519.05,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Craniotomy For Multiple Significant Trauma","code_information":[{"code":"955","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":48311.68,"maximum":125658.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":99048.14},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":48311.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":49277.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":105967.71},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":48311.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48311.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":48794.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48311.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":49761.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":125658.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":48311.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":48311.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":48311.68,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma","code_information":[{"code":"956","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":27743.13,"maximum":72159.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":55372.55},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27743.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28297.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":59240.91},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27743.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27743.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28020.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27743.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28575.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":72159.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":27743.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27743.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27743.13,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other O.R. Procedures For Multiple Significant Trauma With Mcc","code_information":[{"code":"957","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":54470.94,"maximum":141678.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":112126.83},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":54470.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":55560.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":119960.09},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":54470.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54470.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":55015.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54470.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":56105.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":141678.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":54470.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":54470.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":54470.94,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other O.R. Procedures For Multiple Significant Trauma With Cc","code_information":[{"code":"958","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":30867.81,"maximum":80287.17,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":62007.54},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30867.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31485.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":66339.43},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30867.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30867.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31176.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30867.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":31793.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":80287.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":30867.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30867.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30867.81,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other O.R. Procedures For Multiple Significant Trauma Without Cc/Mcc","code_information":[{"code":"959","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":22068.27,"maximum":57399.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":43322.43},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22068.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22509.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":46348.97},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22068.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22068.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22288.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22068.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22730.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":57399.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":22068.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22068.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22068.27,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Multiple Significant Trauma With Mcc","code_information":[{"code":"963","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20610.91,"maximum":53608.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":40227.87},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20610.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21023.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":43038.21},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20610.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20610.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20817.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20610.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21229.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":53608.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":20610.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20610.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20610.91,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"1 through 10","median_amount":20647.49,"10th_percentile":20647.49,"90th_percentile":20647.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Multiple Significant Trauma With Cc","code_information":[{"code":"964","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12286.76,"maximum":31957.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":22552.21},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12286.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12532.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24127.72},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12286.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12286.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12409.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12286.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12655.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":31957.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":12286.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12286.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12286.76,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Multiple Significant Trauma Without Cc/Mcc","code_information":[{"code":"965","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8183.58,"maximum":21285.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":13839.46},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8183.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8347.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14806.29},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8183.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8183.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8265.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8183.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8429.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":21285.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":8183.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8183.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8183.58,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hiv With Extensive O.R. Procedures With Mcc","code_information":[{"code":"969","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":44085.84,"maximum":114667.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":90074.93},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":44085.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":44967.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":96367.63},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":44085.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44085.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":44526.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44085.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":45408.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":114667.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":44085.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":44085.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":44085.84,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hiv With Extensive O.R. Procedures Without Mcc","code_information":[{"code":"970","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19942.87,"maximum":51871.40,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":38809.34},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19942.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20341.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":41520.59},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19942.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19942.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20142.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19942.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20541.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":51871.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":19942.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19942.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19942.87,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hiv With Major Related Condition With Mcc","code_information":[{"code":"974","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21665.64,"maximum":56352.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":42467.49},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21665.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22098.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":45434.3},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21665.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21665.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21882.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21665.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22315.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":56352.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":21665.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21665.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21665.64,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hiv With Major Related Condition With Cc","code_information":[{"code":"975","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10640.22,"maximum":27675.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":19055.93},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10640.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10853.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20387.19},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10640.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10640.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10746.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10640.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10959.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":27675.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":10640.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10640.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10640.22,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hiv With Major Related Condition Without Cc/Mcc","code_information":[{"code":"976","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7921.63,"maximum":20604.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":13283.23},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7921.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8080.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14211.21},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7921.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7921.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8000.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7921.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8159.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":20604.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":7921.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7921.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7921.63,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hiv With Or Without Other Related Condition","code_information":[{"code":"977","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10658.93,"maximum":27723.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":19095.66},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10658.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10872.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20429.69},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10658.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10658.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10765.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10658.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10978.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":27723.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":10658.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10658.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10658.93,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc","code_information":[{"code":"981","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":34179.6,"maximum":88901.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":69039.84},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":34179.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34863.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":73863.01},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34179.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34179.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34521.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34179.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35204.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":88901.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":34179.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34179.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":34179.6,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"1 through 10","median_amount":24939.47,"10th_percentile":24939.47,"90th_percentile":24939.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc","code_information":[{"code":"982","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18703.12,"maximum":48646.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":36176.83},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18703.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19077.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38704.17},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18703.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18703.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18890.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18703.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19264.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":48646.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":18703.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18703.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18703.12,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/Mcc","code_information":[{"code":"983","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13543.83,"maximum":35227.50,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":25221.51},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13543.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13814.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26983.5},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13543.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13543.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13679.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13543.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13950.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":35227.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":13543.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13543.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13543.83,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc","code_information":[{"code":"987","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":25424.4,"maximum":66128.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":50448.91},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25424.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25932.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":53973.3},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25424.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25424.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25678.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25424.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26187.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":66128.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":25424.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25424.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25424.4,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc","code_information":[{"code":"988","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13055.97,"maximum":33958.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":24185.57},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13055.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13317.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25875.19},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13055.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13055.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13186.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13055.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13447.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":33958.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":13055.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13055.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13055.97,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/Mcc","code_information":[{"code":"989","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9976.34,"maximum":25948.46,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":17646.23},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9976.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10175.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18879.01},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9976.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9976.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10076.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Pffs Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9976.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10275.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":25948.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"fee schedule","standard_charge_dollar":9976.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9976.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9976.34,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bone marrow transplant","code_information":[{"code":"009","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hyphema","code_information":[{"code":"043","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Major Eye Infections","code_information":[{"code":"044","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Neurological eye disorders","code_information":[{"code":"045","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders of the Eye Age >17 w CC","code_information":[{"code":"046","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders of the Eye Age >17 w/o CC","code_information":[{"code":"047","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders of the Eye Age 0-17","code_information":[{"code":"048","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Head & Neck Procedures","code_information":[{"code":"049","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Sialoadenectomy","code_information":[{"code":"050","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Salivary Gland Procedures Except Sialoadenectomy","code_information":[{"code":"051","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hypertensive Encephalopathy With Mcc","code_information":[{"code":"077","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hypertensive Encephalopathy With Cc","code_information":[{"code":"078","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hypertensive Encephalopathy Without Cc/Mcc","code_information":[{"code":"079","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Valve & Oth Major Cardiothoracic Proc w Cardiac Cath","code_information":[{"code":"104","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Valve & Oth Major Cardiothoracic Proc w/o Cardiac Cath","code_information":[{"code":"105","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Bypass w PTCA","code_information":[{"code":"106","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"No Longer Valid","code_information":[{"code":"107","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Cardiothoracic Procedures","code_information":[{"code":"108","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"No Longer Valid","code_information":[{"code":"109","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Cardiovascular Procedures w CC","code_information":[{"code":"110","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Cardiovascular Procedures w/o CC","code_information":[{"code":"111","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"No Longer Valid","code_information":[{"code":"112","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Pacemaker Device Replacement","code_information":[{"code":"118","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vein ligation & stripping","code_information":[{"code":"119","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other circulatory system O.R. procedures","code_information":[{"code":"120","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute & Subacute Endocarditis","code_information":[{"code":"126","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Heart Failure & Shock","code_information":[{"code":"127","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Deep Vein Thrombophlebitis","code_information":[{"code":"128","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Head & Neck Procedures W Cc/Mcc Or Major Device","code_information":[{"code":"129","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Head & Neck Procedures W/O Cc/Mcc","code_information":[{"code":"130","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cranial/Facial Procedures W Cc/Mcc","code_information":[{"code":"131","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cranial/Facial Procedures W/O Cc/Mcc","code_information":[{"code":"132","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Ear, Nose, Mouth & Throat O.R. Procedures W Cc/Mcc","code_information":[{"code":"133","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Ear, Nose, Mouth & Throat O.R. Procedures W/O Cc/Mcc","code_information":[{"code":"134","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hernia Procedures Except Inguinal & Femoral Age >17 w/o CC","code_information":[{"code":"160","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inguinal & Femoral Hernia Procedures Age >17 w CC","code_information":[{"code":"161","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inguinal & Femoral Hernia Procedures Age >17 w/o CC","code_information":[{"code":"162","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Mouth Procedures w/o CC","code_information":[{"code":"169","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Digestive System O.R. Procedures w/o CC","code_information":[{"code":"171","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"G.I. hemorrhage w CC","code_information":[{"code":"174","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hip & Femur Procedures Except Major Joint Age >17 w CC","code_information":[{"code":"210","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hip & Femur Procedures Except Major Joint Age >17 w/o CC","code_information":[{"code":"211","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"No Longer Valid","code_information":[{"code":"214","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With Mcc","code_information":[{"code":"222","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without Mcc","code_information":[{"code":"223","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With Mcc","code_information":[{"code":"224","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without Mcc","code_information":[{"code":"225","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant Without Cardiac Catheterization With Mcc","code_information":[{"code":"226","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant Without Cardiac Catheterization Without Mcc","code_information":[{"code":"227","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other cardiothoracic procedures w/o CC/MCC","code_information":[{"code":"230","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major cardiovasc procedures w MCC","code_information":[{"code":"237","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major cardiovasc procedures w/o MCC","code_information":[{"code":"238","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With Mcc Or 4+ Arteries Or Stents","code_information":[{"code":"246","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without Mcc","code_information":[{"code":"247","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With Mcc Or 4+ Arteries Or Stents","code_information":[{"code":"248","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without Mcc","code_information":[{"code":"249","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Deep Vein Thrombophlebitis With Cc/Mcc","code_information":[{"code":"294","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Deep Vein Thrombophlebitis Without Cc/Mcc","code_information":[{"code":"295","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendectomy With Complicated Principal Diagnosis With Mcc","code_information":[{"code":"338","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendectomy With Complicated Principal Diagnosis With Cc","code_information":[{"code":"339","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendectomy With Complicated Principal Diagnosis Without Cc/Mcc","code_information":[{"code":"340","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendectomy Without Complicated Principal Diagnosis With Mcc","code_information":[{"code":"341","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendectomy Without Complicated Principal Diagnosis With Cc","code_information":[{"code":"342","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendectomy Without Complicated Principal Diagnosis Without Cc/Mcc","code_information":[{"code":"343","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Laparoscopy & Incisional Tubal Interruption","code_information":[{"code":"361","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Endoscopic Tubal Interruption","code_information":[{"code":"362","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"D&C, Conization & Radio-Implant, for Malignancy","code_information":[{"code":"363","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"D&C, Conization Except for Malignancy","code_information":[{"code":"364","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Female Reproductive System O.R. Procedures","code_information":[{"code":"365","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy, female reproductive system w CC","code_information":[{"code":"366","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy, Female Reproductive System w/o CC","code_information":[{"code":"367","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Red Blood Cell Disorders Age 0-17","code_information":[{"code":"396","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"No Longer Valid","code_information":[{"code":"400","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma & non-acute leukemia w other O.R. proc w CC","code_information":[{"code":"401","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma & non-acute leukemia w CC","code_information":[{"code":"403","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma & Non-Acute Leukemia w/o CC","code_information":[{"code":"404","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Childhood Mental Disorders","code_information":[{"code":"431","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Poisoning & toxic Effects of Drugs Age >17 w CC","code_information":[{"code":"449","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complications of treatment w CC","code_information":[{"code":"452","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Combined Anterior And Posterior Spinal Fusion With Mcc","code_information":[{"code":"453","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Combined Anterior And Posterior Spinal Fusion With Cc","code_information":[{"code":"454","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Combined Anterior And Posterior Spinal Fusion Without Cc/Mcc","code_information":[{"code":"455","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":50721.54,"10th_percentile":50721.54,"90th_percentile":50721.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":27291.1,"10th_percentile":27291.1,"90th_percentile":27291.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":33768.33,"10th_percentile":33768.33,"90th_percentile":33768.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Fusion Except Cervical With Mcc","code_information":[{"code":"459","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":37294.29,"10th_percentile":37294.29,"90th_percentile":37294.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Fusion Except Cervical Without Mcc","code_information":[{"code":"460","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major joint & limb reattachment proc of upper extremity w/o CC/MCC","code_information":[{"code":"484","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Back & neck proc exc spinal fusion w CC/MCC or disc device/neurostim","code_information":[{"code":"490","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Back & neck proc exc spinal fusion w/o CC/MCC","code_information":[{"code":"491","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Arthroscopy","code_information":[{"code":"509","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Alc/Drug Abuse or Depend w/o Rehabilitation therapy w/o CC","code_information":[{"code":"523","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Transient ischemia","code_information":[{"code":"524","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other heart assist system implant","code_information":[{"code":"525","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"No Longer Valid","code_information":[{"code":"526","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"No Longer Valid","code_information":[{"code":"527","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intracranial Vascular Proc w Pdx Hemorrhage","code_information":[{"code":"528","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ventricular shunt procedures w CC","code_information":[{"code":"529","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ventricular Shunt Procedures w/o CC","code_information":[{"code":"530","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Procedures w CC","code_information":[{"code":"531","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Procedures w/o CC","code_information":[{"code":"532","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Stomach, Esophageal & Duodenal Proc Age > 17 w CC w Major Gi Dx","code_information":[{"code":"567","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Stomach, Esophageal & Duodenal Procedures Proc Age > 17 w CC w/o Major Gi Dx","code_information":[{"code":"568","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Small & Large Bowel Procedures w CC w Major Gi Dx","code_information":[{"code":"569","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Admit For Renal Dialysis","code_information":[{"code":"685","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Urinary Stones W Esw Lithotripsy W Cc/Mcc","code_information":[{"code":"691","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Urinary Stones W Esw Lithotripsy W/O Cc/Mcc","code_information":[{"code":"692","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cesarean Section W Cc/Mcc","code_information":[{"code":"765","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cesarean Section W/O Cc/Mcc","code_information":[{"code":"766","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery W Sterilization &/Or D&C","code_information":[{"code":"767","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery W Complicating Diagnoses","code_information":[{"code":"774","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery W/O Complicating Diagnoses","code_information":[{"code":"775","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ectopic Pregnancy","code_information":[{"code":"777","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Threatened Abortion","code_information":[{"code":"778","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"False Labor","code_information":[{"code":"780","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Antepartum Diagnoses W Medical Complications","code_information":[{"code":"781","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Antepartum Diagnoses W/O Medical Complications","code_information":[{"code":"782","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Prostatic O.R. Procedure Unrelated To Principal Diagnosis W Mcc","code_information":[{"code":"984","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Prostatic O.R. Procedure Unrelated To Principal Diagnosis W Cc","code_information":[{"code":"985","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Prostatic O.R. Procedure Unrelated To Principal Diagnosis W/O Cc/Mcc","code_information":[{"code":"986","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Principal Diagnosis Invalid As Discharge Diagnosis","code_information":[{"code":"998","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ungroupable","code_information":[{"code":"999","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2.96 | Excess % of Charge: 67.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7444] [Normal Vaginal Delivery-Case Rate: 7444] [Nursery  Level 1- Boarder-Per Diem: 1458] [Psych-Per Diem: 1776]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Psych-Per Diem: 1092] [All Other IP (%BC): 65.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1715.07]","count":"1 through 10","median_amount":6224.12,"10th_percentile":6224.12,"90th_percentile":6224.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ketorolac tromethamine inj","code_information":[{"code":"0764","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [Mental Health-Intensive ($): 201] [Mental Health-Partial Hospitalization ($): 401] [All Other OP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.2] [Cardiac Cath (%BC): 71.1] [Lithotripsy (%BC): 71.1] [Observation (%BC): 71.1] [Emergency Department (%BC): 73.2] [Radiology (%BC): 71.1] [Laboratory (%BC): 26.1] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 71.1] [Speech Therapy (%BC): 46] [Mental Health ($): 1776] [OP High Cost Drugs (%BC): 52.9] [All Other OP (%BC): 71.1]","count":"1 through 10","median_amount":6325.13,"10th_percentile":6325.13,"90th_percentile":6325.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"First Health Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health-Intensive ($): 467.68] [Mental Health-Partial Hospitalization ($): 777.57] [OP ECT Mental Health ($): 1195.36] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inj, methylpred acetate 1 mg","code_information":[{"code":"0790","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [Mental Health-Intensive ($): 201] [Mental Health-Partial Hospitalization ($): 401] [All Other OP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":862.16,"10th_percentile":862.16,"90th_percentile":862.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.2] [Cardiac Cath (%BC): 71.1] [Lithotripsy (%BC): 71.1] [Observation (%BC): 71.1] [Emergency Department (%BC): 73.2] [Radiology (%BC): 71.1] [Laboratory (%BC): 26.1] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 71.1] [Speech Therapy (%BC): 46] [Mental Health ($): 1776] [OP High Cost Drugs (%BC): 52.9] [All Other OP (%BC): 71.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"First Health Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health-Intensive ($): 467.68] [Mental Health-Partial Hospitalization ($): 777.57] [OP ECT Mental Health ($): 1195.36] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Clinic Visits and Related Services","code_information":[{"code":"5012","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [Mental Health-Intensive ($): 201] [Mental Health-Partial Hospitalization ($): 401] [All Other OP (%BC): 78]","count":"1 through 10","median_amount":156.78,"10th_percentile":156.78,"90th_percentile":1382.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":118.48,"10th_percentile":118.48,"90th_percentile":118.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"75","median_amount":34.21,"10th_percentile":34.21,"90th_percentile":99.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"589","median_amount":33.87,"10th_percentile":33.87,"90th_percentile":136.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.2] [Cardiac Cath (%BC): 71.1] [Lithotripsy (%BC): 71.1] [Observation (%BC): 71.1] [Emergency Department (%BC): 73.2] [Radiology (%BC): 71.1] [Laboratory (%BC): 26.1] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 71.1] [Speech Therapy (%BC): 46] [Mental Health ($): 1776] [OP High Cost Drugs (%BC): 52.9] [All Other OP (%BC): 71.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":118.48,"10th_percentile":118.48,"90th_percentile":118.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.6,"count":"1 through 10","median_amount":145.64,"10th_percentile":145.64,"90th_percentile":508.57},{"payer_name":"First Health/Coventry","plan_name":"First Health Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health-Intensive ($): 467.68] [Mental Health-Partial Hospitalization ($): 777.57] [OP ECT Mental Health ($): 1195.36] [APC ($): FEE SCHEDULE]","count":"42","median_amount":119.67,"10th_percentile":119.67,"90th_percentile":119.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":552.6,"10th_percentile":552.6,"90th_percentile":552.6},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"492","median_amount":33.87,"10th_percentile":33.87,"90th_percentile":129.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"1 through 10","median_amount":421.15,"10th_percentile":243.19,"90th_percentile":623.22},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"11","median_amount":118.49,"10th_percentile":118.49,"90th_percentile":118.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"26","median_amount":73.96,"10th_percentile":34.71,"90th_percentile":266.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":118.48,"10th_percentile":118.48,"90th_percentile":118.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 1 Type A ED Visits","code_information":[{"code":"5021","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [Mental Health-Intensive ($): 201] [Mental Health-Partial Hospitalization ($): 401] [All Other OP (%BC): 78]","count":"1 through 10","median_amount":333.84,"10th_percentile":333.84,"90th_percentile":333.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":96.31,"10th_percentile":96.31,"90th_percentile":96.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":95.36,"10th_percentile":95.36,"90th_percentile":95.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.2] [Cardiac Cath (%BC): 71.1] [Lithotripsy (%BC): 71.1] [Observation (%BC): 71.1] [Emergency Department (%BC): 73.2] [Radiology (%BC): 71.1] [Laboratory (%BC): 26.1] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 71.1] [Speech Therapy (%BC): 46] [Mental Health ($): 1776] [OP High Cost Drugs (%BC): 52.9] [All Other OP (%BC): 71.1]","count":"1 through 10","median_amount":292.8,"10th_percentile":292.8,"90th_percentile":292.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"First Health Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health-Intensive ($): 467.68] [Mental Health-Partial Hospitalization ($): 777.57] [OP ECT Mental Health ($): 1195.36] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":394.74,"10th_percentile":394.74,"90th_percentile":394.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":95.36,"10th_percentile":95.36,"90th_percentile":367.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":82.6,"10th_percentile":82.6,"90th_percentile":82.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":97.74,"10th_percentile":97.74,"90th_percentile":97.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Type A ED Visits","code_information":[{"code":"5022","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [Mental Health-Intensive ($): 201] [Mental Health-Partial Hospitalization ($): 401] [All Other OP (%BC): 78]","count":"1 through 10","median_amount":367.82,"10th_percentile":300.0,"90th_percentile":1283.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":172.08,"10th_percentile":172.08,"90th_percentile":172.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":161.35,"10th_percentile":161.35,"90th_percentile":161.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"20","median_amount":159.75,"10th_percentile":159.75,"90th_percentile":454.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.2] [Cardiac Cath (%BC): 71.1] [Lithotripsy (%BC): 71.1] [Observation (%BC): 71.1] [Emergency Department (%BC): 73.2] [Radiology (%BC): 71.1] [Laboratory (%BC): 26.1] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 71.1] [Speech Therapy (%BC): 46] [Mental Health ($): 1776] [OP High Cost Drugs (%BC): 52.9] [All Other OP (%BC): 71.1]","count":"12","median_amount":524.84,"10th_percentile":524.84,"90th_percentile":717.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.6,"count":"1 through 10","median_amount":470.35,"10th_percentile":470.35,"90th_percentile":470.35},{"payer_name":"First Health/Coventry","plan_name":"First Health Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health-Intensive ($): 467.68] [Mental Health-Partial Hospitalization ($): 777.57] [OP ECT Mental Health ($): 1195.36] [APC ($): FEE SCHEDULE]","count":"12","median_amount":149.25,"10th_percentile":148.35,"90th_percentile":149.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"19","median_amount":159.75,"10th_percentile":159.75,"90th_percentile":159.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"1 through 10","median_amount":508.35,"10th_percentile":508.35,"90th_percentile":508.35},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":147.79,"10th_percentile":147.79,"90th_percentile":148.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":163.74,"10th_percentile":163.74,"90th_percentile":163.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Type A ED Visits","code_information":[{"code":"5023","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [Mental Health-Intensive ($): 201] [Mental Health-Partial Hospitalization ($): 401] [All Other OP (%BC): 78]","count":"23","median_amount":1180.4,"10th_percentile":300.0,"90th_percentile":1599.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":256.56,"10th_percentile":255.06,"90th_percentile":477.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":378.27,"10th_percentile":274.31,"90th_percentile":546.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"65","median_amount":329.81,"10th_percentile":271.59,"90th_percentile":499.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.2] [Cardiac Cath (%BC): 71.1] [Lithotripsy (%BC): 71.1] [Observation (%BC): 71.1] [Emergency Department (%BC): 73.2] [Radiology (%BC): 71.1] [Laboratory (%BC): 26.1] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 71.1] [Speech Therapy (%BC): 46] [Mental Health ($): 1776] [OP High Cost Drugs (%BC): 52.9] [All Other OP (%BC): 71.1]","count":"58","median_amount":1138.32,"10th_percentile":904.18,"90th_percentile":1819.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":342.36,"10th_percentile":256.96,"90th_percentile":478.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.6,"count":"20","median_amount":1087.64,"10th_percentile":876.03,"90th_percentile":1738.39},{"payer_name":"First Health/Coventry","plan_name":"First Health Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health-Intensive ($): 467.68] [Mental Health-Partial Hospitalization ($): 777.57] [OP ECT Mental Health ($): 1195.36] [APC ($): FEE SCHEDULE]","count":"39","median_amount":258.41,"10th_percentile":148.35,"90th_percentile":340.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"50","median_amount":369.4,"10th_percentile":271.59,"90th_percentile":499.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"26","median_amount":1203.55,"10th_percentile":887.28,"90th_percentile":1874.83},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"17","median_amount":257.07,"10th_percentile":255.57,"90th_percentile":355.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"33","median_amount":381.17,"10th_percentile":278.38,"90th_percentile":532.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":257.06,"10th_percentile":257.06,"90th_percentile":257.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 4 Type A ED Visits","code_information":[{"code":"5024","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [Mental Health-Intensive ($): 201] [Mental Health-Partial Hospitalization ($): 401] [All Other OP (%BC): 78]","count":"81","median_amount":2755.02,"10th_percentile":1072.67,"90th_percentile":5927.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"23","median_amount":614.42,"10th_percentile":490.75,"90th_percentile":836.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":871.39,"10th_percentile":747.62,"90th_percentile":2000.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"70","median_amount":786.72,"10th_percentile":609.83,"90th_percentile":2153.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.2] [Cardiac Cath (%BC): 71.1] [Lithotripsy (%BC): 71.1] [Observation (%BC): 71.1] [Emergency Department (%BC): 73.2] [Radiology (%BC): 71.1] [Laboratory (%BC): 26.1] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 71.1] [Speech Therapy (%BC): 46] [Mental Health ($): 1776] [OP High Cost Drugs (%BC): 52.9] [All Other OP (%BC): 71.1]","count":"249","median_amount":2886.07,"10th_percentile":1952.17,"90th_percentile":7631.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"27","median_amount":587.6,"10th_percentile":320.98,"90th_percentile":916.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.6,"count":"45","median_amount":2867.37,"10th_percentile":1535.04,"90th_percentile":6018.75},{"payer_name":"First Health/Coventry","plan_name":"First Health Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health-Intensive ($): 467.68] [Mental Health-Partial Hospitalization ($): 777.57] [OP ECT Mental Health ($): 1195.36] [APC ($): FEE SCHEDULE]","count":"106","median_amount":497.81,"10th_percentile":259.31,"90th_percentile":859.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1034.65,"10th_percentile":1034.65,"90th_percentile":1034.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"59","median_amount":848.16,"10th_percentile":688.98,"90th_percentile":1941.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"39","median_amount":3496.98,"10th_percentile":2030.98,"90th_percentile":6765.82},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"62","median_amount":597.95,"10th_percentile":338.02,"90th_percentile":917.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"51","median_amount":1087.26,"10th_percentile":676.3,"90th_percentile":2008.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":492.34,"10th_percentile":393.99,"90th_percentile":791.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 5 Type A ED Visits","code_information":[{"code":"5025","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [Mental Health-Intensive ($): 201] [Mental Health-Partial Hospitalization ($): 401] [All Other OP (%BC): 78]","count":"74","median_amount":6455.47,"10th_percentile":410.28,"90th_percentile":12093.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"29","median_amount":894.01,"10th_percentile":646.61,"90th_percentile":2607.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"11","median_amount":2065.29,"10th_percentile":1452.05,"90th_percentile":2965.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"42","median_amount":2652.05,"10th_percentile":1086.99,"90th_percentile":3163.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.2] [Cardiac Cath (%BC): 71.1] [Lithotripsy (%BC): 71.1] [Observation (%BC): 71.1] [Emergency Department (%BC): 73.2] [Radiology (%BC): 71.1] [Laboratory (%BC): 26.1] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 71.1] [Speech Therapy (%BC): 46] [Mental Health ($): 1776] [OP High Cost Drugs (%BC): 52.9] [All Other OP (%BC): 71.1]","count":"123","median_amount":6005.29,"10th_percentile":664.03,"90th_percentile":9903.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"12","median_amount":674.7,"10th_percentile":317.08,"90th_percentile":2602.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.6,"count":"38","median_amount":7860.85,"10th_percentile":3226.86,"90th_percentile":9480.37},{"payer_name":"First Health/Coventry","plan_name":"First Health Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health-Intensive ($): 467.68] [Mental Health-Partial Hospitalization ($): 777.57] [OP ECT Mental Health ($): 1195.36] [APC ($): FEE SCHEDULE]","count":"111","median_amount":859.04,"10th_percentile":482.55,"90th_percentile":1215.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2763.99,"10th_percentile":2763.99,"90th_percentile":2763.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"34","median_amount":1848.54,"10th_percentile":901.39,"90th_percentile":3313.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"26","median_amount":7226.14,"10th_percentile":3123.15,"90th_percentile":9265.65},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"54","median_amount":985.76,"10th_percentile":646.82,"90th_percentile":1417.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"49","median_amount":1488.74,"10th_percentile":928.2,"90th_percentile":3365.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"11","median_amount":993.35,"10th_percentile":894.21,"90th_percentile":1216.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Critical Care","code_information":[{"code":"5041","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [Mental Health-Intensive ($): 201] [Mental Health-Partial Hospitalization ($): 401] [All Other OP (%BC): 78]","count":"1 through 10","median_amount":7861.8,"10th_percentile":6217.54,"90th_percentile":16619.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2440.16,"10th_percentile":2014.97,"90th_percentile":8108.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":2341.4,"10th_percentile":2341.4,"90th_percentile":2341.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":2375.94,"10th_percentile":2375.94,"90th_percentile":8371.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.2] [Cardiac Cath (%BC): 71.1] [Lithotripsy (%BC): 71.1] [Observation (%BC): 71.1] [Emergency Department (%BC): 73.2] [Radiology (%BC): 71.1] [Laboratory (%BC): 26.1] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 71.1] [Speech Therapy (%BC): 46] [Mental Health ($): 1776] [OP High Cost Drugs (%BC): 52.9] [All Other OP (%BC): 71.1]","count":"14","median_amount":8507.32,"10th_percentile":5797.13,"90th_percentile":18555.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1357.38,"10th_percentile":1357.38,"90th_percentile":2436.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.6,"count":"1 through 10","median_amount":23134.32,"10th_percentile":23134.32,"90th_percentile":23134.32},{"payer_name":"First Health/Coventry","plan_name":"First Health Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health-Intensive ($): 467.68] [Mental Health-Partial Hospitalization ($): 777.57] [OP ECT Mental Health ($): 1195.36] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1192.84,"10th_percentile":784.92,"90th_percentile":3222.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3580.4,"10th_percentile":3580.4,"90th_percentile":3580.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":2751.06,"10th_percentile":2545.31,"90th_percentile":3691.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"1 through 10","median_amount":22371.33,"10th_percentile":22371.33,"90th_percentile":22371.33},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":1792.53,"10th_percentile":1792.53,"90th_percentile":1792.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Skin Procedures","code_information":[{"code":"5051","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [Mental Health-Intensive ($): 201] [Mental Health-Partial Hospitalization ($): 401] [All Other OP (%BC): 78]","count":"1 through 10","median_amount":416.52,"10th_percentile":416.52,"90th_percentile":416.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":186.41,"10th_percentile":186.41,"90th_percentile":301.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":120.17,"10th_percentile":120.17,"90th_percentile":120.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":118.98,"10th_percentile":84.22,"90th_percentile":132.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.2] [Cardiac Cath (%BC): 71.1] [Lithotripsy (%BC): 71.1] [Observation (%BC): 71.1] [Emergency Department (%BC): 73.2] [Radiology (%BC): 71.1] [Laboratory (%BC): 26.1] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 71.1] [Speech Therapy (%BC): 46] [Mental Health ($): 1776] [OP High Cost Drugs (%BC): 52.9] [All Other OP (%BC): 71.1]","count":"12","median_amount":390.89,"10th_percentile":390.89,"90th_percentile":534.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":186.41,"10th_percentile":182.68,"90th_percentile":301.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.6,"count":"1 through 10","median_amount":325.38,"10th_percentile":325.38,"90th_percentile":350.3},{"payer_name":"First Health/Coventry","plan_name":"First Health Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health-Intensive ($): 467.68] [Mental Health-Partial Hospitalization ($): 777.57] [OP ECT Mental Health ($): 1195.36] [APC ($): FEE SCHEDULE]","count":"17","median_amount":185.3,"10th_percentile":184.5,"90th_percentile":307.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":775.57,"10th_percentile":118.98,"90th_percentile":775.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":182.69,"10th_percentile":182.69,"90th_percentile":302.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":196.4,"10th_percentile":196.4,"90th_percentile":204.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Skin Procedures","code_information":[{"code":"5052","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [Mental Health-Intensive ($): 201] [Mental Health-Partial Hospitalization ($): 401] [All Other OP (%BC): 78]","count":"1 through 10","median_amount":627.9,"10th_percentile":627.9,"90th_percentile":1124.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":373.32,"10th_percentile":367.32,"90th_percentile":491.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":211.53,"10th_percentile":211.53,"90th_percentile":211.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"20","median_amount":215.22,"10th_percentile":215.22,"90th_percentile":452.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.2] [Cardiac Cath (%BC): 71.1] [Lithotripsy (%BC): 71.1] [Observation (%BC): 71.1] [Emergency Department (%BC): 73.2] [Radiology (%BC): 71.1] [Laboratory (%BC): 26.1] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 71.1] [Speech Therapy (%BC): 46] [Mental Health ($): 1776] [OP High Cost Drugs (%BC): 52.9] [All Other OP (%BC): 71.1]","count":"11","median_amount":707.11,"10th_percentile":707.11,"90th_percentile":1705.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":374.02,"10th_percentile":374.02,"90th_percentile":374.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.6,"count":"1 through 10","median_amount":904.63,"10th_percentile":633.7,"90th_percentile":1718.72},{"payer_name":"First Health/Coventry","plan_name":"First Health Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health-Intensive ($): 467.68] [Mental Health-Partial Hospitalization ($): 777.57] [OP ECT Mental Health ($): 1195.36] [APC ($): FEE SCHEDULE]","count":"23","median_amount":371.9,"10th_percentile":371.3,"90th_percentile":493.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":215.22,"10th_percentile":34.54,"90th_percentile":992.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"17","median_amount":374.82,"10th_percentile":367.33,"90th_percentile":495.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":298.94,"10th_percentile":220.61,"90th_percentile":545.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":383.12,"10th_percentile":383.12,"90th_percentile":383.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 4 Skin Procedures","code_information":[{"code":"5054","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [Mental Health-Intensive ($): 201] [Mental Health-Partial Hospitalization ($): 401] [All Other OP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1689.31,"10th_percentile":1689.31,"90th_percentile":1689.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.2] [Cardiac Cath (%BC): 71.1] [Lithotripsy (%BC): 71.1] [Observation (%BC): 71.1] [Emergency Department (%BC): 73.2] [Radiology (%BC): 71.1] [Laboratory (%BC): 26.1] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 71.1] [Speech Therapy (%BC): 46] [Mental Health ($): 1776] [OP High Cost Drugs (%BC): 52.9] [All Other OP (%BC): 71.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"First Health Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health-Intensive ($): 467.68] [Mental Health-Partial Hospitalization ($): 777.57] [OP ECT Mental Health ($): 1195.36] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"1 through 10","median_amount":10678.96,"10th_percentile":10678.96,"90th_percentile":10678.96},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2337.97,"10th_percentile":2337.97,"90th_percentile":2337.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":3276.52,"10th_percentile":3276.52,"90th_percentile":3276.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hyperbaric Oxygen","code_information":[{"code":"5061","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [Mental Health-Intensive ($): 201] [Mental Health-Partial Hospitalization ($): 401] [All Other OP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.2] [Cardiac Cath (%BC): 71.1] [Lithotripsy (%BC): 71.1] [Observation (%BC): 71.1] [Emergency Department (%BC): 73.2] [Radiology (%BC): 71.1] [Laboratory (%BC): 26.1] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 71.1] [Speech Therapy (%BC): 46] [Mental Health ($): 1776] [OP High Cost Drugs (%BC): 52.9] [All Other OP (%BC): 71.1]","count":"28","median_amount":2280.89,"10th_percentile":2280.89,"90th_percentile":2280.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"First Health Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health-Intensive ($): 467.68] [Mental Health-Partial Hospitalization ($): 777.57] [OP ECT Mental Health ($): 1195.36] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":512.2,"10th_percentile":512.2,"90th_percentile":883.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":507.14,"10th_percentile":507.14,"90th_percentile":874.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Excision/ Biopsy/ Incision and Drainage","code_information":[{"code":"5071","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [Mental Health-Intensive ($): 201] [Mental Health-Partial Hospitalization ($): 401] [All Other OP (%BC): 78]","count":"1 through 10","median_amount":766.51,"10th_percentile":766.51,"90th_percentile":904.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":434.4,"10th_percentile":434.4,"90th_percentile":434.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.2] [Cardiac Cath (%BC): 71.1] [Lithotripsy (%BC): 71.1] [Observation (%BC): 71.1] [Emergency Department (%BC): 73.2] [Radiology (%BC): 71.1] [Laboratory (%BC): 26.1] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 71.1] [Speech Therapy (%BC): 46] [Mental Health ($): 1776] [OP High Cost Drugs (%BC): 52.9] [All Other OP (%BC): 71.1]","count":"1 through 10","median_amount":2530.6,"10th_percentile":1963.22,"90th_percentile":16331.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.6,"count":"1 through 10","median_amount":2282.88,"10th_percentile":1631.36,"90th_percentile":6271.86},{"payer_name":"First Health/Coventry","plan_name":"First Health Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health-Intensive ($): 467.68] [Mental Health-Partial Hospitalization ($): 777.57] [OP ECT Mental Health ($): 1195.36] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":662.34,"10th_percentile":662.34,"90th_percentile":662.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"1 through 10","median_amount":2467.32,"10th_percentile":2467.32,"90th_percentile":2467.32},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":654.77,"10th_percentile":654.77,"90th_percentile":654.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Excision/ Biopsy/ Incision and Drainage","code_information":[{"code":"5072","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [Mental Health-Intensive ($): 201] [Mental Health-Partial Hospitalization ($): 401] [All Other OP (%BC): 78]","count":"12","median_amount":2091.62,"10th_percentile":125.14,"90th_percentile":7167.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2639.35,"10th_percentile":2639.35,"90th_percentile":2639.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.2] [Cardiac Cath (%BC): 71.1] [Lithotripsy (%BC): 71.1] [Observation (%BC): 71.1] [Emergency Department (%BC): 73.2] [Radiology (%BC): 71.1] [Laboratory (%BC): 26.1] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 71.1] [Speech Therapy (%BC): 46] [Mental Health ($): 1776] [OP High Cost Drugs (%BC): 52.9] [All Other OP (%BC): 71.1]","count":"18","median_amount":3654.56,"10th_percentile":3219.73,"90th_percentile":10736.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1513.01,"10th_percentile":1513.01,"90th_percentile":1513.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.6,"count":"1 through 10","median_amount":4932.47,"10th_percentile":4932.47,"90th_percentile":16623.39},{"payer_name":"First Health/Coventry","plan_name":"First Health Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health-Intensive ($): 467.68] [Mental Health-Partial Hospitalization ($): 777.57] [OP ECT Mental Health ($): 1195.36] [APC ($): FEE SCHEDULE]","count":"13","median_amount":1513.51,"10th_percentile":450.0,"90th_percentile":1519.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":1599.13,"10th_percentile":1599.13,"90th_percentile":1599.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"1 through 10","median_amount":3720.71,"10th_percentile":3720.71,"90th_percentile":8952.03},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1496.51,"10th_percentile":1495.69,"90th_percentile":1497.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1499.61,"10th_percentile":1499.61,"90th_percentile":1499.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 3 Excision/ Biopsy/ Incision and Drainage","code_information":[{"code":"5073","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [Mental Health-Intensive ($): 201] [Mental Health-Partial Hospitalization ($): 401] [All Other OP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.2] [Cardiac Cath (%BC): 71.1] [Lithotripsy (%BC): 71.1] [Observation (%BC): 71.1] [Emergency Department (%BC): 73.2] [Radiology (%BC): 71.1] [Laboratory (%BC): 26.1] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 71.1] [Speech Therapy (%BC): 46] [Mental Health ($): 1776] [OP High Cost Drugs (%BC): 52.9] [All Other OP (%BC): 71.1]","count":"1 through 10","median_amount":23193.98,"10th_percentile":12112.86,"90th_percentile":41836.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"First Health Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health-Intensive ($): 467.68] [Mental Health-Partial Hospitalization ($): 777.57] [OP ECT Mental Health ($): 1195.36] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":3213.36,"10th_percentile":1286.68,"90th_percentile":7900.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"1 through 10","median_amount":15473.97,"10th_percentile":15473.97,"90th_percentile":15473.97},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2645.9,"10th_percentile":2645.9,"90th_percentile":2645.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Breast/Lymphatic Surgery and Related Procedures","code_information":[{"code":"5091","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [Mental Health-Intensive ($): 201] [Mental Health-Partial Hospitalization ($): 401] [All Other OP (%BC): 78]","count":"1 through 10","median_amount":2841.54,"10th_percentile":2841.54,"90th_percentile":2841.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.2] [Cardiac Cath (%BC): 71.1] [Lithotripsy (%BC): 71.1] [Observation (%BC): 71.1] [Emergency Department (%BC): 73.2] [Radiology (%BC): 71.1] [Laboratory (%BC): 26.1] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 71.1] [Speech Therapy (%BC): 46] [Mental Health ($): 1776] [OP High Cost Drugs (%BC): 52.9] [All Other OP (%BC): 71.1]","count":"1 through 10","median_amount":24127.96,"10th_percentile":23905.85,"90th_percentile":35732.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3528.55,"10th_percentile":3528.55,"90th_percentile":3528.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.6,"count":"1 through 10","median_amount":22707.05,"10th_percentile":22707.05,"90th_percentile":22707.05},{"payer_name":"First Health/Coventry","plan_name":"First Health Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health-Intensive ($): 467.68] [Mental Health-Partial Hospitalization ($): 777.57] [OP ECT Mental Health ($): 1195.36] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3566.81,"10th_percentile":3566.81,"90th_percentile":6072.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":8413.79,"10th_percentile":8413.79,"90th_percentile":8413.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"1 through 10","median_amount":14061.81,"10th_percentile":14061.81,"90th_percentile":14061.81},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6003.58,"10th_percentile":6003.58,"90th_percentile":6003.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Breast/Lymphatic Surgery and Related Procedures","code_information":[{"code":"5092","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [Mental Health-Intensive ($): 201] [Mental Health-Partial Hospitalization ($): 401] [All Other OP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.2] [Cardiac Cath (%BC): 71.1] [Lithotripsy (%BC): 71.1] [Observation (%BC): 71.1] [Emergency Department (%BC): 73.2] [Radiology (%BC): 71.1] [Laboratory (%BC): 26.1] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 71.1] [Speech Therapy (%BC): 46] [Mental Health ($): 1776] [OP High Cost Drugs (%BC): 52.9] [All Other OP (%BC): 71.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.6,"count":"1 through 10","median_amount":23993.17,"10th_percentile":23993.17,"90th_percentile":23993.17},{"payer_name":"First Health/Coventry","plan_name":"First Health Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health-Intensive ($): 467.68] [Mental Health-Partial Hospitalization ($): 777.57] [OP ECT Mental Health ($): 1195.36] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6003.18,"10th_percentile":6003.18,"90th_percentile":6003.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Strapping and Cast Application","code_information":[{"code":"5101","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [Mental Health-Intensive ($): 201] [Mental Health-Partial Hospitalization ($): 401] [All Other OP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":469.44,"10th_percentile":389.01,"90th_percentile":873.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.2] [Cardiac Cath (%BC): 71.1] [Lithotripsy (%BC): 71.1] [Observation (%BC): 71.1] [Emergency Department (%BC): 73.2] [Radiology (%BC): 71.1] [Laboratory (%BC): 26.1] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 71.1] [Speech Therapy (%BC): 46] [Mental Health ($): 1776] [OP High Cost Drugs (%BC): 52.9] [All Other OP (%BC): 71.1]","count":"1 through 10","median_amount":1278.07,"10th_percentile":1278.07,"90th_percentile":1278.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":148.03,"10th_percentile":148.03,"90th_percentile":266.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"First Health Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health-Intensive ($): 467.68] [Mental Health-Partial Hospitalization ($): 777.57] [OP ECT Mental Health ($): 1195.36] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":147.12,"10th_percentile":146.82,"90th_percentile":147.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":583.52,"10th_percentile":583.52,"90th_percentile":583.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":145.67,"10th_percentile":145.67,"90th_percentile":148.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Strapping and Cast Application","code_information":[{"code":"5102","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [Mental Health-Intensive ($): 201] [Mental Health-Partial Hospitalization ($): 401] [All Other OP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":282.29,"10th_percentile":173.79,"90th_percentile":525.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.2] [Cardiac Cath (%BC): 71.1] [Lithotripsy (%BC): 71.1] [Observation (%BC): 71.1] [Emergency Department (%BC): 73.2] [Radiology (%BC): 71.1] [Laboratory (%BC): 26.1] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 71.1] [Speech Therapy (%BC): 46] [Mental Health ($): 1776] [OP High Cost Drugs (%BC): 52.9] [All Other OP (%BC): 71.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"First Health Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health-Intensive ($): 467.68] [Mental Health-Partial Hospitalization ($): 777.57] [OP ECT Mental Health ($): 1195.36] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Musculoskeletal Procedures","code_information":[{"code":"5112","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [Mental Health-Intensive ($): 201] [Mental Health-Partial Hospitalization ($): 401] [All Other OP (%BC): 78]","count":"1 through 10","median_amount":12420.85,"10th_percentile":8625.63,"90th_percentile":16053.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1478.86,"10th_percentile":1478.86,"90th_percentile":1478.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":3254.4,"10th_percentile":3254.4,"90th_percentile":3254.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.2] [Cardiac Cath (%BC): 71.1] [Lithotripsy (%BC): 71.1] [Observation (%BC): 71.1] [Emergency Department (%BC): 73.2] [Radiology (%BC): 71.1] [Laboratory (%BC): 26.1] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 71.1] [Speech Therapy (%BC): 46] [Mental Health ($): 1776] [OP High Cost Drugs (%BC): 52.9] [All Other OP (%BC): 71.1]","count":"1 through 10","median_amount":10700.61,"10th_percentile":10203.02,"90th_percentile":11945.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1478.08,"10th_percentile":1478.08,"90th_percentile":1478.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.6,"count":"1 through 10","median_amount":10015.15,"10th_percentile":10015.15,"90th_percentile":11769.21},{"payer_name":"First Health/Coventry","plan_name":"First Health Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health-Intensive ($): 467.68] [Mental Health-Partial Hospitalization ($): 777.57] [OP ECT Mental Health ($): 1195.36] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1495.09,"10th_percentile":1495.09,"90th_percentile":1498.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"1 through 10","median_amount":8090.04,"10th_percentile":8090.04,"90th_percentile":8090.04},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1477.39,"10th_percentile":1477.39,"90th_percentile":1477.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Musculoskeletal Procedures","code_information":[{"code":"5113","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [Mental Health-Intensive ($): 201] [Mental Health-Partial Hospitalization ($): 401] [All Other OP (%BC): 78]","count":"1 through 10","median_amount":20545.11,"10th_percentile":6122.3,"90th_percentile":26244.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":5912.27,"10th_percentile":5912.27,"90th_percentile":5912.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.2] [Cardiac Cath (%BC): 71.1] [Lithotripsy (%BC): 71.1] [Observation (%BC): 71.1] [Emergency Department (%BC): 73.2] [Radiology (%BC): 71.1] [Laboratory (%BC): 26.1] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 71.1] [Speech Therapy (%BC): 46] [Mental Health ($): 1776] [OP High Cost Drugs (%BC): 52.9] [All Other OP (%BC): 71.1]","count":"11","median_amount":16518.68,"10th_percentile":8880.21,"90th_percentile":22573.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3186.8,"10th_percentile":3186.8,"90th_percentile":13545.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.6,"count":"1 through 10","median_amount":29750.1,"10th_percentile":29750.1,"90th_percentile":29750.1},{"payer_name":"First Health/Coventry","plan_name":"First Health Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health-Intensive ($): 467.68] [Mental Health-Partial Hospitalization ($): 777.57] [OP ECT Mental Health ($): 1195.36] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3219.46,"10th_percentile":3219.46,"90th_percentile":3219.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":6266.26,"10th_percentile":6266.26,"90th_percentile":6266.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"1 through 10","median_amount":24257.98,"10th_percentile":24257.98,"90th_percentile":24257.98},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3181.53,"10th_percentile":3181.53,"90th_percentile":3181.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":7326.59,"10th_percentile":7326.59,"90th_percentile":7326.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 4 Musculoskeletal Procedures","code_information":[{"code":"5114","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [Mental Health-Intensive ($): 201] [Mental Health-Partial Hospitalization ($): 401] [All Other OP (%BC): 78]","count":"1 through 10","median_amount":23021.92,"10th_percentile":2287.52,"90th_percentile":39779.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":9946.48,"10th_percentile":9946.48,"90th_percentile":15295.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":12312.1,"10th_percentile":12312.1,"90th_percentile":12312.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":10391.21,"10th_percentile":7001.04,"90th_percentile":23373.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.2] [Cardiac Cath (%BC): 71.1] [Lithotripsy (%BC): 71.1] [Observation (%BC): 71.1] [Emergency Department (%BC): 73.2] [Radiology (%BC): 71.1] [Laboratory (%BC): 26.1] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 71.1] [Speech Therapy (%BC): 46] [Mental Health ($): 1776] [OP High Cost Drugs (%BC): 52.9] [All Other OP (%BC): 71.1]","count":"21","median_amount":30765.63,"10th_percentile":18003.69,"90th_percentile":44998.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":12613.18,"10th_percentile":11715.53,"90th_percentile":12898.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.6,"count":"1 through 10","median_amount":42195.67,"10th_percentile":28735.24,"90th_percentile":45295.32},{"payer_name":"First Health/Coventry","plan_name":"First Health Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health-Intensive ($): 467.68] [Mental Health-Partial Hospitalization ($): 777.57] [OP ECT Mental Health ($): 1195.36] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":9947.82,"10th_percentile":9619.96,"90th_percentile":13354.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":14847.65,"10th_percentile":14847.65,"90th_percentile":14847.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":10821.18,"10th_percentile":10821.18,"90th_percentile":10821.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":12013.07,"10th_percentile":12013.07,"90th_percentile":12013.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 5 Musculoskeletal Procedures","code_information":[{"code":"5115","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [Mental Health-Intensive ($): 201] [Mental Health-Partial Hospitalization ($): 401] [All Other OP (%BC): 78]","count":"1 through 10","median_amount":31590.0,"10th_percentile":686.78,"90th_percentile":65347.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":15339.41,"10th_percentile":13787.89,"90th_percentile":28889.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":18035.69,"10th_percentile":18035.69,"90th_percentile":18035.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.2] [Cardiac Cath (%BC): 71.1] [Lithotripsy (%BC): 71.1] [Observation (%BC): 71.1] [Emergency Department (%BC): 73.2] [Radiology (%BC): 71.1] [Laboratory (%BC): 26.1] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 71.1] [Speech Therapy (%BC): 46] [Mental Health ($): 1776] [OP High Cost Drugs (%BC): 52.9] [All Other OP (%BC): 71.1]","count":"24","median_amount":54413.57,"10th_percentile":38501.92,"90th_percentile":59245.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":16855.47,"10th_percentile":15719.39,"90th_percentile":17848.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.6,"count":"1 through 10","median_amount":57218.3,"10th_percentile":57218.3,"90th_percentile":57218.3},{"payer_name":"First Health/Coventry","plan_name":"First Health Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health-Intensive ($): 467.68] [Mental Health-Partial Hospitalization ($): 777.57] [OP ECT Mental Health ($): 1195.36] [APC ($): FEE SCHEDULE]","count":"16","median_amount":15838.39,"10th_percentile":14190.4,"90th_percentile":18550.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":19231.56,"10th_percentile":19231.56,"90th_percentile":19420.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"1 through 10","median_amount":59158.47,"10th_percentile":59158.47,"90th_percentile":59158.47},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":16390.72,"10th_percentile":15563.88,"90th_percentile":20843.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":20409.67,"10th_percentile":20409.67,"90th_percentile":20409.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 6 Musculoskeletal Procedures","code_information":[{"code":"5116","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [Mental Health-Intensive ($): 201] [Mental Health-Partial Hospitalization ($): 401] [All Other OP (%BC): 78]","count":"1 through 10","median_amount":31255.59,"10th_percentile":31255.59,"90th_percentile":68120.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":366.11,"10th_percentile":366.11,"90th_percentile":366.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.2] [Cardiac Cath (%BC): 71.1] [Lithotripsy (%BC): 71.1] [Observation (%BC): 71.1] [Emergency Department (%BC): 73.2] [Radiology (%BC): 71.1] [Laboratory (%BC): 26.1] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 71.1] [Speech Therapy (%BC): 46] [Mental Health ($): 1776] [OP High Cost Drugs (%BC): 52.9] [All Other OP (%BC): 71.1]","count":"1 through 10","median_amount":92184.17,"10th_percentile":92184.17,"90th_percentile":92184.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":21847.66,"10th_percentile":21847.66,"90th_percentile":21847.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"First Health Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health-Intensive ($): 467.68] [Mental Health-Partial Hospitalization ($): 777.57] [OP ECT Mental Health ($): 1195.36] [APC ($): FEE SCHEDULE]","count":"11","median_amount":22274.07,"10th_percentile":19541.87,"90th_percentile":22796.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":25282.67,"10th_percentile":25282.67,"90th_percentile":25282.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Airway Endoscopy","code_information":[{"code":"5151","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [Mental Health-Intensive ($): 201] [Mental Health-Partial Hospitalization ($): 401] [All Other OP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":84.62,"10th_percentile":50.41,"90th_percentile":135.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"19","median_amount":83.78,"10th_percentile":83.78,"90th_percentile":133.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.2] [Cardiac Cath (%BC): 71.1] [Lithotripsy (%BC): 71.1] [Observation (%BC): 71.1] [Emergency Department (%BC): 73.2] [Radiology (%BC): 71.1] [Laboratory (%BC): 26.1] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 71.1] [Speech Therapy (%BC): 46] [Mental Health ($): 1776] [OP High Cost Drugs (%BC): 52.9] [All Other OP (%BC): 71.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"First Health Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health-Intensive ($): 467.68] [Mental Health-Partial Hospitalization ($): 777.57] [OP ECT Mental Health ($): 1195.36] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"15","median_amount":33.87,"10th_percentile":33.87,"90th_percentile":151.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":85.86,"10th_percentile":85.86,"90th_percentile":85.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Airway Endoscopy","code_information":[{"code":"5153","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [Mental Health-Intensive ($): 201] [Mental Health-Partial Hospitalization ($): 401] [All Other OP (%BC): 78]","count":"1 through 10","median_amount":8578.45,"10th_percentile":8578.45,"90th_percentile":8578.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1589.28,"10th_percentile":1589.28,"90th_percentile":1589.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":899.66,"10th_percentile":899.66,"90th_percentile":3196.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.2] [Cardiac Cath (%BC): 71.1] [Lithotripsy (%BC): 71.1] [Observation (%BC): 71.1] [Emergency Department (%BC): 73.2] [Radiology (%BC): 71.1] [Laboratory (%BC): 26.1] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 71.1] [Speech Therapy (%BC): 46] [Mental Health ($): 1776] [OP High Cost Drugs (%BC): 52.9] [All Other OP (%BC): 71.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"First Health Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health-Intensive ($): 467.68] [Mental Health-Partial Hospitalization ($): 777.57] [OP ECT Mental Health ($): 1195.36] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 4 Airway Endoscopy","code_information":[{"code":"5154","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [Mental Health-Intensive ($): 201] [Mental Health-Partial Hospitalization ($): 401] [All Other OP (%BC): 78]","count":"1 through 10","median_amount":11970.48,"10th_percentile":11970.48,"90th_percentile":11970.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.2] [Cardiac Cath (%BC): 71.1] [Lithotripsy (%BC): 71.1] [Observation (%BC): 71.1] [Emergency Department (%BC): 73.2] [Radiology (%BC): 71.1] [Laboratory (%BC): 26.1] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 71.1] [Speech Therapy (%BC): 46] [Mental Health ($): 1776] [OP High Cost Drugs (%BC): 52.9] [All Other OP (%BC): 71.1]","count":"1 through 10","median_amount":9802.29,"10th_percentile":9802.29,"90th_percentile":9802.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"First Health Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health-Intensive ($): 467.68] [Mental Health-Partial Hospitalization ($): 777.57] [OP ECT Mental Health ($): 1195.36] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3432.6,"10th_percentile":3432.6,"90th_percentile":6437.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"1 through 10","median_amount":11471.63,"10th_percentile":11471.63,"90th_percentile":11471.63},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3396.81,"10th_percentile":3396.81,"90th_percentile":6494.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 5 Airway Endoscopy","code_information":[{"code":"5155","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [Mental Health-Intensive ($): 201] [Mental Health-Partial Hospitalization ($): 401] [All Other OP (%BC): 78]","count":"1 through 10","median_amount":13003.0,"10th_percentile":13003.0,"90th_percentile":13003.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.2] [Cardiac Cath (%BC): 71.1] [Lithotripsy (%BC): 71.1] [Observation (%BC): 71.1] [Emergency Department (%BC): 73.2] [Radiology (%BC): 71.1] [Laboratory (%BC): 26.1] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 71.1] [Speech Therapy (%BC): 46] [Mental Health ($): 1776] [OP High Cost Drugs (%BC): 52.9] [All Other OP (%BC): 71.1]","count":"1 through 10","median_amount":25935.82,"10th_percentile":16149.45,"90th_percentile":33383.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"First Health Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health-Intensive ($): 467.68] [Mental Health-Partial Hospitalization ($): 777.57] [OP ECT Mental Health ($): 1195.36] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":14818.57,"10th_percentile":14818.57,"90th_percentile":14818.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6371.37,"10th_percentile":6371.37,"90th_percentile":6371.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":7400.22,"10th_percentile":7400.22,"90th_percentile":7400.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 ENT Procedures","code_information":[{"code":"5161","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [Mental Health-Intensive ($): 201] [Mental Health-Partial Hospitalization ($): 401] [All Other OP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.2] [Cardiac Cath (%BC): 71.1] [Lithotripsy (%BC): 71.1] [Observation (%BC): 71.1] [Emergency Department (%BC): 73.2] [Radiology (%BC): 71.1] [Laboratory (%BC): 26.1] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 71.1] [Speech Therapy (%BC): 46] [Mental Health ($): 1776] [OP High Cost Drugs (%BC): 52.9] [All Other OP (%BC): 71.1]","count":"1 through 10","median_amount":18864.35,"10th_percentile":18864.35,"90th_percentile":18864.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"First Health Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health-Intensive ($): 467.68] [Mental Health-Partial Hospitalization ($): 777.57] [OP ECT Mental Health ($): 1195.36] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 ENT Procedures","code_information":[{"code":"5162","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [Mental Health-Intensive ($): 201] [Mental Health-Partial Hospitalization ($): 401] [All Other OP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":37.64,"10th_percentile":37.64,"90th_percentile":37.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.2] [Cardiac Cath (%BC): 71.1] [Lithotripsy (%BC): 71.1] [Observation (%BC): 71.1] [Emergency Department (%BC): 73.2] [Radiology (%BC): 71.1] [Laboratory (%BC): 26.1] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 71.1] [Speech Therapy (%BC): 46] [Mental Health ($): 1776] [OP High Cost Drugs (%BC): 52.9] [All Other OP (%BC): 71.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":959.84,"10th_percentile":959.84,"90th_percentile":959.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"First Health Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health-Intensive ($): 467.68] [Mental Health-Partial Hospitalization ($): 777.57] [OP ECT Mental Health ($): 1195.36] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 ENT Procedures","code_information":[{"code":"5163","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [Mental Health-Intensive ($): 201] [Mental Health-Partial Hospitalization ($): 401] [All Other OP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":2574.86,"10th_percentile":2574.86,"90th_percentile":2574.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.2] [Cardiac Cath (%BC): 71.1] [Lithotripsy (%BC): 71.1] [Observation (%BC): 71.1] [Emergency Department (%BC): 73.2] [Radiology (%BC): 71.1] [Laboratory (%BC): 26.1] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 71.1] [Speech Therapy (%BC): 46] [Mental Health ($): 1776] [OP High Cost Drugs (%BC): 52.9] [All Other OP (%BC): 71.1]","count":"1 through 10","median_amount":8993.0,"10th_percentile":8993.0,"90th_percentile":9021.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"First Health Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health-Intensive ($): 467.68] [Mental Health-Partial Hospitalization ($): 777.57] [OP ECT Mental Health ($): 1195.36] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1377.68,"10th_percentile":1377.68,"90th_percentile":1377.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":3293.5,"10th_percentile":3293.5,"90th_percentile":3293.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"1 through 10","median_amount":13805.37,"10th_percentile":13805.37,"90th_percentile":13805.37},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 4 ENT Procedures","code_information":[{"code":"5164","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [Mental Health-Intensive ($): 201] [Mental Health-Partial Hospitalization ($): 401] [All Other OP (%BC): 78]","count":"1 through 10","median_amount":12294.99,"10th_percentile":12294.99,"90th_percentile":12294.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2981.6,"10th_percentile":2981.6,"90th_percentile":2981.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":3565.53,"10th_percentile":3565.53,"90th_percentile":3565.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":4658.71,"10th_percentile":4658.71,"90th_percentile":4658.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.2] [Cardiac Cath (%BC): 71.1] [Lithotripsy (%BC): 71.1] [Observation (%BC): 71.1] [Emergency Department (%BC): 73.2] [Radiology (%BC): 71.1] [Laboratory (%BC): 26.1] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 71.1] [Speech Therapy (%BC): 46] [Mental Health ($): 1776] [OP High Cost Drugs (%BC): 52.9] [All Other OP (%BC): 71.1]","count":"1 through 10","median_amount":10395.39,"10th_percentile":10395.39,"90th_percentile":11415.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"First Health Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health-Intensive ($): 467.68] [Mental Health-Partial Hospitalization ($): 777.57] [OP ECT Mental Health ($): 1195.36] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3020.41,"10th_percentile":3020.41,"90th_percentile":3020.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":3249.41,"10th_percentile":3249.41,"90th_percentile":3249.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 5 ENT Procedures","code_information":[{"code":"5165","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [Mental Health-Intensive ($): 201] [Mental Health-Partial Hospitalization ($): 401] [All Other OP (%BC): 78]","count":"1 through 10","median_amount":2405.52,"10th_percentile":2405.52,"90th_percentile":36445.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":3600.85,"10th_percentile":3557.76,"90th_percentile":4136.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":6532.49,"10th_percentile":6532.49,"90th_percentile":7645.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.2] [Cardiac Cath (%BC): 71.1] [Lithotripsy (%BC): 71.1] [Observation (%BC): 71.1] [Emergency Department (%BC): 73.2] [Radiology (%BC): 71.1] [Laboratory (%BC): 26.1] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 71.1] [Speech Therapy (%BC): 46] [Mental Health ($): 1776] [OP High Cost Drugs (%BC): 52.9] [All Other OP (%BC): 71.1]","count":"1 through 10","median_amount":18711.03,"10th_percentile":18711.03,"90th_percentile":21323.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5460.92,"10th_percentile":5460.92,"90th_percentile":5460.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"First Health Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health-Intensive ($): 467.68] [Mental Health-Partial Hospitalization ($): 777.57] [OP ECT Mental Health ($): 1195.36] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5498.12,"10th_percentile":5498.12,"90th_percentile":5498.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":3298.88,"10th_percentile":3298.88,"90th_percentile":3298.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"1 through 10","median_amount":22336.24,"10th_percentile":22336.24,"90th_percentile":26402.48},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":5596.95,"10th_percentile":5596.95,"90th_percentile":5596.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Vascular Procedures","code_information":[{"code":"5181","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [Mental Health-Intensive ($): 201] [Mental Health-Partial Hospitalization ($): 401] [All Other OP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.2] [Cardiac Cath (%BC): 71.1] [Lithotripsy (%BC): 71.1] [Observation (%BC): 71.1] [Emergency Department (%BC): 73.2] [Radiology (%BC): 71.1] [Laboratory (%BC): 26.1] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 71.1] [Speech Therapy (%BC): 46] [Mental Health ($): 1776] [OP High Cost Drugs (%BC): 52.9] [All Other OP (%BC): 71.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"First Health Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health-Intensive ($): 467.68] [Mental Health-Partial Hospitalization ($): 777.57] [OP ECT Mental Health ($): 1195.36] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":664.85,"10th_percentile":664.85,"90th_percentile":664.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Vascular Procedures","code_information":[{"code":"5182","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [Mental Health-Intensive ($): 201] [Mental Health-Partial Hospitalization ($): 401] [All Other OP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":414.41,"10th_percentile":414.41,"90th_percentile":414.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.2] [Cardiac Cath (%BC): 71.1] [Lithotripsy (%BC): 71.1] [Observation (%BC): 71.1] [Emergency Department (%BC): 73.2] [Radiology (%BC): 71.1] [Laboratory (%BC): 26.1] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 71.1] [Speech Therapy (%BC): 46] [Mental Health ($): 1776] [OP High Cost Drugs (%BC): 52.9] [All Other OP (%BC): 71.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"First Health Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health-Intensive ($): 467.68] [Mental Health-Partial Hospitalization ($): 777.57] [OP ECT Mental Health ($): 1195.36] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Vascular Procedures","code_information":[{"code":"5183","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [Mental Health-Intensive ($): 201] [Mental Health-Partial Hospitalization ($): 401] [All Other OP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2899.74,"10th_percentile":2899.74,"90th_percentile":2899.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":3658.28,"10th_percentile":3658.28,"90th_percentile":3658.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.2] [Cardiac Cath (%BC): 71.1] [Lithotripsy (%BC): 71.1] [Observation (%BC): 71.1] [Emergency Department (%BC): 73.2] [Radiology (%BC): 71.1] [Laboratory (%BC): 26.1] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 71.1] [Speech Therapy (%BC): 46] [Mental Health ($): 1776] [OP High Cost Drugs (%BC): 52.9] [All Other OP (%BC): 71.1]","count":"1 through 10","median_amount":13775.67,"10th_percentile":13775.67,"90th_percentile":16600.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"First Health Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health-Intensive ($): 467.68] [Mental Health-Partial Hospitalization ($): 777.57] [OP ECT Mental Health ($): 1195.36] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2935.46,"10th_percentile":2935.46,"90th_percentile":2935.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2897.61,"10th_percentile":2897.61,"90th_percentile":2897.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Pacemaker and Similar Procedures","code_information":[{"code":"5222","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [Mental Health-Intensive ($): 201] [Mental Health-Partial Hospitalization ($): 401] [All Other OP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.2] [Cardiac Cath (%BC): 71.1] [Lithotripsy (%BC): 71.1] [Observation (%BC): 71.1] [Emergency Department (%BC): 73.2] [Radiology (%BC): 71.1] [Laboratory (%BC): 26.1] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 71.1] [Speech Therapy (%BC): 46] [Mental Health ($): 1776] [OP High Cost Drugs (%BC): 52.9] [All Other OP (%BC): 71.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"First Health Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health-Intensive ($): 467.68] [Mental Health-Partial Hospitalization ($): 777.57] [OP ECT Mental Health ($): 1195.36] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":7617.45,"10th_percentile":7617.45,"90th_percentile":7617.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Blood Product Exchange and Related Services","code_information":[{"code":"5241","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [Mental Health-Intensive ($): 201] [Mental Health-Partial Hospitalization ($): 401] [All Other OP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.2] [Cardiac Cath (%BC): 71.1] [Lithotripsy (%BC): 71.1] [Observation (%BC): 71.1] [Emergency Department (%BC): 73.2] [Radiology (%BC): 71.1] [Laboratory (%BC): 26.1] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 71.1] [Speech Therapy (%BC): 46] [Mental Health ($): 1776] [OP High Cost Drugs (%BC): 52.9] [All Other OP (%BC): 71.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"First Health Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health-Intensive ($): 467.68] [Mental Health-Partial Hospitalization ($): 777.57] [OP ECT Mental Health ($): 1195.36] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":588.5,"10th_percentile":588.5,"90th_percentile":588.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":655.47,"10th_percentile":655.47,"90th_percentile":655.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":816.44,"10th_percentile":816.44,"90th_percentile":816.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Upper GI Procedures","code_information":[{"code":"5301","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [Mental Health-Intensive ($): 201] [Mental Health-Partial Hospitalization ($): 401] [All Other OP (%BC): 78]","count":"1 through 10","median_amount":1606.94,"10th_percentile":1306.73,"90th_percentile":7434.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2551.47,"10th_percentile":2551.47,"90th_percentile":2551.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":2507.26,"10th_percentile":2507.26,"90th_percentile":2507.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.2] [Cardiac Cath (%BC): 71.1] [Lithotripsy (%BC): 71.1] [Observation (%BC): 71.1] [Emergency Department (%BC): 73.2] [Radiology (%BC): 71.1] [Laboratory (%BC): 26.1] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 71.1] [Speech Therapy (%BC): 46] [Mental Health ($): 1776] [OP High Cost Drugs (%BC): 52.9] [All Other OP (%BC): 71.1]","count":"1 through 10","median_amount":7753.17,"10th_percentile":7753.17,"90th_percentile":10009.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2935.55,"10th_percentile":2935.55,"90th_percentile":2935.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"First Health Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health-Intensive ($): 467.68] [Mental Health-Partial Hospitalization ($): 777.57] [OP ECT Mental Health ($): 1195.36] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":879.59,"10th_percentile":875.59,"90th_percentile":1314.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":885.04,"10th_percentile":885.04,"90th_percentile":885.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Upper GI Procedures","code_information":[{"code":"5302","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [Mental Health-Intensive ($): 201] [Mental Health-Partial Hospitalization ($): 401] [All Other OP (%BC): 78]","count":"1 through 10","median_amount":9803.8,"10th_percentile":9803.8,"90th_percentile":9803.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1974.55,"10th_percentile":1974.55,"90th_percentile":1974.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.2] [Cardiac Cath (%BC): 71.1] [Lithotripsy (%BC): 71.1] [Observation (%BC): 71.1] [Emergency Department (%BC): 73.2] [Radiology (%BC): 71.1] [Laboratory (%BC): 26.1] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 71.1] [Speech Therapy (%BC): 46] [Mental Health ($): 1776] [OP High Cost Drugs (%BC): 52.9] [All Other OP (%BC): 71.1]","count":"1 through 10","median_amount":8282.54,"10th_percentile":4531.48,"90th_percentile":18330.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1750.75,"10th_percentile":1750.75,"90th_percentile":1750.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"First Health Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health-Intensive ($): 467.68] [Mental Health-Partial Hospitalization ($): 777.57] [OP ECT Mental Health ($): 1195.36] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1766.49,"10th_percentile":1766.49,"90th_percentile":1770.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"1 through 10","median_amount":5626.33,"10th_percentile":5626.33,"90th_percentile":5626.33},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1779.64,"10th_percentile":1779.64,"90th_percentile":5408.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1744.05,"10th_percentile":1744.05,"90th_percentile":1744.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 3 Upper GI Procedures","code_information":[{"code":"5303","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [Mental Health-Intensive ($): 201] [Mental Health-Partial Hospitalization ($): 401] [All Other OP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.2] [Cardiac Cath (%BC): 71.1] [Lithotripsy (%BC): 71.1] [Observation (%BC): 71.1] [Emergency Department (%BC): 73.2] [Radiology (%BC): 71.1] [Laboratory (%BC): 26.1] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 71.1] [Speech Therapy (%BC): 46] [Mental Health ($): 1776] [OP High Cost Drugs (%BC): 52.9] [All Other OP (%BC): 71.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"First Health Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health-Intensive ($): 467.68] [Mental Health-Partial Hospitalization ($): 777.57] [OP ECT Mental Health ($): 1195.36] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3545.66,"10th_percentile":3545.66,"90th_percentile":3545.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Lower GI Procedures","code_information":[{"code":"5311","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [Mental Health-Intensive ($): 201] [Mental Health-Partial Hospitalization ($): 401] [All Other OP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.2] [Cardiac Cath (%BC): 71.1] [Lithotripsy (%BC): 71.1] [Observation (%BC): 71.1] [Emergency Department (%BC): 73.2] [Radiology (%BC): 71.1] [Laboratory (%BC): 26.1] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 71.1] [Speech Therapy (%BC): 46] [Mental Health ($): 1776] [OP High Cost Drugs (%BC): 52.9] [All Other OP (%BC): 71.1]","count":"1 through 10","median_amount":7212.35,"10th_percentile":7212.35,"90th_percentile":7212.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"First Health Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health-Intensive ($): 467.68] [Mental Health-Partial Hospitalization ($): 777.57] [OP ECT Mental Health ($): 1195.36] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":851.58,"10th_percentile":851.58,"90th_percentile":851.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":863.17,"10th_percentile":863.17,"90th_percentile":863.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":678.27,"10th_percentile":678.27,"90th_percentile":678.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Lower GI Procedures","code_information":[{"code":"5312","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [Mental Health-Intensive ($): 201] [Mental Health-Partial Hospitalization ($): 401] [All Other OP (%BC): 78]","count":"1 through 10","median_amount":8135.38,"10th_percentile":2529.15,"90th_percentile":10807.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2229.74,"10th_percentile":1084.24,"90th_percentile":19924.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":2239.87,"10th_percentile":2239.87,"90th_percentile":2239.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.2] [Cardiac Cath (%BC): 71.1] [Lithotripsy (%BC): 71.1] [Observation (%BC): 71.1] [Emergency Department (%BC): 73.2] [Radiology (%BC): 71.1] [Laboratory (%BC): 26.1] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 71.1] [Speech Therapy (%BC): 46] [Mental Health ($): 1776] [OP High Cost Drugs (%BC): 52.9] [All Other OP (%BC): 71.1]","count":"1 through 10","median_amount":6596.29,"10th_percentile":4467.54,"90th_percentile":8629.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1632.73,"10th_percentile":1632.73,"90th_percentile":1632.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.6,"count":"1 through 10","median_amount":6390.95,"10th_percentile":6390.95,"90th_percentile":6390.95},{"payer_name":"First Health/Coventry","plan_name":"First Health Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health-Intensive ($): 467.68] [Mental Health-Partial Hospitalization ($): 777.57] [OP ECT Mental Health ($): 1195.36] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1530.16,"10th_percentile":1094.86,"90th_percentile":1541.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":2607.94,"10th_percentile":2607.94,"90th_percentile":2607.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"1 through 10","median_amount":8092.43,"10th_percentile":8092.43,"90th_percentile":8092.43},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1515.01,"10th_percentile":1515.01,"90th_percentile":1515.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Lower GI Procedures","code_information":[{"code":"5313","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [Mental Health-Intensive ($): 201] [Mental Health-Partial Hospitalization ($): 401] [All Other OP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.2] [Cardiac Cath (%BC): 71.1] [Lithotripsy (%BC): 71.1] [Observation (%BC): 71.1] [Emergency Department (%BC): 73.2] [Radiology (%BC): 71.1] [Laboratory (%BC): 26.1] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 71.1] [Speech Therapy (%BC): 46] [Mental Health ($): 1776] [OP High Cost Drugs (%BC): 52.9] [All Other OP (%BC): 71.1]","count":"1 through 10","median_amount":15318.19,"10th_percentile":15318.19,"90th_percentile":20336.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"First Health Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health-Intensive ($): 467.68] [Mental Health-Partial Hospitalization ($): 777.57] [OP ECT Mental Health ($): 1195.36] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Abdominal/Peritoneal/Biliary and Related Procedures","code_information":[{"code":"5341","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [Mental Health-Intensive ($): 201] [Mental Health-Partial Hospitalization ($): 401] [All Other OP (%BC): 78]","count":"1 through 10","median_amount":14814.16,"10th_percentile":14814.16,"90th_percentile":17543.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3439.13,"10th_percentile":3439.13,"90th_percentile":3439.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":5048.47,"10th_percentile":5048.47,"90th_percentile":5048.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.2] [Cardiac Cath (%BC): 71.1] [Lithotripsy (%BC): 71.1] [Observation (%BC): 71.1] [Emergency Department (%BC): 73.2] [Radiology (%BC): 71.1] [Laboratory (%BC): 26.1] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 71.1] [Speech Therapy (%BC): 46] [Mental Health ($): 1776] [OP High Cost Drugs (%BC): 52.9] [All Other OP (%BC): 71.1]","count":"1 through 10","median_amount":16125.54,"10th_percentile":12649.94,"90th_percentile":29196.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5864.37,"10th_percentile":5864.37,"90th_percentile":5864.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"First Health Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health-Intensive ($): 467.68] [Mental Health-Partial Hospitalization ($): 777.57] [OP ECT Mental Health ($): 1195.36] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6001.42,"10th_percentile":6001.42,"90th_percentile":6001.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":9428.04,"10th_percentile":9428.04,"90th_percentile":9428.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"1 through 10","median_amount":19692.71,"10th_percentile":19692.71,"90th_percentile":21057.68},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3633.74,"10th_percentile":3633.74,"90th_percentile":3633.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Abdominal/Peritoneal/Biliary and Related Procedures","code_information":[{"code":"5342","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [Mental Health-Intensive ($): 201] [Mental Health-Partial Hospitalization ($): 401] [All Other OP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6128.86,"10th_percentile":6128.86,"90th_percentile":6128.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.2] [Cardiac Cath (%BC): 71.1] [Lithotripsy (%BC): 71.1] [Observation (%BC): 71.1] [Emergency Department (%BC): 73.2] [Radiology (%BC): 71.1] [Laboratory (%BC): 26.1] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 71.1] [Speech Therapy (%BC): 46] [Mental Health ($): 1776] [OP High Cost Drugs (%BC): 52.9] [All Other OP (%BC): 71.1]","count":"1 through 10","median_amount":19659.05,"10th_percentile":19659.05,"90th_percentile":19659.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"First Health Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health-Intensive ($): 467.68] [Mental Health-Partial Hospitalization ($): 777.57] [OP ECT Mental Health ($): 1195.36] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6128.59,"10th_percentile":6128.59,"90th_percentile":6128.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Laparoscopy and Related Services","code_information":[{"code":"5361","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [Mental Health-Intensive ($): 201] [Mental Health-Partial Hospitalization ($): 401] [All Other OP (%BC): 78]","count":"1 through 10","median_amount":7368.83,"10th_percentile":417.3,"90th_percentile":29426.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":8681.22,"10th_percentile":8681.22,"90th_percentile":8681.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":7638.73,"10th_percentile":7638.73,"90th_percentile":7638.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":7369.1,"10th_percentile":4818.4,"90th_percentile":8776.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.2] [Cardiac Cath (%BC): 71.1] [Lithotripsy (%BC): 71.1] [Observation (%BC): 71.1] [Emergency Department (%BC): 73.2] [Radiology (%BC): 71.1] [Laboratory (%BC): 26.1] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 71.1] [Speech Therapy (%BC): 46] [Mental Health ($): 1776] [OP High Cost Drugs (%BC): 52.9] [All Other OP (%BC): 71.1]","count":"30","median_amount":22503.46,"10th_percentile":13418.9,"90th_percentile":32105.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":7840.11,"10th_percentile":7840.11,"90th_percentile":8797.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.6,"count":"1 through 10","median_amount":26042.45,"10th_percentile":22536.22,"90th_percentile":31788.92},{"payer_name":"First Health/Coventry","plan_name":"First Health Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health-Intensive ($): 467.68] [Mental Health-Partial Hospitalization ($): 777.57] [OP ECT Mental Health ($): 1195.36] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5817.43,"10th_percentile":3333.74,"90th_percentile":8772.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":10149.71,"10th_percentile":10149.71,"90th_percentile":10149.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"1 through 10","median_amount":24722.06,"10th_percentile":19223.07,"90th_percentile":36820.94},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5372.85,"10th_percentile":5372.85,"90th_percentile":12496.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":6786.42,"10th_percentile":6786.42,"90th_percentile":6786.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Laparoscopy and Related Services","code_information":[{"code":"5362","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [Mental Health-Intensive ($): 201] [Mental Health-Partial Hospitalization ($): 401] [All Other OP (%BC): 78]","count":"1 through 10","median_amount":12569.25,"10th_percentile":12569.25,"90th_percentile":12569.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":17503.99,"10th_percentile":17503.99,"90th_percentile":17503.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":12000.5,"10th_percentile":12000.5,"90th_percentile":12000.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.2] [Cardiac Cath (%BC): 71.1] [Lithotripsy (%BC): 71.1] [Observation (%BC): 71.1] [Emergency Department (%BC): 73.2] [Radiology (%BC): 71.1] [Laboratory (%BC): 26.1] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 71.1] [Speech Therapy (%BC): 46] [Mental Health ($): 1776] [OP High Cost Drugs (%BC): 52.9] [All Other OP (%BC): 71.1]","count":"1 through 10","median_amount":30882.14,"10th_percentile":28012.16,"90th_percentile":42193.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.6,"count":"1 through 10","median_amount":38104.06,"10th_percentile":38104.06,"90th_percentile":38104.06},{"payer_name":"First Health/Coventry","plan_name":"First Health Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health-Intensive ($): 467.68] [Mental Health-Partial Hospitalization ($): 777.57] [OP ECT Mental Health ($): 1195.36] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":20901.58,"10th_percentile":20901.58,"90th_percentile":20901.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Urology and Related Services","code_information":[{"code":"5372","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [Mental Health-Intensive ($): 201] [Mental Health-Partial Hospitalization ($): 401] [All Other OP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":175.97,"10th_percentile":175.97,"90th_percentile":175.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.2] [Cardiac Cath (%BC): 71.1] [Lithotripsy (%BC): 71.1] [Observation (%BC): 71.1] [Emergency Department (%BC): 73.2] [Radiology (%BC): 71.1] [Laboratory (%BC): 26.1] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 71.1] [Speech Therapy (%BC): 46] [Mental Health ($): 1776] [OP High Cost Drugs (%BC): 52.9] [All Other OP (%BC): 71.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":621.66,"10th_percentile":621.66,"90th_percentile":621.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"First Health Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health-Intensive ($): 467.68] [Mental Health-Partial Hospitalization ($): 777.57] [OP ECT Mental Health ($): 1195.36] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":37.56,"10th_percentile":37.56,"90th_percentile":37.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Urology and Related Services","code_information":[{"code":"5373","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [Mental Health-Intensive ($): 201] [Mental Health-Partial Hospitalization ($): 401] [All Other OP (%BC): 78]","count":"1 through 10","median_amount":13022.33,"10th_percentile":10434.97,"90th_percentile":13971.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1898.54,"10th_percentile":1898.54,"90th_percentile":1898.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.2] [Cardiac Cath (%BC): 71.1] [Lithotripsy (%BC): 71.1] [Observation (%BC): 71.1] [Emergency Department (%BC): 73.2] [Radiology (%BC): 71.1] [Laboratory (%BC): 26.1] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 71.1] [Speech Therapy (%BC): 46] [Mental Health ($): 1776] [OP High Cost Drugs (%BC): 52.9] [All Other OP (%BC): 71.1]","count":"1 through 10","median_amount":11544.98,"10th_percentile":10654.7,"90th_percentile":17504.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.6,"count":"1 through 10","median_amount":10940.3,"10th_percentile":10940.3,"90th_percentile":10940.3},{"payer_name":"First Health/Coventry","plan_name":"First Health Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health-Intensive ($): 467.68] [Mental Health-Partial Hospitalization ($): 777.57] [OP ECT Mental Health ($): 1195.36] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1914.97,"10th_percentile":1907.19,"90th_percentile":6059.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"1 through 10","median_amount":19415.47,"10th_percentile":19415.47,"90th_percentile":19415.47},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1892.86,"10th_percentile":1892.86,"90th_percentile":1892.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":4013.4,"10th_percentile":4013.4,"90th_percentile":4013.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 4 Urology and Related Services","code_information":[{"code":"5374","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [Mental Health-Intensive ($): 201] [Mental Health-Partial Hospitalization ($): 401] [All Other OP (%BC): 78]","count":"1 through 10","median_amount":11550.25,"10th_percentile":11550.25,"90th_percentile":11550.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":5294.86,"10th_percentile":5294.86,"90th_percentile":6856.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.2] [Cardiac Cath (%BC): 71.1] [Lithotripsy (%BC): 71.1] [Observation (%BC): 71.1] [Emergency Department (%BC): 73.2] [Radiology (%BC): 71.1] [Laboratory (%BC): 26.1] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 71.1] [Speech Therapy (%BC): 46] [Mental Health ($): 1776] [OP High Cost Drugs (%BC): 52.9] [All Other OP (%BC): 71.1]","count":"1 through 10","median_amount":18297.32,"10th_percentile":8836.36,"90th_percentile":20263.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3186.61,"10th_percentile":3178.91,"90th_percentile":3235.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.6,"count":"1 through 10","median_amount":13614.86,"10th_percentile":13614.86,"90th_percentile":13614.86},{"payer_name":"First Health/Coventry","plan_name":"First Health Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health-Intensive ($): 467.68] [Mental Health-Partial Hospitalization ($): 777.57] [OP ECT Mental Health ($): 1195.36] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3219.4,"10th_percentile":3211.62,"90th_percentile":6849.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3235.62,"10th_percentile":3235.62,"90th_percentile":3235.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":1444.31,"10th_percentile":1444.31,"90th_percentile":1444.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 5 Urology and Related Services","code_information":[{"code":"5375","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [Mental Health-Intensive ($): 201] [Mental Health-Partial Hospitalization ($): 401] [All Other OP (%BC): 78]","count":"1 through 10","median_amount":17014.18,"10th_percentile":5046.6,"90th_percentile":22817.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5782.62,"10th_percentile":5570.98,"90th_percentile":7681.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.2] [Cardiac Cath (%BC): 71.1] [Lithotripsy (%BC): 71.1] [Observation (%BC): 71.1] [Emergency Department (%BC): 73.2] [Radiology (%BC): 71.1] [Laboratory (%BC): 26.1] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 71.1] [Speech Therapy (%BC): 46] [Mental Health ($): 1776] [OP High Cost Drugs (%BC): 52.9] [All Other OP (%BC): 71.1]","count":"12","median_amount":16085.34,"10th_percentile":15171.25,"90th_percentile":20248.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":4681.77,"10th_percentile":4681.77,"90th_percentile":8868.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.6,"count":"1 through 10","median_amount":17038.68,"10th_percentile":17038.68,"90th_percentile":17227.5},{"payer_name":"First Health/Coventry","plan_name":"First Health Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health-Intensive ($): 467.68] [Mental Health-Partial Hospitalization ($): 777.57] [OP ECT Mental Health ($): 1195.36] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5624.13,"10th_percentile":4729.5,"90th_percentile":13631.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":8027.19,"10th_percentile":8027.19,"90th_percentile":8027.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5586.22,"10th_percentile":4688.39,"90th_percentile":6580.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":8948.67,"10th_percentile":8948.67,"90th_percentile":8948.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":7420.37,"10th_percentile":7420.37,"90th_percentile":7420.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 6 Urology and Related Services","code_information":[{"code":"5376","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [Mental Health-Intensive ($): 201] [Mental Health-Partial Hospitalization ($): 401] [All Other OP (%BC): 78]","count":"1 through 10","median_amount":44406.05,"10th_percentile":44406.05,"90th_percentile":44406.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":14227.57,"10th_percentile":14227.57,"90th_percentile":14227.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.2] [Cardiac Cath (%BC): 71.1] [Lithotripsy (%BC): 71.1] [Observation (%BC): 71.1] [Emergency Department (%BC): 73.2] [Radiology (%BC): 71.1] [Laboratory (%BC): 26.1] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 71.1] [Speech Therapy (%BC): 46] [Mental Health ($): 1776] [OP High Cost Drugs (%BC): 52.9] [All Other OP (%BC): 71.1]","count":"1 through 10","median_amount":13327.41,"10th_percentile":13327.41,"90th_percentile":15085.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":8516.02,"10th_percentile":8516.02,"90th_percentile":8516.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.6,"count":"1 through 10","median_amount":13498.82,"10th_percentile":13498.82,"90th_percentile":13498.82},{"payer_name":"First Health/Coventry","plan_name":"First Health Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health-Intensive ($): 467.68] [Mental Health-Partial Hospitalization ($): 777.57] [OP ECT Mental Health ($): 1195.36] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":11566.44,"10th_percentile":11566.44,"90th_percentile":11566.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 8 Urology and Related Services","code_information":[{"code":"5378","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [Mental Health-Intensive ($): 201] [Mental Health-Partial Hospitalization ($): 401] [All Other OP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":34630.98,"10th_percentile":34630.98,"90th_percentile":34630.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.2] [Cardiac Cath (%BC): 71.1] [Lithotripsy (%BC): 71.1] [Observation (%BC): 71.1] [Emergency Department (%BC): 73.2] [Radiology (%BC): 71.1] [Laboratory (%BC): 26.1] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 71.1] [Speech Therapy (%BC): 46] [Mental Health ($): 1776] [OP High Cost Drugs (%BC): 52.9] [All Other OP (%BC): 71.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"First Health Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health-Intensive ($): 467.68] [Mental Health-Partial Hospitalization ($): 777.57] [OP ECT Mental Health ($): 1195.36] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":21911.55,"10th_percentile":21911.55,"90th_percentile":21911.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Gynecologic Procedures","code_information":[{"code":"5411","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [Mental Health-Intensive ($): 201] [Mental Health-Partial Hospitalization ($): 401] [All Other OP (%BC): 78]","count":"1 through 10","median_amount":211.64,"10th_percentile":174.72,"90th_percentile":2324.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":331.32,"10th_percentile":280.83,"90th_percentile":550.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":185.05,"10th_percentile":177.57,"90th_percentile":724.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.2] [Cardiac Cath (%BC): 71.1] [Lithotripsy (%BC): 71.1] [Observation (%BC): 71.1] [Emergency Department (%BC): 73.2] [Radiology (%BC): 71.1] [Laboratory (%BC): 26.1] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 71.1] [Speech Therapy (%BC): 46] [Mental Health ($): 1776] [OP High Cost Drugs (%BC): 52.9] [All Other OP (%BC): 71.1]","count":"18","median_amount":471.0,"10th_percentile":334.88,"90th_percentile":1207.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.6,"count":"1 through 10","median_amount":357.52,"10th_percentile":357.52,"90th_percentile":357.52},{"payer_name":"First Health/Coventry","plan_name":"First Health Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health-Intensive ($): 467.68] [Mental Health-Partial Hospitalization ($): 777.57] [OP ECT Mental Health ($): 1195.36] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"18","median_amount":216.63,"10th_percentile":104.94,"90th_percentile":339.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":78.33,"10th_percentile":78.33,"90th_percentile":321.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Gynecologic Procedures","code_information":[{"code":"5412","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [Mental Health-Intensive ($): 201] [Mental Health-Partial Hospitalization ($): 401] [All Other OP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.2] [Cardiac Cath (%BC): 71.1] [Lithotripsy (%BC): 71.1] [Observation (%BC): 71.1] [Emergency Department (%BC): 73.2] [Radiology (%BC): 71.1] [Laboratory (%BC): 26.1] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 71.1] [Speech Therapy (%BC): 46] [Mental Health ($): 1776] [OP High Cost Drugs (%BC): 52.9] [All Other OP (%BC): 71.1]","count":"1 through 10","median_amount":13375.3,"10th_percentile":13375.3,"90th_percentile":13375.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"First Health Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health-Intensive ($): 467.68] [Mental Health-Partial Hospitalization ($): 777.57] [OP ECT Mental Health ($): 1195.36] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":81.32,"10th_percentile":81.32,"90th_percentile":81.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 4 Gynecologic Procedures","code_information":[{"code":"5414","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [Mental Health-Intensive ($): 201] [Mental Health-Partial Hospitalization ($): 401] [All Other OP (%BC): 78]","count":"1 through 10","median_amount":15292.81,"10th_percentile":15292.81,"90th_percentile":16241.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.2] [Cardiac Cath (%BC): 71.1] [Lithotripsy (%BC): 71.1] [Observation (%BC): 71.1] [Emergency Department (%BC): 73.2] [Radiology (%BC): 71.1] [Laboratory (%BC): 26.1] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 71.1] [Speech Therapy (%BC): 46] [Mental Health ($): 1776] [OP High Cost Drugs (%BC): 52.9] [All Other OP (%BC): 71.1]","count":"1 through 10","median_amount":15131.01,"10th_percentile":14002.81,"90th_percentile":18827.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2929.88,"10th_percentile":2929.88,"90th_percentile":2929.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.6,"count":"1 through 10","median_amount":13928.96,"10th_percentile":13928.96,"90th_percentile":14805.26},{"payer_name":"First Health/Coventry","plan_name":"First Health Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health-Intensive ($): 467.68] [Mental Health-Partial Hospitalization ($): 777.57] [OP ECT Mental Health ($): 1195.36] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2961.42,"10th_percentile":2961.42,"90th_percentile":2961.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":3733.7,"10th_percentile":3733.7,"90th_percentile":3733.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"1 through 10","median_amount":14405.93,"10th_percentile":14405.93,"90th_percentile":14405.93},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2987.37,"10th_percentile":2987.37,"90th_percentile":2987.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 5 Gynecologic Procedures","code_information":[{"code":"5415","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [Mental Health-Intensive ($): 201] [Mental Health-Partial Hospitalization ($): 401] [All Other OP (%BC): 78]","count":"1 through 10","median_amount":15251.56,"10th_percentile":2234.76,"90th_percentile":22176.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":7373.18,"10th_percentile":7373.18,"90th_percentile":7373.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":5385.59,"10th_percentile":5385.59,"90th_percentile":5385.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.2] [Cardiac Cath (%BC): 71.1] [Lithotripsy (%BC): 71.1] [Observation (%BC): 71.1] [Emergency Department (%BC): 73.2] [Radiology (%BC): 71.1] [Laboratory (%BC): 26.1] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 71.1] [Speech Therapy (%BC): 46] [Mental Health ($): 1776] [OP High Cost Drugs (%BC): 52.9] [All Other OP (%BC): 71.1]","count":"1 through 10","median_amount":20304.79,"10th_percentile":18166.57,"90th_percentile":28103.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":4546.46,"10th_percentile":4546.46,"90th_percentile":4546.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"First Health Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health-Intensive ($): 467.68] [Mental Health-Partial Hospitalization ($): 777.57] [OP ECT Mental Health ($): 1195.36] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":4592.84,"10th_percentile":4592.84,"90th_percentile":10273.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":4638.94,"10th_percentile":4638.94,"90th_percentile":4638.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 6 Gynecologic Procedures","code_information":[{"code":"5416","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [Mental Health-Intensive ($): 201] [Mental Health-Partial Hospitalization ($): 401] [All Other OP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.2] [Cardiac Cath (%BC): 71.1] [Lithotripsy (%BC): 71.1] [Observation (%BC): 71.1] [Emergency Department (%BC): 73.2] [Radiology (%BC): 71.1] [Laboratory (%BC): 26.1] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 71.1] [Speech Therapy (%BC): 46] [Mental Health ($): 1776] [OP High Cost Drugs (%BC): 52.9] [All Other OP (%BC): 71.1]","count":"1 through 10","median_amount":34568.52,"10th_percentile":34568.52,"90th_percentile":34568.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"First Health Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health-Intensive ($): 467.68] [Mental Health-Partial Hospitalization ($): 777.57] [OP ECT Mental Health ($): 1195.36] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6807.33,"10th_percentile":6807.33,"90th_percentile":6807.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Nerve Procedures","code_information":[{"code":"5431","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [Mental Health-Intensive ($): 201] [Mental Health-Partial Hospitalization ($): 401] [All Other OP (%BC): 78]","count":"1 through 10","median_amount":6986.59,"10th_percentile":6986.59,"90th_percentile":6986.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5444.56,"10th_percentile":5444.56,"90th_percentile":5444.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":1001.66,"10th_percentile":1001.66,"90th_percentile":1001.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.2] [Cardiac Cath (%BC): 71.1] [Lithotripsy (%BC): 71.1] [Observation (%BC): 71.1] [Emergency Department (%BC): 73.2] [Radiology (%BC): 71.1] [Laboratory (%BC): 26.1] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 71.1] [Speech Therapy (%BC): 46] [Mental Health ($): 1776] [OP High Cost Drugs (%BC): 52.9] [All Other OP (%BC): 71.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1805.88,"10th_percentile":1805.88,"90th_percentile":1805.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"First Health Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health-Intensive ($): 467.68] [Mental Health-Partial Hospitalization ($): 777.57] [OP ECT Mental Health ($): 1195.36] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5516.15,"10th_percentile":5516.15,"90th_percentile":5516.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":4694.19,"10th_percentile":4694.19,"90th_percentile":4694.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Nerve Injections","code_information":[{"code":"5441","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [Mental Health-Intensive ($): 201] [Mental Health-Partial Hospitalization ($): 401] [All Other OP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":110.77,"10th_percentile":110.77,"90th_percentile":153.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"30","median_amount":110.18,"10th_percentile":53.08,"90th_percentile":252.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.2] [Cardiac Cath (%BC): 71.1] [Lithotripsy (%BC): 71.1] [Observation (%BC): 71.1] [Emergency Department (%BC): 73.2] [Radiology (%BC): 71.1] [Laboratory (%BC): 26.1] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 71.1] [Speech Therapy (%BC): 46] [Mental Health ($): 1776] [OP High Cost Drugs (%BC): 52.9] [All Other OP (%BC): 71.1]","count":"1 through 10","median_amount":1829.44,"10th_percentile":1829.44,"90th_percentile":2258.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"First Health Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health-Intensive ($): 467.68] [Mental Health-Partial Hospitalization ($): 777.57] [OP ECT Mental Health ($): 1195.36] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":36.09,"10th_percentile":33.87,"90th_percentile":470.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":276.93,"10th_percentile":276.93,"90th_percentile":276.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":514.92,"10th_percentile":514.92,"90th_percentile":514.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Nerve Injections","code_information":[{"code":"5442","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [Mental Health-Intensive ($): 201] [Mental Health-Partial Hospitalization ($): 401] [All Other OP (%BC): 78]","count":"1 through 10","median_amount":564.2,"10th_percentile":564.2,"90th_percentile":1240.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":503.72,"10th_percentile":503.72,"90th_percentile":503.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.2] [Cardiac Cath (%BC): 71.1] [Lithotripsy (%BC): 71.1] [Observation (%BC): 71.1] [Emergency Department (%BC): 73.2] [Radiology (%BC): 71.1] [Laboratory (%BC): 26.1] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 71.1] [Speech Therapy (%BC): 46] [Mental Health ($): 1776] [OP High Cost Drugs (%BC): 52.9] [All Other OP (%BC): 71.1]","count":"1 through 10","median_amount":1588.44,"10th_percentile":1588.44,"90th_percentile":1588.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.6,"count":"1 through 10","median_amount":1874.19,"10th_percentile":1874.19,"90th_percentile":1874.19},{"payer_name":"First Health/Coventry","plan_name":"First Health Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health-Intensive ($): 467.68] [Mental Health-Partial Hospitalization ($): 777.57] [OP ECT Mental Health ($): 1195.36] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":652.06,"10th_percentile":652.06,"90th_percentile":652.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":35.24,"10th_percentile":35.24,"90th_percentile":483.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"1 through 10","median_amount":4041.2,"10th_percentile":4041.2,"90th_percentile":4041.2},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":16579.19,"10th_percentile":16579.19,"90th_percentile":16579.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Nerve Injections","code_information":[{"code":"5443","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [Mental Health-Intensive ($): 201] [Mental Health-Partial Hospitalization ($): 401] [All Other OP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":476.9,"10th_percentile":266.04,"90th_percentile":526.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.2] [Cardiac Cath (%BC): 71.1] [Lithotripsy (%BC): 71.1] [Observation (%BC): 71.1] [Emergency Department (%BC): 73.2] [Radiology (%BC): 71.1] [Laboratory (%BC): 26.1] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 71.1] [Speech Therapy (%BC): 46] [Mental Health ($): 1776] [OP High Cost Drugs (%BC): 52.9] [All Other OP (%BC): 71.1]","count":"1 through 10","median_amount":1191.42,"10th_percentile":1191.42,"90th_percentile":1191.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"First Health Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health-Intensive ($): 467.68] [Mental Health-Partial Hospitalization ($): 777.57] [OP ECT Mental Health ($): 1195.36] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":789.78,"10th_percentile":289.69,"90th_percentile":790.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Neurostimulator and Related Procedures","code_information":[{"code":"5461","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [Mental Health-Intensive ($): 201] [Mental Health-Partial Hospitalization ($): 401] [All Other OP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.2] [Cardiac Cath (%BC): 71.1] [Lithotripsy (%BC): 71.1] [Observation (%BC): 71.1] [Emergency Department (%BC): 73.2] [Radiology (%BC): 71.1] [Laboratory (%BC): 26.1] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 71.1] [Speech Therapy (%BC): 46] [Mental Health ($): 1776] [OP High Cost Drugs (%BC): 52.9] [All Other OP (%BC): 71.1]","count":"1 through 10","median_amount":19173.75,"10th_percentile":19173.75,"90th_percentile":19173.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"First Health Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health-Intensive ($): 467.68] [Mental Health-Partial Hospitalization ($): 777.57] [OP ECT Mental Health ($): 1195.36] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Neurostimulator and Related Procedures","code_information":[{"code":"5462","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [Mental Health-Intensive ($): 201] [Mental Health-Partial Hospitalization ($): 401] [All Other OP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.2] [Cardiac Cath (%BC): 71.1] [Lithotripsy (%BC): 71.1] [Observation (%BC): 71.1] [Emergency Department (%BC): 73.2] [Radiology (%BC): 71.1] [Laboratory (%BC): 26.1] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 71.1] [Speech Therapy (%BC): 46] [Mental Health ($): 1776] [OP High Cost Drugs (%BC): 52.9] [All Other OP (%BC): 71.1]","count":"1 through 10","median_amount":23906.26,"10th_percentile":23906.26,"90th_percentile":23906.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"First Health Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health-Intensive ($): 467.68] [Mental Health-Partial Hospitalization ($): 777.57] [OP ECT Mental Health ($): 1195.36] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":12863.48,"10th_percentile":12863.48,"90th_percentile":12863.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 4 Neurostimulator and Related Procedures","code_information":[{"code":"5464","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [Mental Health-Intensive ($): 201] [Mental Health-Partial Hospitalization ($): 401] [All Other OP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.2] [Cardiac Cath (%BC): 71.1] [Lithotripsy (%BC): 71.1] [Observation (%BC): 71.1] [Emergency Department (%BC): 73.2] [Radiology (%BC): 71.1] [Laboratory (%BC): 26.1] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 71.1] [Speech Therapy (%BC): 46] [Mental Health ($): 1776] [OP High Cost Drugs (%BC): 52.9] [All Other OP (%BC): 71.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"First Health Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health-Intensive ($): 467.68] [Mental Health-Partial Hospitalization ($): 777.57] [OP ECT Mental Health ($): 1195.36] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":24684.03,"10th_percentile":24684.03,"90th_percentile":24684.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Imaging without Contrast","code_information":[{"code":"5521","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [Mental Health-Intensive ($): 201] [Mental Health-Partial Hospitalization ($): 401] [All Other OP (%BC): 78]","count":"145","median_amount":333.06,"10th_percentile":111.8,"90th_percentile":829.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"80","median_amount":81.23,"10th_percentile":81.23,"90th_percentile":127.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":103.96,"10th_percentile":91.59,"90th_percentile":330.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"65","median_amount":124.55,"10th_percentile":95.8,"90th_percentile":236.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.2] [Cardiac Cath (%BC): 71.1] [Lithotripsy (%BC): 71.1] [Observation (%BC): 71.1] [Emergency Department (%BC): 73.2] [Radiology (%BC): 71.1] [Laboratory (%BC): 26.1] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 71.1] [Speech Therapy (%BC): 46] [Mental Health ($): 1776] [OP High Cost Drugs (%BC): 52.9] [All Other OP (%BC): 71.1]","count":"235","median_amount":328.48,"10th_percentile":233.21,"90th_percentile":837.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"61","median_amount":81.45,"10th_percentile":81.45,"90th_percentile":82.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.6,"count":"60","median_amount":322.1,"10th_percentile":257.15,"90th_percentile":953.82},{"payer_name":"First Health/Coventry","plan_name":"First Health Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health-Intensive ($): 467.68] [Mental Health-Partial Hospitalization ($): 777.57] [OP ECT Mental Health ($): 1195.36] [APC ($): FEE SCHEDULE]","count":"235","median_amount":83.43,"10th_percentile":82.1,"90th_percentile":83.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":552.6,"10th_percentile":552.6,"90th_percentile":552.6},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"35","median_amount":130.69,"10th_percentile":90.01,"90th_percentile":315.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"42","median_amount":354.5,"10th_percentile":232.55,"90th_percentile":1030.89},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"94","median_amount":81.45,"10th_percentile":80.95,"90th_percentile":82.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"28","median_amount":114.19,"10th_percentile":92.95,"90th_percentile":242.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":81.55,"10th_percentile":81.05,"90th_percentile":194.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 2 Imaging without Contrast","code_information":[{"code":"5522","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [Mental Health-Intensive ($): 201] [Mental Health-Partial Hospitalization ($): 401] [All Other OP (%BC): 78]","count":"168","median_amount":485.94,"10th_percentile":161.98,"90th_percentile":971.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"110","median_amount":98.04,"10th_percentile":97.76,"90th_percentile":282.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"17","median_amount":147.72,"10th_percentile":30.16,"90th_percentile":447.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"115","median_amount":74.11,"10th_percentile":29.86,"90th_percentile":426.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.2] [Cardiac Cath (%BC): 71.1] [Lithotripsy (%BC): 71.1] [Observation (%BC): 71.1] [Emergency Department (%BC): 73.2] [Radiology (%BC): 71.1] [Laboratory (%BC): 26.1] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 71.1] [Speech Therapy (%BC): 46] [Mental Health ($): 1776] [OP High Cost Drugs (%BC): 52.9] [All Other OP (%BC): 71.1]","count":"306","median_amount":747.26,"10th_percentile":289.38,"90th_percentile":1934.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"86","median_amount":98.26,"10th_percentile":97.76,"90th_percentile":99.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.6,"count":"76","median_amount":661.9,"10th_percentile":249.28,"90th_percentile":1784.98},{"payer_name":"First Health/Coventry","plan_name":"First Health Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health-Intensive ($): 467.68] [Mental Health-Partial Hospitalization ($): 777.57] [OP ECT Mental Health ($): 1195.36] [APC ($): FEE SCHEDULE]","count":"380","median_amount":99.54,"10th_percentile":98.74,"90th_percentile":100.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":98.16,"10th_percentile":98.16,"90th_percentile":98.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"90","median_amount":74.11,"10th_percentile":29.86,"90th_percentile":245.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"62","median_amount":663.62,"10th_percentile":441.71,"90th_percentile":2019.23},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"137","median_amount":98.17,"10th_percentile":97.77,"90th_percentile":99.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"26","median_amount":184.98,"10th_percentile":34.01,"90th_percentile":650.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":99.76,"10th_percentile":98.76,"90th_percentile":111.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 3 Imaging without Contrast","code_information":[{"code":"5523","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [Mental Health-Intensive ($): 201] [Mental Health-Partial Hospitalization ($): 401] [All Other OP (%BC): 78]","count":"23","median_amount":1067.04,"10th_percentile":143.86,"90th_percentile":3201.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"13","median_amount":226.77,"10th_percentile":226.77,"90th_percentile":984.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":876.71,"10th_percentile":876.71,"90th_percentile":876.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":1078.35,"10th_percentile":914.37,"90th_percentile":2201.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.2] [Cardiac Cath (%BC): 71.1] [Lithotripsy (%BC): 71.1] [Observation (%BC): 71.1] [Emergency Department (%BC): 73.2] [Radiology (%BC): 71.1] [Laboratory (%BC): 26.1] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 71.1] [Speech Therapy (%BC): 46] [Mental Health ($): 1776] [OP High Cost Drugs (%BC): 52.9] [All Other OP (%BC): 71.1]","count":"46","median_amount":2917.94,"10th_percentile":2688.63,"90th_percentile":3945.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":223.14,"10th_percentile":222.73,"90th_percentile":321.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.6,"count":"1 through 10","median_amount":2692.22,"10th_percentile":1008.93,"90th_percentile":3640.14},{"payer_name":"First Health/Coventry","plan_name":"First Health Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health-Intensive ($): 467.68] [Mental Health-Partial Hospitalization ($): 777.57] [OP ECT Mental Health ($): 1195.36] [APC ($): FEE SCHEDULE]","count":"75","median_amount":229.04,"10th_percentile":225.46,"90th_percentile":312.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":914.37,"10th_percentile":914.37,"90th_percentile":2397.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"1 through 10","median_amount":2909.74,"10th_percentile":2909.74,"90th_percentile":3934.24},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"17","median_amount":223.15,"10th_percentile":222.24,"90th_percentile":303.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":937.23,"10th_percentile":937.23,"90th_percentile":937.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":223.14,"10th_percentile":222.23,"90th_percentile":496.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 4 Imaging without Contrast","code_information":[{"code":"5524","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [Mental Health-Intensive ($): 201] [Mental Health-Partial Hospitalization ($): 401] [All Other OP (%BC): 78]","count":"14","median_amount":1653.6,"10th_percentile":878.28,"90th_percentile":2383.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"12","median_amount":506.09,"10th_percentile":504.09,"90th_percentile":804.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":477.06,"10th_percentile":477.06,"90th_percentile":477.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":472.34,"10th_percentile":472.34,"90th_percentile":472.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.2] [Cardiac Cath (%BC): 71.1] [Lithotripsy (%BC): 71.1] [Observation (%BC): 71.1] [Emergency Department (%BC): 73.2] [Radiology (%BC): 71.1] [Laboratory (%BC): 26.1] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 71.1] [Speech Therapy (%BC): 46] [Mental Health ($): 1776] [OP High Cost Drugs (%BC): 52.9] [All Other OP (%BC): 71.1]","count":"22","median_amount":1551.84,"10th_percentile":1551.84,"90th_percentile":2472.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":504.09,"10th_percentile":504.09,"90th_percentile":504.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.6,"count":"1 through 10","median_amount":1390.72,"10th_percentile":1390.72,"90th_percentile":2215.96},{"payer_name":"First Health/Coventry","plan_name":"First Health Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health-Intensive ($): 467.68] [Mental Health-Partial Hospitalization ($): 777.57] [OP ECT Mental Health ($): 1195.36] [APC ($): FEE SCHEDULE]","count":"32","median_amount":511.73,"10th_percentile":509.93,"90th_percentile":517.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":472.34,"10th_percentile":472.34,"90th_percentile":708.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"1 through 10","median_amount":1503.08,"10th_percentile":1503.08,"90th_percentile":2775.63},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"17","median_amount":507.6,"10th_percentile":506.15,"90th_percentile":604.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":484.14,"10th_percentile":484.14,"90th_percentile":484.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":506.09,"10th_percentile":506.09,"90th_percentile":506.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 1 Imaging with Contrast","code_information":[{"code":"5571","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [Mental Health-Intensive ($): 201] [Mental Health-Partial Hospitalization ($): 401] [All Other OP (%BC): 78]","count":"13","median_amount":428.78,"10th_percentile":244.14,"90th_percentile":3986.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"11","median_amount":167.01,"10th_percentile":163.67,"90th_percentile":1294.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":1142.01,"10th_percentile":976.73,"90th_percentile":1258.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.2] [Cardiac Cath (%BC): 71.1] [Lithotripsy (%BC): 71.1] [Observation (%BC): 71.1] [Emergency Department (%BC): 73.2] [Radiology (%BC): 71.1] [Laboratory (%BC): 26.1] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 71.1] [Speech Therapy (%BC): 46] [Mental Health ($): 1776] [OP High Cost Drugs (%BC): 52.9] [All Other OP (%BC): 71.1]","count":"28","median_amount":3875.57,"10th_percentile":1428.72,"90th_percentile":7351.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":167.01,"10th_percentile":164.17,"90th_percentile":408.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.6,"count":"1 through 10","median_amount":4100.87,"10th_percentile":3352.36,"90th_percentile":8231.5},{"payer_name":"First Health/Coventry","plan_name":"First Health Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health-Intensive ($): 467.68] [Mental Health-Partial Hospitalization ($): 777.57] [OP ECT Mental Health ($): 1195.36] [APC ($): FEE SCHEDULE]","count":"28","median_amount":168.68,"10th_percentile":166.11,"90th_percentile":410.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":151.95,"10th_percentile":151.95,"90th_percentile":1227.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"1 through 10","median_amount":3822.94,"10th_percentile":3128.34,"90th_percentile":12914.02},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"15","median_amount":164.37,"10th_percentile":164.17,"90th_percentile":167.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":2865.59,"10th_percentile":2865.59,"90th_percentile":2865.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":164.67,"10th_percentile":164.67,"90th_percentile":164.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 2 Imaging with Contrast","code_information":[{"code":"5572","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [Mental Health-Intensive ($): 201] [Mental Health-Partial Hospitalization ($): 401] [All Other OP (%BC): 78]","count":"27","median_amount":2583.36,"10th_percentile":1942.81,"90th_percentile":7303.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"19","median_amount":334.34,"10th_percentile":328.34,"90th_percentile":1793.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":158.92,"10th_percentile":158.92,"90th_percentile":158.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":1664.84,"10th_percentile":1657.49,"90th_percentile":2213.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.2] [Cardiac Cath (%BC): 71.1] [Lithotripsy (%BC): 71.1] [Observation (%BC): 71.1] [Emergency Department (%BC): 73.2] [Radiology (%BC): 71.1] [Laboratory (%BC): 26.1] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 71.1] [Speech Therapy (%BC): 46] [Mental Health ($): 1776] [OP High Cost Drugs (%BC): 52.9] [All Other OP (%BC): 71.1]","count":"64","median_amount":5568.34,"10th_percentile":5289.38,"90th_percentile":7064.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"20","median_amount":329.68,"10th_percentile":329.68,"90th_percentile":427.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.6,"count":"1 through 10","median_amount":5392.98,"10th_percentile":2799.16,"90th_percentile":14344.99},{"payer_name":"First Health/Coventry","plan_name":"First Health Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health-Intensive ($): 467.68] [Mental Health-Partial Hospitalization ($): 777.57] [OP ECT Mental Health ($): 1195.36] [APC ($): FEE SCHEDULE]","count":"85","median_amount":338.12,"10th_percentile":333.62,"90th_percentile":338.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":1846.79,"10th_percentile":1577.42,"90th_percentile":3207.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"1 through 10","median_amount":7044.63,"10th_percentile":5620.51,"90th_percentile":7710.38},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"20","median_amount":330.84,"10th_percentile":328.34,"90th_percentile":430.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":1877.43,"10th_percentile":1877.43,"90th_percentile":1877.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Imaging with Contrast","code_information":[{"code":"5573","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [Mental Health-Intensive ($): 201] [Mental Health-Partial Hospitalization ($): 401] [All Other OP (%BC): 78]","count":"1 through 10","median_amount":1732.34,"10th_percentile":1732.34,"90th_percentile":1732.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":728.37,"10th_percentile":728.37,"90th_percentile":728.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":1496.51,"10th_percentile":1496.51,"90th_percentile":1496.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.2] [Cardiac Cath (%BC): 71.1] [Lithotripsy (%BC): 71.1] [Observation (%BC): 71.1] [Emergency Department (%BC): 73.2] [Radiology (%BC): 71.1] [Laboratory (%BC): 26.1] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 71.1] [Speech Therapy (%BC): 46] [Mental Health ($): 1776] [OP High Cost Drugs (%BC): 52.9] [All Other OP (%BC): 71.1]","count":"1 through 10","median_amount":4834.56,"10th_percentile":4787.49,"90th_percentile":5028.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"First Health Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health-Intensive ($): 467.68] [Mental Health-Partial Hospitalization ($): 777.57] [OP ECT Mental Health ($): 1195.36] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":739.2,"10th_percentile":739.2,"90th_percentile":739.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1131.01,"10th_percentile":1131.01,"90th_percentile":1131.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Nuclear Medicine and Related Services","code_information":[{"code":"5591","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [Mental Health-Intensive ($): 201] [Mental Health-Partial Hospitalization ($): 401] [All Other OP (%BC): 78]","count":"1 through 10","median_amount":2749.32,"10th_percentile":2749.32,"90th_percentile":2749.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":375.43,"10th_percentile":375.43,"90th_percentile":375.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":785.32,"10th_percentile":785.32,"90th_percentile":785.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.2] [Cardiac Cath (%BC): 71.1] [Lithotripsy (%BC): 71.1] [Observation (%BC): 71.1] [Emergency Department (%BC): 73.2] [Radiology (%BC): 71.1] [Laboratory (%BC): 26.1] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 71.1] [Speech Therapy (%BC): 46] [Mental Health ($): 1776] [OP High Cost Drugs (%BC): 52.9] [All Other OP (%BC): 71.1]","count":"1 through 10","median_amount":2211.09,"10th_percentile":1374.78,"90th_percentile":2506.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.6,"count":"1 through 10","median_amount":2312.24,"10th_percentile":2312.24,"90th_percentile":2312.24},{"payer_name":"First Health/Coventry","plan_name":"First Health Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health-Intensive ($): 467.68] [Mental Health-Partial Hospitalization ($): 777.57] [OP ECT Mental Health ($): 1195.36] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":379.63,"10th_percentile":379.63,"90th_percentile":379.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":956.84,"10th_percentile":956.84,"90th_percentile":956.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":372.94,"10th_percentile":372.94,"90th_percentile":372.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":1199.41,"10th_percentile":1199.41,"90th_percentile":1199.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Nuclear Medicine and Related Services","code_information":[{"code":"5592","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [Mental Health-Intensive ($): 201] [Mental Health-Partial Hospitalization ($): 401] [All Other OP (%BC): 78]","count":"1 through 10","median_amount":51.8,"10th_percentile":51.8,"90th_percentile":4779.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":500.87,"10th_percentile":500.87,"90th_percentile":500.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":718.41,"10th_percentile":718.41,"90th_percentile":718.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.2] [Cardiac Cath (%BC): 71.1] [Lithotripsy (%BC): 71.1] [Observation (%BC): 71.1] [Emergency Department (%BC): 73.2] [Radiology (%BC): 71.1] [Laboratory (%BC): 26.1] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 71.1] [Speech Therapy (%BC): 46] [Mental Health ($): 1776] [OP High Cost Drugs (%BC): 52.9] [All Other OP (%BC): 71.1]","count":"1 through 10","median_amount":4369.89,"10th_percentile":2321.03,"90th_percentile":27247.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":496.89,"10th_percentile":496.89,"90th_percentile":496.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.6,"count":"1 through 10","median_amount":1891.11,"10th_percentile":1891.11,"90th_percentile":1891.11},{"payer_name":"First Health/Coventry","plan_name":"First Health Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health-Intensive ($): 467.68] [Mental Health-Partial Hospitalization ($): 777.57] [OP ECT Mental Health ($): 1195.36] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":506.32,"10th_percentile":506.32,"90th_percentile":588.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"1 through 10","median_amount":4362.09,"10th_percentile":4362.09,"90th_percentile":4362.09},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":4526.88,"10th_percentile":4526.88,"90th_percentile":4526.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":494.87,"10th_percentile":494.87,"90th_percentile":494.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 3 Nuclear Medicine and Related Services","code_information":[{"code":"5593","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [Mental Health-Intensive ($): 201] [Mental Health-Partial Hospitalization ($): 401] [All Other OP (%BC): 78]","count":"1 through 10","median_amount":2236.06,"10th_percentile":2236.06,"90th_percentile":6074.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1206.23,"10th_percentile":1205.12,"90th_percentile":1206.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":1904.14,"10th_percentile":1904.14,"90th_percentile":1904.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.2] [Cardiac Cath (%BC): 71.1] [Lithotripsy (%BC): 71.1] [Observation (%BC): 71.1] [Emergency Department (%BC): 73.2] [Radiology (%BC): 71.1] [Laboratory (%BC): 26.1] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 71.1] [Speech Therapy (%BC): 46] [Mental Health ($): 1776] [OP High Cost Drugs (%BC): 52.9] [All Other OP (%BC): 71.1]","count":"1 through 10","median_amount":6098.72,"10th_percentile":6098.72,"90th_percentile":6098.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1205.12,"10th_percentile":1205.12,"90th_percentile":1205.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.6,"count":"1 through 10","median_amount":5640.93,"10th_percentile":5640.93,"90th_percentile":6009.87},{"payer_name":"First Health/Coventry","plan_name":"First Health Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health-Intensive ($): 467.68] [Mental Health-Partial Hospitalization ($): 777.57] [OP ECT Mental Health ($): 1195.36] [APC ($): FEE SCHEDULE]","count":"11","median_amount":1218.73,"10th_percentile":1214.23,"90th_percentile":1223.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":1915.85,"10th_percentile":1915.85,"90th_percentile":1915.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"1 through 10","median_amount":6059.4,"10th_percentile":6059.4,"90th_percentile":6059.4},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1205.13,"10th_percentile":1205.13,"90th_percentile":1224.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 4 Nuclear Medicine and Related Services","code_information":[{"code":"5594","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [Mental Health-Intensive ($): 201] [Mental Health-Partial Hospitalization ($): 401] [All Other OP (%BC): 78]","count":"1 through 10","median_amount":7736.82,"10th_percentile":90.65,"90th_percentile":17795.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1342.09,"10th_percentile":1342.09,"90th_percentile":1342.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":2708.19,"10th_percentile":2708.19,"90th_percentile":2708.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.2] [Cardiac Cath (%BC): 71.1] [Lithotripsy (%BC): 71.1] [Observation (%BC): 71.1] [Emergency Department (%BC): 73.2] [Radiology (%BC): 71.1] [Laboratory (%BC): 26.1] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 71.1] [Speech Therapy (%BC): 46] [Mental Health ($): 1776] [OP High Cost Drugs (%BC): 52.9] [All Other OP (%BC): 71.1]","count":"1 through 10","median_amount":7937.06,"10th_percentile":7937.06,"90th_percentile":62912.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1368.36,"10th_percentile":1346.99,"90th_percentile":11677.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.6,"count":"1 through 10","median_amount":58045.84,"10th_percentile":58045.84,"90th_percentile":58045.84},{"payer_name":"First Health/Coventry","plan_name":"First Health Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health-Intensive ($): 467.68] [Mental Health-Partial Hospitalization ($): 777.57] [OP ECT Mental Health ($): 1195.36] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1360.9,"10th_percentile":1360.9,"90th_percentile":11795.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":11671.87,"10th_percentile":1344.5,"90th_percentile":11676.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1340.99,"10th_percentile":1340.99,"90th_percentile":1340.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 3 Therapeutic Radiation Treatment Preparation","code_information":[{"code":"5613","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [Mental Health-Intensive ($): 201] [Mental Health-Partial Hospitalization ($): 401] [All Other OP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.2] [Cardiac Cath (%BC): 71.1] [Lithotripsy (%BC): 71.1] [Observation (%BC): 71.1] [Emergency Department (%BC): 73.2] [Radiology (%BC): 71.1] [Laboratory (%BC): 26.1] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 71.1] [Speech Therapy (%BC): 46] [Mental Health ($): 1776] [OP High Cost Drugs (%BC): 52.9] [All Other OP (%BC): 71.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"First Health Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health-Intensive ($): 467.68] [Mental Health-Partial Hospitalization ($): 777.57] [OP ECT Mental Health ($): 1195.36] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1580.83,"10th_percentile":1580.83,"90th_percentile":1580.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Radiation Therapy","code_information":[{"code":"5623","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [Mental Health-Intensive ($): 201] [Mental Health-Partial Hospitalization ($): 401] [All Other OP (%BC): 78]","count":"1 through 10","median_amount":129.48,"10th_percentile":129.48,"90th_percentile":129.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.2] [Cardiac Cath (%BC): 71.1] [Lithotripsy (%BC): 71.1] [Observation (%BC): 71.1] [Emergency Department (%BC): 73.2] [Radiology (%BC): 71.1] [Laboratory (%BC): 26.1] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 71.1] [Speech Therapy (%BC): 46] [Mental Health ($): 1776] [OP High Cost Drugs (%BC): 52.9] [All Other OP (%BC): 71.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"First Health Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health-Intensive ($): 467.68] [Mental Health-Partial Hospitalization ($): 777.57] [OP ECT Mental Health ($): 1195.36] [APC ($): FEE SCHEDULE]","count":"16","median_amount":539.35,"10th_percentile":537.16,"90th_percentile":1566.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":135.69,"10th_percentile":135.69,"90th_percentile":135.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 1 Pathology","code_information":[{"code":"5671","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [Mental Health-Intensive ($): 201] [Mental Health-Partial Hospitalization ($): 401] [All Other OP (%BC): 78]","count":"1 through 10","median_amount":453.18,"10th_percentile":42.28,"90th_percentile":1035.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":49.12,"10th_percentile":49.12,"90th_percentile":49.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":142.55,"10th_percentile":142.55,"90th_percentile":142.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.2] [Cardiac Cath (%BC): 71.1] [Lithotripsy (%BC): 71.1] [Observation (%BC): 71.1] [Emergency Department (%BC): 73.2] [Radiology (%BC): 71.1] [Laboratory (%BC): 26.1] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 71.1] [Speech Therapy (%BC): 46] [Mental Health ($): 1776] [OP High Cost Drugs (%BC): 52.9] [All Other OP (%BC): 71.1]","count":"12","median_amount":413.09,"10th_percentile":413.09,"90th_percentile":826.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":49.22,"10th_percentile":49.22,"90th_percentile":50.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.6,"count":"1 through 10","median_amount":724.88,"10th_percentile":724.88,"90th_percentile":724.88},{"payer_name":"First Health/Coventry","plan_name":"First Health Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health-Intensive ($): 467.68] [Mental Health-Partial Hospitalization ($): 777.57] [OP ECT Mental Health ($): 1195.36] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":49.61,"10th_percentile":49.61,"90th_percentile":49.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":76.02,"10th_percentile":76.02,"90th_percentile":76.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"1 through 10","median_amount":411.93,"10th_percentile":411.93,"90th_percentile":600.52},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":49.12,"10th_percentile":49.12,"90th_percentile":49.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":70.13,"10th_percentile":70.13,"90th_percentile":70.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Pathology","code_information":[{"code":"5672","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [Mental Health-Intensive ($): 201] [Mental Health-Partial Hospitalization ($): 401] [All Other OP (%BC): 78]","count":"1 through 10","median_amount":1415.05,"10th_percentile":695.63,"90th_percentile":4302.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.2] [Cardiac Cath (%BC): 71.1] [Lithotripsy (%BC): 71.1] [Observation (%BC): 71.1] [Emergency Department (%BC): 73.2] [Radiology (%BC): 71.1] [Laboratory (%BC): 26.1] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 71.1] [Speech Therapy (%BC): 46] [Mental Health ($): 1776] [OP High Cost Drugs (%BC): 52.9] [All Other OP (%BC): 71.1]","count":"1 through 10","median_amount":3095.7,"10th_percentile":1806.65,"90th_percentile":3817.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":157.64,"10th_percentile":157.64,"90th_percentile":157.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.6,"count":"1 through 10","median_amount":1666.9,"10th_percentile":1666.9,"90th_percentile":1666.9},{"payer_name":"First Health/Coventry","plan_name":"First Health Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health-Intensive ($): 467.68] [Mental Health-Partial Hospitalization ($): 777.57] [OP ECT Mental Health ($): 1195.36] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":159.12,"10th_percentile":159.12,"90th_percentile":159.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":152.17,"10th_percentile":102.23,"90th_percentile":348.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":157.55,"10th_percentile":157.55,"90th_percentile":157.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Pathology","code_information":[{"code":"5673","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [Mental Health-Intensive ($): 201] [Mental Health-Partial Hospitalization ($): 401] [All Other OP (%BC): 78]","count":"1 through 10","median_amount":13382.46,"10th_percentile":13382.46,"90th_percentile":13382.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":330.72,"10th_percentile":330.72,"90th_percentile":330.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.2] [Cardiac Cath (%BC): 71.1] [Lithotripsy (%BC): 71.1] [Observation (%BC): 71.1] [Emergency Department (%BC): 73.2] [Radiology (%BC): 71.1] [Laboratory (%BC): 26.1] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 71.1] [Speech Therapy (%BC): 46] [Mental Health ($): 1776] [OP High Cost Drugs (%BC): 52.9] [All Other OP (%BC): 71.1]","count":"1 through 10","median_amount":12039.1,"10th_percentile":12039.1,"90th_percentile":12039.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.6,"count":"1 through 10","median_amount":9809.82,"10th_percentile":9809.82,"90th_percentile":9809.82},{"payer_name":"First Health/Coventry","plan_name":"First Health Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health-Intensive ($): 467.68] [Mental Health-Partial Hospitalization ($): 777.57] [OP ECT Mental Health ($): 1195.36] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":335.02,"10th_percentile":334.82,"90th_percentile":335.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":218.37,"10th_percentile":218.37,"90th_percentile":218.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"1 through 10","median_amount":10602.39,"10th_percentile":10602.39,"90th_percentile":10602.39},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":118.18,"10th_percentile":118.18,"90th_percentile":118.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Drug Administration","code_information":[{"code":"5691","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [Mental Health-Intensive ($): 201] [Mental Health-Partial Hospitalization ($): 401] [All Other OP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":9802.02,"10th_percentile":9802.02,"90th_percentile":9802.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.2] [Cardiac Cath (%BC): 71.1] [Lithotripsy (%BC): 71.1] [Observation (%BC): 71.1] [Emergency Department (%BC): 73.2] [Radiology (%BC): 71.1] [Laboratory (%BC): 26.1] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 71.1] [Speech Therapy (%BC): 46] [Mental Health ($): 1776] [OP High Cost Drugs (%BC): 52.9] [All Other OP (%BC): 71.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.6,"count":"1 through 10","median_amount":95.23,"10th_percentile":95.23,"90th_percentile":95.23},{"payer_name":"First Health/Coventry","plan_name":"First Health Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health-Intensive ($): 467.68] [Mental Health-Partial Hospitalization ($): 777.57] [OP ECT Mental Health ($): 1195.36] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Drug Administration","code_information":[{"code":"5692","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [Mental Health-Intensive ($): 201] [Mental Health-Partial Hospitalization ($): 401] [All Other OP (%BC): 78]","count":"12","median_amount":5492.74,"10th_percentile":162.65,"90th_percentile":41312.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"16","median_amount":66.23,"10th_percentile":65.56,"90th_percentile":4069.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":54.88,"10th_percentile":53.91,"90th_percentile":195.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"21","median_amount":66.57,"10th_percentile":19.44,"90th_percentile":1241.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.2] [Cardiac Cath (%BC): 71.1] [Lithotripsy (%BC): 71.1] [Observation (%BC): 71.1] [Emergency Department (%BC): 73.2] [Radiology (%BC): 71.1] [Laboratory (%BC): 26.1] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 71.1] [Speech Therapy (%BC): 46] [Mental Health ($): 1776] [OP High Cost Drugs (%BC): 52.9] [All Other OP (%BC): 71.1]","count":"38","median_amount":2296.76,"10th_percentile":141.98,"90th_percentile":11849.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"19","median_amount":4055.66,"10th_percentile":65.43,"90th_percentile":9867.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.6,"count":"1 through 10","median_amount":35652.16,"10th_percentile":35652.16,"90th_percentile":35652.16},{"payer_name":"First Health/Coventry","plan_name":"First Health Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health-Intensive ($): 467.68] [Mental Health-Partial Hospitalization ($): 777.57] [OP ECT Mental Health ($): 1195.36] [APC ($): FEE SCHEDULE]","count":"72","median_amount":573.51,"10th_percentile":67.09,"90th_percentile":12329.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"30","median_amount":75.39,"10th_percentile":24.45,"90th_percentile":311.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"1 through 10","median_amount":4017.48,"10th_percentile":428.82,"90th_percentile":11660.43},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"19","median_amount":1799.43,"10th_percentile":142.97,"90th_percentile":4152.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":40.36,"10th_percentile":40.36,"90th_percentile":225.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3522.39,"10th_percentile":3520.52,"90th_percentile":12408.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 3 Drug Administration","code_information":[{"code":"5693","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [Mental Health-Intensive ($): 201] [Mental Health-Partial Hospitalization ($): 401] [All Other OP (%BC): 78]","count":"26","median_amount":562.25,"10th_percentile":245.13,"90th_percentile":1694.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"13","median_amount":278.96,"10th_percentile":194.61,"90th_percentile":5803.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":314.56,"10th_percentile":175.41,"90th_percentile":2245.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"17","median_amount":340.63,"10th_percentile":213.0,"90th_percentile":2509.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.2] [Cardiac Cath (%BC): 71.1] [Lithotripsy (%BC): 71.1] [Observation (%BC): 71.1] [Emergency Department (%BC): 73.2] [Radiology (%BC): 71.1] [Laboratory (%BC): 26.1] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 71.1] [Speech Therapy (%BC): 46] [Mental Health ($): 1776] [OP High Cost Drugs (%BC): 52.9] [All Other OP (%BC): 71.1]","count":"43","median_amount":707.94,"10th_percentile":504.48,"90th_percentile":3771.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"16","median_amount":197.66,"10th_percentile":193.71,"90th_percentile":610.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.6,"count":"1 through 10","median_amount":2376.18,"10th_percentile":2376.18,"90th_percentile":2376.18},{"payer_name":"First Health/Coventry","plan_name":"First Health Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health-Intensive ($): 467.68] [Mental Health-Partial Hospitalization ($): 777.57] [OP ECT Mental Health ($): 1195.36] [APC ($): FEE SCHEDULE]","count":"79","median_amount":239.47,"10th_percentile":196.45,"90th_percentile":6126.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"12","median_amount":389.51,"10th_percentile":311.43,"90th_percentile":848.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"1 through 10","median_amount":1025.25,"10th_percentile":1025.25,"90th_percentile":1920.45},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"37","median_amount":239.64,"10th_percentile":197.66,"90th_percentile":5721.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":279.34,"10th_percentile":218.56,"90th_percentile":1739.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":4020.87,"10th_percentile":4020.87,"90th_percentile":4020.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 4 Drug Administration","code_information":[{"code":"5694","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [Mental Health-Intensive ($): 201] [Mental Health-Partial Hospitalization ($): 401] [All Other OP (%BC): 78]","count":"15","median_amount":25977.43,"10th_percentile":1401.94,"90th_percentile":56790.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":8090.33,"10th_percentile":3216.47,"90th_percentile":12961.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":15045.9,"10th_percentile":698.97,"90th_percentile":35093.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":13460.77,"10th_percentile":404.83,"90th_percentile":14412.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.2] [Cardiac Cath (%BC): 71.1] [Lithotripsy (%BC): 71.1] [Observation (%BC): 71.1] [Emergency Department (%BC): 73.2] [Radiology (%BC): 71.1] [Laboratory (%BC): 26.1] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 71.1] [Speech Therapy (%BC): 46] [Mental Health ($): 1776] [OP High Cost Drugs (%BC): 52.9] [All Other OP (%BC): 71.1]","count":"37","median_amount":8769.81,"10th_percentile":2943.76,"90th_percentile":16448.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":8153.56,"10th_percentile":2564.07,"90th_percentile":25651.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"First Health Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health-Intensive ($): 467.68] [Mental Health-Partial Hospitalization ($): 777.57] [OP ECT Mental Health ($): 1195.36] [APC ($): FEE SCHEDULE]","count":"59","median_amount":11108.4,"10th_percentile":395.3,"90th_percentile":21795.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":17888.56,"10th_percentile":17888.56,"90th_percentile":17888.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"1 through 10","median_amount":28340.37,"10th_percentile":28340.37,"90th_percentile":28340.37},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"23","median_amount":12121.99,"10th_percentile":1782.06,"90th_percentile":24559.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":3745.48,"10th_percentile":3668.78,"90th_percentile":17210.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":12817.59,"10th_percentile":12187.42,"90th_percentile":12817.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 1 Diagnostic Tests and Related Services","code_information":[{"code":"5721","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [Mental Health-Intensive ($): 201] [Mental Health-Partial Hospitalization ($): 401] [All Other OP (%BC): 78]","count":"11","median_amount":980.46,"10th_percentile":326.82,"90th_percentile":980.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":145.84,"10th_percentile":145.84,"90th_percentile":145.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":282.86,"10th_percentile":282.86,"90th_percentile":282.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":280.06,"10th_percentile":84.0,"90th_percentile":280.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.2] [Cardiac Cath (%BC): 71.1] [Lithotripsy (%BC): 71.1] [Observation (%BC): 71.1] [Emergency Department (%BC): 73.2] [Radiology (%BC): 71.1] [Laboratory (%BC): 26.1] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 71.1] [Speech Therapy (%BC): 46] [Mental Health ($): 1776] [OP High Cost Drugs (%BC): 52.9] [All Other OP (%BC): 71.1]","count":"16","median_amount":893.73,"10th_percentile":893.73,"90th_percentile":937.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":144.34,"10th_percentile":144.34,"90th_percentile":144.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.6,"count":"1 through 10","median_amount":824.59,"10th_percentile":824.59,"90th_percentile":824.59},{"payer_name":"First Health/Coventry","plan_name":"First Health Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health-Intensive ($): 467.68] [Mental Health-Partial Hospitalization ($): 777.57] [OP ECT Mental Health ($): 1195.36] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":145.28,"10th_percentile":145.28,"90th_percentile":146.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":210.55,"10th_percentile":210.55,"90th_percentile":210.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"1 through 10","median_amount":891.21,"10th_percentile":891.21,"90th_percentile":891.21},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":144.05,"10th_percentile":144.05,"90th_percentile":144.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Diagnostic Tests and Related Services","code_information":[{"code":"5722","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [Mental Health-Intensive ($): 201] [Mental Health-Partial Hospitalization ($): 401] [All Other OP (%BC): 78]","count":"1 through 10","median_amount":688.35,"10th_percentile":275.34,"90th_percentile":1432.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":286.3,"10th_percentile":286.3,"90th_percentile":440.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":104.86,"10th_percentile":104.86,"90th_percentile":104.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"20","median_amount":193.17,"10th_percentile":106.27,"90th_percentile":243.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.2] [Cardiac Cath (%BC): 71.1] [Lithotripsy (%BC): 71.1] [Observation (%BC): 71.1] [Emergency Department (%BC): 73.2] [Radiology (%BC): 71.1] [Laboratory (%BC): 26.1] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 71.1] [Speech Therapy (%BC): 46] [Mental Health ($): 1776] [OP High Cost Drugs (%BC): 52.9] [All Other OP (%BC): 71.1]","count":"1 through 10","median_amount":775.19,"10th_percentile":775.19,"90th_percentile":1304.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":286.6,"10th_percentile":286.6,"90th_percentile":286.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.6,"count":"1 through 10","median_amount":1203.98,"10th_percentile":694.7,"90th_percentile":1204.8},{"payer_name":"First Health/Coventry","plan_name":"First Health Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health-Intensive ($): 467.68] [Mental Health-Partial Hospitalization ($): 777.57] [OP ECT Mental Health ($): 1195.36] [APC ($): FEE SCHEDULE]","count":"12","median_amount":290.34,"10th_percentile":289.96,"90th_percentile":291.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"15","median_amount":159.3,"10th_percentile":106.27,"90th_percentile":193.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"1 through 10","median_amount":1302.14,"10th_percentile":1302.14,"90th_percentile":1302.14},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":287.3,"10th_percentile":286.8,"90th_percentile":287.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":176.32,"10th_percentile":176.32,"90th_percentile":241.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Diagnostic Tests and Related Services","code_information":[{"code":"5723","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [Mental Health-Intensive ($): 201] [Mental Health-Partial Hospitalization ($): 401] [All Other OP (%BC): 78]","count":"1 through 10","median_amount":4402.32,"10th_percentile":4402.32,"90th_percentile":4402.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":171.33,"10th_percentile":162.86,"90th_percentile":357.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.2] [Cardiac Cath (%BC): 71.1] [Lithotripsy (%BC): 71.1] [Observation (%BC): 71.1] [Emergency Department (%BC): 73.2] [Radiology (%BC): 71.1] [Laboratory (%BC): 26.1] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 71.1] [Speech Therapy (%BC): 46] [Mental Health ($): 1776] [OP High Cost Drugs (%BC): 52.9] [All Other OP (%BC): 71.1]","count":"1 through 10","median_amount":3943.92,"10th_percentile":3943.92,"90th_percentile":3943.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"First Health Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health-Intensive ($): 467.68] [Mental Health-Partial Hospitalization ($): 777.57] [OP ECT Mental Health ($): 1195.36] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":162.86,"10th_percentile":162.86,"90th_percentile":162.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 4 Diagnostic Tests and Related Services","code_information":[{"code":"5724","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [Mental Health-Intensive ($): 201] [Mental Health-Partial Hospitalization ($): 401] [All Other OP (%BC): 78]","count":"1 through 10","median_amount":2985.84,"10th_percentile":2488.2,"90th_percentile":3510.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":937.36,"10th_percentile":937.36,"90th_percentile":937.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":861.41,"10th_percentile":861.41,"90th_percentile":861.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":929.43,"10th_percentile":929.43,"90th_percentile":929.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.2] [Cardiac Cath (%BC): 71.1] [Lithotripsy (%BC): 71.1] [Observation (%BC): 71.1] [Emergency Department (%BC): 73.2] [Radiology (%BC): 71.1] [Laboratory (%BC): 26.1] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 71.1] [Speech Therapy (%BC): 46] [Mental Health ($): 1776] [OP High Cost Drugs (%BC): 52.9] [All Other OP (%BC): 71.1]","count":"19","median_amount":2721.71,"10th_percentile":2721.71,"90th_percentile":7718.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":935.86,"10th_percentile":935.86,"90th_percentile":954.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.6,"count":"1 through 10","median_amount":2511.17,"10th_percentile":2511.17,"90th_percentile":2952.66},{"payer_name":"First Health/Coventry","plan_name":"First Health Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health-Intensive ($): 467.68] [Mental Health-Partial Hospitalization ($): 777.57] [OP ECT Mental Health ($): 1195.36] [APC ($): FEE SCHEDULE]","count":"16","median_amount":947.11,"10th_percentile":338.12,"90th_percentile":954.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":852.88,"10th_percentile":852.88,"90th_percentile":929.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"1 through 10","median_amount":3191.21,"10th_percentile":3191.21,"90th_percentile":7552.56},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":329.68,"10th_percentile":329.68,"90th_percentile":935.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":874.2,"10th_percentile":874.2,"90th_percentile":874.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Minor Procedures","code_information":[{"code":"5731","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [Mental Health-Intensive ($): 201] [Mental Health-Partial Hospitalization ($): 401] [All Other OP (%BC): 78]","count":"1 through 10","median_amount":24551.21,"10th_percentile":24551.21,"90th_percentile":24551.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.2] [Cardiac Cath (%BC): 71.1] [Lithotripsy (%BC): 71.1] [Observation (%BC): 71.1] [Emergency Department (%BC): 73.2] [Radiology (%BC): 71.1] [Laboratory (%BC): 26.1] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 71.1] [Speech Therapy (%BC): 46] [Mental Health ($): 1776] [OP High Cost Drugs (%BC): 52.9] [All Other OP (%BC): 71.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"First Health Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health-Intensive ($): 467.68] [Mental Health-Partial Hospitalization ($): 777.57] [OP ECT Mental Health ($): 1195.36] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Minor Procedures","code_information":[{"code":"5732","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [Mental Health-Intensive ($): 201] [Mental Health-Partial Hospitalization ($): 401] [All Other OP (%BC): 78]","count":"1 through 10","median_amount":399.75,"10th_percentile":320.06,"90th_percentile":800.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":36.82,"10th_percentile":36.82,"90th_percentile":36.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":138.39,"10th_percentile":138.39,"90th_percentile":138.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"15","median_amount":56.82,"10th_percentile":52.14,"90th_percentile":274.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.2] [Cardiac Cath (%BC): 71.1] [Lithotripsy (%BC): 71.1] [Observation (%BC): 71.1] [Emergency Department (%BC): 73.2] [Radiology (%BC): 71.1] [Laboratory (%BC): 26.1] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 71.1] [Speech Therapy (%BC): 46] [Mental Health ($): 1776] [OP High Cost Drugs (%BC): 52.9] [All Other OP (%BC): 71.1]","count":"1 through 10","median_amount":901.09,"10th_percentile":901.09,"90th_percentile":901.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":36.58,"10th_percentile":36.58,"90th_percentile":36.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"First Health Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health-Intensive ($): 467.68] [Mental Health-Partial Hospitalization ($): 777.57] [OP ECT Mental Health ($): 1195.36] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":37.19,"10th_percentile":37.19,"90th_percentile":37.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":56.82,"10th_percentile":52.14,"90th_percentile":142.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"1 through 10","median_amount":436.04,"10th_percentile":436.04,"90th_percentile":436.04},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":36.82,"10th_percentile":36.82,"90th_percentile":36.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":281.12,"10th_percentile":281.12,"90th_percentile":281.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Minor Procedures","code_information":[{"code":"5733","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [Mental Health-Intensive ($): 201] [Mental Health-Partial Hospitalization ($): 401] [All Other OP (%BC): 78]","count":"15","median_amount":751.92,"10th_percentile":82.47,"90th_percentile":858.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"11","median_amount":54.66,"10th_percentile":54.62,"90th_percentile":55.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":53.41,"10th_percentile":50.41,"90th_percentile":133.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"15","median_amount":60.82,"10th_percentile":49.91,"90th_percentile":72.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.2] [Cardiac Cath (%BC): 71.1] [Lithotripsy (%BC): 71.1] [Observation (%BC): 71.1] [Emergency Department (%BC): 73.2] [Radiology (%BC): 71.1] [Laboratory (%BC): 26.1] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 71.1] [Speech Therapy (%BC): 46] [Mental Health ($): 1776] [OP High Cost Drugs (%BC): 52.9] [All Other OP (%BC): 71.1]","count":"23","median_amount":350.69,"10th_percentile":205.51,"90th_percentile":457.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":55.12,"10th_percentile":55.12,"90th_percentile":55.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.6,"count":"1 through 10","median_amount":632.38,"10th_percentile":202.7,"90th_percentile":711.1},{"payer_name":"First Health/Coventry","plan_name":"First Health Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health-Intensive ($): 467.68] [Mental Health-Partial Hospitalization ($): 777.57] [OP ECT Mental Health ($): 1195.36] [APC ($): FEE SCHEDULE]","count":"37","median_amount":55.39,"10th_percentile":55.16,"90th_percentile":56.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":49.91,"10th_percentile":49.24,"90th_percentile":80.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"1 through 10","median_amount":705.46,"10th_percentile":705.46,"90th_percentile":705.46},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":55.62,"10th_percentile":54.62,"90th_percentile":55.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 4 Minor Procedures","code_information":[{"code":"5734","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [Mental Health-Intensive ($): 201] [Mental Health-Partial Hospitalization ($): 401] [All Other OP (%BC): 78]","count":"24","median_amount":511.68,"10th_percentile":266.76,"90th_percentile":1246.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":118.51,"10th_percentile":118.51,"90th_percentile":120.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":75.16,"10th_percentile":75.16,"90th_percentile":279.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"21","median_amount":162.44,"10th_percentile":66.4,"90th_percentile":371.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.2] [Cardiac Cath (%BC): 71.1] [Lithotripsy (%BC): 71.1] [Observation (%BC): 71.1] [Emergency Department (%BC): 73.2] [Radiology (%BC): 71.1] [Laboratory (%BC): 26.1] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 71.1] [Speech Therapy (%BC): 46] [Mental Health ($): 1776] [OP High Cost Drugs (%BC): 52.9] [All Other OP (%BC): 71.1]","count":"47","median_amount":297.92,"10th_percentile":118.23,"90th_percentile":556.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":118.61,"10th_percentile":118.61,"90th_percentile":120.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.6,"count":"1 through 10","median_amount":1048.28,"10th_percentile":1048.28,"90th_percentile":1959.47},{"payer_name":"First Health/Coventry","plan_name":"First Health Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health-Intensive ($): 467.68] [Mental Health-Partial Hospitalization ($): 777.57] [OP ECT Mental Health ($): 1195.36] [APC ($): FEE SCHEDULE]","count":"45","median_amount":120.2,"10th_percentile":119.7,"90th_percentile":120.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":308.0,"10th_percentile":308.0,"90th_percentile":308.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"16","median_amount":113.15,"10th_percentile":66.4,"90th_percentile":300.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"1 through 10","median_amount":971.34,"10th_percentile":288.56,"90th_percentile":1395.31},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"12","median_amount":118.52,"10th_percentile":118.52,"90th_percentile":120.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":98.41,"10th_percentile":54.98,"90th_percentile":266.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pulmonary Treatment","code_information":[{"code":"5791","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [Mental Health-Intensive ($): 201] [Mental Health-Partial Hospitalization ($): 401] [All Other OP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":171.11,"10th_percentile":171.11,"90th_percentile":171.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.2] [Cardiac Cath (%BC): 71.1] [Lithotripsy (%BC): 71.1] [Observation (%BC): 71.1] [Emergency Department (%BC): 73.2] [Radiology (%BC): 71.1] [Laboratory (%BC): 26.1] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 71.1] [Speech Therapy (%BC): 46] [Mental Health ($): 1776] [OP High Cost Drugs (%BC): 52.9] [All Other OP (%BC): 71.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"First Health Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health-Intensive ($): 467.68] [Mental Health-Partial Hospitalization ($): 777.57] [OP ECT Mental Health ($): 1195.36] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":92.02,"10th_percentile":92.02,"90th_percentile":92.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Manipulation Therapy","code_information":[{"code":"5811","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [Mental Health-Intensive ($): 201] [Mental Health-Partial Hospitalization ($): 401] [All Other OP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":41.41,"10th_percentile":41.41,"90th_percentile":41.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":33.87,"10th_percentile":33.87,"90th_percentile":33.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.2] [Cardiac Cath (%BC): 71.1] [Lithotripsy (%BC): 71.1] [Observation (%BC): 71.1] [Emergency Department (%BC): 73.2] [Radiology (%BC): 71.1] [Laboratory (%BC): 26.1] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 71.1] [Speech Therapy (%BC): 46] [Mental Health ($): 1776] [OP High Cost Drugs (%BC): 52.9] [All Other OP (%BC): 71.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"First Health Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health-Intensive ($): 467.68] [Mental Health-Partial Hospitalization ($): 777.57] [OP ECT Mental Health ($): 1195.36] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":41.0,"10th_percentile":41.0,"90th_percentile":41.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Health and Behavior Services","code_information":[{"code":"5821","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [Mental Health-Intensive ($): 201] [Mental Health-Partial Hospitalization ($): 401] [All Other OP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":67.51,"10th_percentile":67.51,"90th_percentile":67.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":42.34,"10th_percentile":42.34,"90th_percentile":42.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.2] [Cardiac Cath (%BC): 71.1] [Lithotripsy (%BC): 71.1] [Observation (%BC): 71.1] [Emergency Department (%BC): 73.2] [Radiology (%BC): 71.1] [Laboratory (%BC): 26.1] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 71.1] [Speech Therapy (%BC): 46] [Mental Health ($): 1776] [OP High Cost Drugs (%BC): 52.9] [All Other OP (%BC): 71.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"First Health Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health-Intensive ($): 467.68] [Mental Health-Partial Hospitalization ($): 777.57] [OP ECT Mental Health ($): 1195.36] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":61.85,"10th_percentile":61.85,"90th_percentile":61.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Health and Behavior Services","code_information":[{"code":"5823","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [Mental Health-Intensive ($): 201] [Mental Health-Partial Hospitalization ($): 401] [All Other OP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":41.18,"10th_percentile":41.18,"90th_percentile":41.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"56","median_amount":40.77,"10th_percentile":40.77,"90th_percentile":40.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.2] [Cardiac Cath (%BC): 71.1] [Lithotripsy (%BC): 71.1] [Observation (%BC): 71.1] [Emergency Department (%BC): 73.2] [Radiology (%BC): 71.1] [Laboratory (%BC): 26.1] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 71.1] [Speech Therapy (%BC): 46] [Mental Health ($): 1776] [OP High Cost Drugs (%BC): 52.9] [All Other OP (%BC): 71.1]","count":"1 through 10","median_amount":10672.56,"10th_percentile":10672.56,"90th_percentile":10672.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"First Health Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health-Intensive ($): 467.68] [Mental Health-Partial Hospitalization ($): 777.57] [OP ECT Mental Health ($): 1195.36] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":40.77,"10th_percentile":40.77,"90th_percentile":40.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Platelet pheres leukoreduced","code_information":[{"code":"9501","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [Mental Health-Intensive ($): 201] [Mental Health-Partial Hospitalization ($): 401] [All Other OP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.2] [Cardiac Cath (%BC): 71.1] [Lithotripsy (%BC): 71.1] [Observation (%BC): 71.1] [Emergency Department (%BC): 73.2] [Radiology (%BC): 71.1] [Laboratory (%BC): 26.1] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 71.1] [Speech Therapy (%BC): 46] [Mental Health ($): 1776] [OP High Cost Drugs (%BC): 52.9] [All Other OP (%BC): 71.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"First Health Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health-Intensive ($): 467.68] [Mental Health-Partial Hospitalization ($): 777.57] [OP ECT Mental Health ($): 1195.36] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":2246.27,"10th_percentile":2246.27,"90th_percentile":2352.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-OPPS Clinic Services","code_information":[{"code":"N700","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [Mental Health-Intensive ($): 201] [Mental Health-Partial Hospitalization ($): 401] [All Other OP (%BC): 78]","count":"1 through 10","median_amount":156.78,"10th_percentile":156.78,"90th_percentile":156.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"47","median_amount":34.21,"10th_percentile":34.21,"90th_percentile":34.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"382","median_amount":33.87,"10th_percentile":33.87,"90th_percentile":33.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.2] [Cardiac Cath (%BC): 71.1] [Lithotripsy (%BC): 71.1] [Observation (%BC): 71.1] [Emergency Department (%BC): 73.2] [Radiology (%BC): 71.1] [Laboratory (%BC): 26.1] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 71.1] [Speech Therapy (%BC): 46] [Mental Health ($): 1776] [OP High Cost Drugs (%BC): 52.9] [All Other OP (%BC): 71.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"First Health Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health-Intensive ($): 467.68] [Mental Health-Partial Hospitalization ($): 777.57] [OP ECT Mental Health ($): 1195.36] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"320","median_amount":33.87,"10th_percentile":33.87,"90th_percentile":33.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"1 through 10","median_amount":243.19,"10th_percentile":243.19,"90th_percentile":243.19},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"13","median_amount":34.71,"10th_percentile":34.71,"90th_percentile":82.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Clinical Diagnostic Lab Services","code_information":[{"code":"N800","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [Mental Health-Intensive ($): 201] [Mental Health-Partial Hospitalization ($): 401] [All Other OP (%BC): 78]","count":"860","median_amount":257.4,"10th_percentile":46.28,"90th_percentile":751.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"409","median_amount":43.73,"10th_percentile":16.52,"90th_percentile":101.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"28","median_amount":55.55,"10th_percentile":12.45,"90th_percentile":183.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"263","median_amount":52.68,"10th_percentile":13.24,"90th_percentile":145.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.2] [Cardiac Cath (%BC): 71.1] [Lithotripsy (%BC): 71.1] [Observation (%BC): 71.1] [Emergency Department (%BC): 73.2] [Radiology (%BC): 71.1] [Laboratory (%BC): 26.1] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 71.1] [Speech Therapy (%BC): 46] [Mental Health ($): 1776] [OP High Cost Drugs (%BC): 52.9] [All Other OP (%BC): 71.1]","count":"1458","median_amount":123.2,"10th_percentile":34.71,"90th_percentile":287.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"403","median_amount":44.66,"10th_percentile":16.62,"90th_percentile":87.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.6,"count":"332","median_amount":309.63,"10th_percentile":61.01,"90th_percentile":712.42},{"payer_name":"First Health/Coventry","plan_name":"First Health Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":430.2,"10th_percentile":430.2,"90th_percentile":430.2},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health-Intensive ($): 467.68] [Mental Health-Partial Hospitalization ($): 777.57] [OP ECT Mental Health ($): 1195.36] [APC ($): FEE SCHEDULE]","count":"1651","median_amount":36.58,"10th_percentile":13.51,"90th_percentile":86.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":45.77,"10th_percentile":45.77,"90th_percentile":45.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":148.5,"10th_percentile":148.5,"90th_percentile":148.5},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"230","median_amount":58.32,"10th_percentile":14.21,"90th_percentile":156.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"313","median_amount":321.89,"10th_percentile":52.47,"90th_percentile":737.37},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"609","median_amount":38.98,"10th_percentile":10.75,"90th_percentile":85.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"99","median_amount":56.78,"10th_percentile":13.57,"90th_percentile":169.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"80","median_amount":40.52,"10th_percentile":16.52,"90th_percentile":93.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Therapy Services","code_information":[{"code":"N801","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [Mental Health-Intensive ($): 201] [Mental Health-Partial Hospitalization ($): 401] [All Other OP (%BC): 78]","count":"1 through 10","median_amount":1196.0,"10th_percentile":1196.0,"90th_percentile":1196.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.2] [Cardiac Cath (%BC): 71.1] [Lithotripsy (%BC): 71.1] [Observation (%BC): 71.1] [Emergency Department (%BC): 73.2] [Radiology (%BC): 71.1] [Laboratory (%BC): 26.1] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 71.1] [Speech Therapy (%BC): 46] [Mental Health ($): 1776] [OP High Cost Drugs (%BC): 52.9] [All Other OP (%BC): 71.1]","count":"1 through 10","median_amount":743.74,"10th_percentile":743.74,"90th_percentile":1880.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"First Health Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health-Intensive ($): 467.68] [Mental Health-Partial Hospitalization ($): 777.57] [OP ECT Mental Health ($): 1195.36] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":587.83,"10th_percentile":587.83,"90th_percentile":587.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":132.09,"10th_percentile":132.09,"90th_percentile":132.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"1 through 10","median_amount":666.46,"10th_percentile":519.0,"90th_percentile":1917.6},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Mammography Services","code_information":[{"code":"N804","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [Mental Health-Intensive ($): 201] [Mental Health-Partial Hospitalization ($): 401] [All Other OP (%BC): 78]","count":"108","median_amount":599.04,"10th_percentile":199.68,"90th_percentile":599.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"39","median_amount":102.36,"10th_percentile":102.36,"90th_percentile":184.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":172.82,"10th_percentile":172.82,"90th_percentile":172.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":171.11,"10th_percentile":171.11,"90th_percentile":204.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.2] [Cardiac Cath (%BC): 71.1] [Lithotripsy (%BC): 71.1] [Observation (%BC): 71.1] [Emergency Department (%BC): 73.2] [Radiology (%BC): 71.1] [Laboratory (%BC): 26.1] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 71.1] [Speech Therapy (%BC): 46] [Mental Health ($): 1776] [OP High Cost Drugs (%BC): 52.9] [All Other OP (%BC): 71.1]","count":"179","median_amount":546.05,"10th_percentile":546.04,"90th_percentile":546.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"33","median_amount":102.36,"10th_percentile":102.36,"90th_percentile":104.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.6,"count":"29","median_amount":503.81,"10th_percentile":503.81,"90th_percentile":503.81},{"payer_name":"First Health/Coventry","plan_name":"First Health Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health-Intensive ($): 467.68] [Mental Health-Partial Hospitalization ($): 777.57] [OP ECT Mental Health ($): 1195.36] [APC ($): FEE SCHEDULE]","count":"117","median_amount":103.39,"10th_percentile":103.39,"90th_percentile":103.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":171.11,"10th_percentile":171.11,"90th_percentile":171.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"27","median_amount":544.52,"10th_percentile":544.51,"90th_percentile":544.52},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"37","median_amount":102.37,"10th_percentile":102.37,"90th_percentile":102.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":102.36,"10th_percentile":102.36,"90th_percentile":102.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Non-covered Services","code_information":[{"code":"N900","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [Mental Health-Intensive ($): 201] [Mental Health-Partial Hospitalization ($): 401] [All Other OP (%BC): 78]","count":"14","median_amount":228.8,"10th_percentile":27.63,"90th_percentile":835.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":238.62,"10th_percentile":238.62,"90th_percentile":290.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.2] [Cardiac Cath (%BC): 71.1] [Lithotripsy (%BC): 71.1] [Observation (%BC): 71.1] [Emergency Department (%BC): 73.2] [Radiology (%BC): 71.1] [Laboratory (%BC): 26.1] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 71.1] [Speech Therapy (%BC): 46] [Mental Health ($): 1776] [OP High Cost Drugs (%BC): 52.9] [All Other OP (%BC): 71.1]","count":"20","median_amount":249.39,"10th_percentile":166.25,"90th_percentile":720.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.6,"count":"1 through 10","median_amount":702.57,"10th_percentile":702.57,"90th_percentile":702.57},{"payer_name":"First Health/Coventry","plan_name":"First Health Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health-Intensive ($): 467.68] [Mental Health-Partial Hospitalization ($): 777.57] [OP ECT Mental Health ($): 1195.36] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":278.5,"10th_percentile":278.5,"90th_percentile":325.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"1 through 10","median_amount":623.92,"10th_percentile":623.92,"90th_percentile":623.92},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Packaged Services","code_information":[{"code":"N902","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [Mental Health-Intensive ($): 201] [Mental Health-Partial Hospitalization ($): 401] [All Other OP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.2] [Cardiac Cath (%BC): 71.1] [Lithotripsy (%BC): 71.1] [Observation (%BC): 71.1] [Emergency Department (%BC): 73.2] [Radiology (%BC): 71.1] [Laboratory (%BC): 26.1] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 71.1] [Speech Therapy (%BC): 46] [Mental Health ($): 1776] [OP High Cost Drugs (%BC): 52.9] [All Other OP (%BC): 71.1]","count":"1 through 10","median_amount":1777.47,"10th_percentile":1777.47,"90th_percentile":1777.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"First Health Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health-Intensive ($): 467.68] [Mental Health-Partial Hospitalization ($): 777.57] [OP ECT Mental Health ($): 1195.36] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":46.34,"10th_percentile":46.34,"90th_percentile":46.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Not Recognized by OPPS","code_information":[{"code":"N905","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [Mental Health-Intensive ($): 201] [Mental Health-Partial Hospitalization ($): 401] [All Other OP (%BC): 78]","count":"1 through 10","median_amount":2466.71,"10th_percentile":2466.71,"90th_percentile":7400.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":42.09,"10th_percentile":4.73,"90th_percentile":46.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Healthy Blue Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"57","median_amount":9.36,"10th_percentile":4.68,"90th_percentile":38.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.2] [Cardiac Cath (%BC): 71.1] [Lithotripsy (%BC): 71.1] [Observation (%BC): 71.1] [Emergency Department (%BC): 73.2] [Radiology (%BC): 71.1] [Laboratory (%BC): 26.1] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 71.1] [Speech Therapy (%BC): 46] [Mental Health ($): 1776] [OP High Cost Drugs (%BC): 52.9] [All Other OP (%BC): 71.1]","count":"1 through 10","median_amount":6745.51,"10th_percentile":6745.51,"90th_percentile":6745.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.6,"count":"1 through 10","median_amount":6223.71,"10th_percentile":6223.71,"90th_percentile":6223.71},{"payer_name":"First Health/Coventry","plan_name":"First Health Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Mental Health-Intensive ($): 467.68] [Mental Health-Partial Hospitalization ($): 777.57] [OP ECT Mental Health ($): 1195.36] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Community Plan Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"43","median_amount":25.4,"10th_percentile":4.68,"90th_percentile":46.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":70.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":2166.63,"10th_percentile":2166.63,"90th_percentile":2166.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ketorolac tromethamine inj","code_information":[{"code":"J1885","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":0.30,"maximum":0.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":0.3,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":0.31,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":0.31,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":0.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":0.76,"additional_payer_notes":"APC"}]}]},{"description":"Rem mlt day uroflow setup","code_information":[{"code":"0811T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":127.25,"maximum":317.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":127.25,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":129.8,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.53,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":131.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":317.76,"additional_payer_notes":"APC"}]}]},{"description":"Rem mntr impl ivc snr set-up","code_information":[{"code":"0982T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":127.25,"maximum":317.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":127.25,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":129.8,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.53,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":131.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":317.76,"additional_payer_notes":"APC"}]}]},{"description":"Rem mntr s-scl eeg sys setup","code_information":[{"code":"1008T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":127.25,"maximum":317.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":127.25,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":129.8,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.53,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":131.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":317.76,"additional_payer_notes":"APC"}]}]},{"description":"Eye exam new patient","code_information":[{"code":"92002","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":127.25,"maximum":317.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":127.25,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":129.8,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.53,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":131.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":317.76,"additional_payer_notes":"APC"}]}]},{"description":"Eye exam new patient","code_information":[{"code":"92004","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":127.25,"maximum":317.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":127.25,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":129.8,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.53,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":131.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":317.76,"additional_payer_notes":"APC"}]}]},{"description":"Eye exam establish patient","code_information":[{"code":"92012","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":127.25,"maximum":317.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":127.25,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":129.8,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.53,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":131.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":317.76,"additional_payer_notes":"APC"}]}]},{"description":"Eye exam&tx estab pt 1/>vst","code_information":[{"code":"92014","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":127.25,"maximum":317.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":127.25,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":129.8,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.53,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":131.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":317.76,"additional_payer_notes":"APC"}]}]},{"description":"Glucose monitoring cont","code_information":[{"code":"95250","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":127.25,"maximum":317.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":127.25,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":129.8,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.53,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":131.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":317.76,"additional_payer_notes":"APC"}]}]},{"description":"Rem ther mntr 1st setup&edu","code_information":[{"code":"98975","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":127.25,"maximum":317.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":127.25,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":129.8,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.53,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":131.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":317.76,"additional_payer_notes":"APC"}]}]},{"description":"Rem mntr physiol param setup","code_information":[{"code":"99453","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":127.25,"maximum":317.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":127.25,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":129.8,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.53,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":131.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":317.76,"additional_payer_notes":"APC"}]}]},{"description":"Init nb em per day hosp","code_information":[{"code":"99460","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":127.25,"maximum":317.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":127.25,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":129.8,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.53,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":131.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":317.76,"additional_payer_notes":"APC"}]}]},{"description":"Same day nb discharge","code_information":[{"code":"99463","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":127.25,"maximum":317.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":127.25,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":129.8,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.53,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":131.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":317.76,"additional_payer_notes":"APC"}]}]},{"description":"Trans care mgmt 14 day disch","code_information":[{"code":"99495","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":127.25,"maximum":317.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":127.25,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":129.8,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.53,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":131.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":317.76,"additional_payer_notes":"APC"}]}]},{"description":"Trans care mgmt 7 day disch","code_information":[{"code":"99496","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":127.25,"maximum":317.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":127.25,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":129.8,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.53,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":131.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":317.76,"additional_payer_notes":"APC"}]}]},{"description":"Periodic oral evaluation","code_information":[{"code":"D0120","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":127.25,"maximum":317.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":127.25,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":129.8,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.53,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":131.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":317.76,"additional_payer_notes":"APC"}]}]},{"description":"Limit oral eval problm focus","code_information":[{"code":"D0140","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":127.25,"maximum":317.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":127.25,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":129.8,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.53,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":131.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":317.76,"additional_payer_notes":"APC"}]}]},{"description":"Comprehensve oral evaluation","code_information":[{"code":"D0150","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":127.25,"maximum":317.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":127.25,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":129.8,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.53,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":131.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":317.76,"additional_payer_notes":"APC"}]}]},{"description":"Extensv oral eval prob focus","code_information":[{"code":"D0160","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":127.25,"maximum":317.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":127.25,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":129.8,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.53,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":131.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":317.76,"additional_payer_notes":"APC"}]}]},{"description":"Re-eval,est pt,problem focus","code_information":[{"code":"D0170","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":127.25,"maximum":317.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":127.25,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":129.8,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.53,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":131.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":317.76,"additional_payer_notes":"APC"}]}]},{"description":"Re-eval post-op visit","code_information":[{"code":"D0171","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":127.25,"maximum":317.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":127.25,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":129.8,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.53,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":131.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":317.76,"additional_payer_notes":"APC"}]}]},{"description":"Comp periodontal evaluation","code_information":[{"code":"D0180","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":127.25,"maximum":317.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":127.25,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":129.8,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.53,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":131.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":317.76,"additional_payer_notes":"APC"}]}]},{"description":"Assessment of a patient","code_information":[{"code":"D0191","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":127.25,"maximum":317.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":127.25,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":129.8,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.53,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":131.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":317.76,"additional_payer_notes":"APC"}]}]},{"description":"Dental prophylaxis adult","code_information":[{"code":"D1110","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":127.25,"maximum":317.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":127.25,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":129.8,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.53,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":131.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":317.76,"additional_payer_notes":"APC"}]}]},{"description":"Gingival irrigation per quad","code_information":[{"code":"D4921","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":127.25,"maximum":317.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":127.25,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":129.8,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.53,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":131.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":317.76,"additional_payer_notes":"APC"}]}]},{"description":"Initial foot exam pt lops","code_information":[{"code":"G0245","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":127.25,"maximum":317.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":127.25,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":129.8,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.53,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":131.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":317.76,"additional_payer_notes":"APC"}]}]},{"description":"Followup eval of foot pt lop","code_information":[{"code":"G0246","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":127.25,"maximum":317.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":127.25,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":129.8,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.53,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":131.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":317.76,"additional_payer_notes":"APC"}]}]},{"description":"Demonstrate use home inr mon","code_information":[{"code":"G0248","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":127.25,"maximum":317.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":127.25,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":129.8,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.53,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":131.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":317.76,"additional_payer_notes":"APC"}]}]},{"description":"Provide INR test mater/equip","code_information":[{"code":"G0249","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":127.25,"maximum":317.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":127.25,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":129.8,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.53,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":131.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":317.76,"additional_payer_notes":"APC"}]}]},{"description":"Initial preventive exam","code_information":[{"code":"G0402","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":127.25,"maximum":317.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":127.25,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":129.8,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.53,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":131.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":317.76,"additional_payer_notes":"APC"}]}]},{"description":"Hospital outpt clinic visit","code_information":[{"code":"G0463","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":127.25,"maximum":317.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":127.25,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":129.8,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.53,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":131.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":317.76,"additional_payer_notes":"APC"}]}]},{"description":"Supply of digital device","code_information":[{"code":"G0552","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":127.25,"maximum":317.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":127.25,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":129.8,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.53,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":131.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":317.76,"additional_payer_notes":"APC"}]}]},{"description":"Monthly tx for dmht 20mins","code_information":[{"code":"G0553","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":127.25,"maximum":317.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":127.25,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":129.8,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.53,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":131.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":317.76,"additional_payer_notes":"APC"}]}]},{"description":"Emergency dept visit","code_information":[{"code":"99281","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":80.60,"maximum":201.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":80.6,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":82.21,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":81.4,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":83.02,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":201.25,"additional_payer_notes":"APC"}]}]},{"description":"Emergency dept visit","code_information":[{"code":"99282","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":146.76,"maximum":366.46,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":146.76,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":149.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":148.23,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":151.16,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":366.46,"additional_payer_notes":"APC"}]}]},{"description":"Emergency dept visit","code_information":[{"code":"99283","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":260.92,"maximum":651.51,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":260.92,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":266.14,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":263.53,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":268.75,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":651.51,"additional_payer_notes":"APC"}]}]},{"description":"Dialysis one evaluation","code_information":[{"code":"90945","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":398.83,"maximum":995.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":398.83,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":406.81,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":402.82,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":410.79,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":995.88,"additional_payer_notes":"APC"}]}]},{"description":"Emergency dept visit","code_information":[{"code":"99284","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":398.83,"maximum":995.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":398.83,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":406.81,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":402.82,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":410.79,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":995.88,"additional_payer_notes":"APC"}]}]},{"description":"Opps service,sched team conf","code_information":[{"code":"G0175","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":398.83,"maximum":995.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":398.83,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":406.81,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":402.82,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":410.79,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":995.88,"additional_payer_notes":"APC"}]}]},{"description":"Emergency dept visit","code_information":[{"code":"99285","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":569.22,"maximum":1421.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":569.22,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":580.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":574.91,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":586.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1421.35,"additional_payer_notes":"APC"}]}]},{"description":"Direct refer hospital observ","code_information":[{"code":"G0379","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":569.22,"maximum":1421.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":569.22,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":580.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":574.91,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":586.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1421.35,"additional_payer_notes":"APC"}]}]},{"description":"Critical care first hour","code_information":[{"code":"99291","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":789.54,"maximum":1971.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":789.54,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":805.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":797.43,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":813.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1971.48,"additional_payer_notes":"APC"}]}]},{"description":"Rmvl impltbl glucose sensor","code_information":[{"code":"0447T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":191.77,"maximum":478.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":191.77,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":195.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":193.69,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":197.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":478.85,"additional_payer_notes":"APC"}]}]},{"description":"Esw integ wnd hlg 1st wnd","code_information":[{"code":"0512T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":191.77,"maximum":478.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":191.77,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":195.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":193.69,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":197.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":478.85,"additional_payer_notes":"APC"}]}]},{"description":"Coms ther 1st appl<=50 sq cm","code_information":[{"code":"0906T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":191.77,"maximum":478.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":191.77,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":195.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":193.69,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":197.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":478.85,"additional_payer_notes":"APC"}]}]},{"description":"Acne surgery","code_information":[{"code":"10040","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":191.77,"maximum":478.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":191.77,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":195.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":193.69,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":197.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":478.85,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of skin abscess","code_information":[{"code":"10060","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":191.77,"maximum":478.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":191.77,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":195.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":193.69,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":197.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":478.85,"additional_payer_notes":"APC"}]}]},{"description":"Trim skin lesion","code_information":[{"code":"11055","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":191.77,"maximum":478.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":191.77,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":195.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":193.69,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":197.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":478.85,"additional_payer_notes":"APC"}]}]},{"description":"Trim skin lesions 2 to 4","code_information":[{"code":"11056","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":191.77,"maximum":478.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":191.77,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":195.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":193.69,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":197.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":478.85,"additional_payer_notes":"APC"}]}]},{"description":"Trim skin lesions over 4","code_information":[{"code":"11057","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":191.77,"maximum":478.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":191.77,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":195.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":193.69,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":197.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":478.85,"additional_payer_notes":"APC"}]}]},{"description":"Removal of skin tags <w/15","code_information":[{"code":"11200","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":191.77,"maximum":478.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":191.77,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":195.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":193.69,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":197.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":478.85,"additional_payer_notes":"APC"}]}]},{"description":"Shave skin lesion 0.6-1.0 cm","code_information":[{"code":"11301","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":191.77,"maximum":478.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":191.77,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":195.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":193.69,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":197.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":478.85,"additional_payer_notes":"APC"}]}]},{"description":"Shave skin lesion 1.1-2.0 cm","code_information":[{"code":"11302","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":191.77,"maximum":478.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":191.77,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":195.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":193.69,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":197.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":478.85,"additional_payer_notes":"APC"}]}]},{"description":"Shave skin lesion 0.5 cm/<","code_information":[{"code":"11305","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":191.77,"maximum":478.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":191.77,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":195.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":193.69,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":197.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":478.85,"additional_payer_notes":"APC"}]}]},{"description":"Shave skin lesion 0.6-1.0 cm","code_information":[{"code":"11306","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":191.77,"maximum":478.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":191.77,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":195.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":193.69,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":197.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":478.85,"additional_payer_notes":"APC"}]}]},{"description":"Shave skin lesion 1.1-2.0 cm","code_information":[{"code":"11307","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":191.77,"maximum":478.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":191.77,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":195.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":193.69,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":197.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":478.85,"additional_payer_notes":"APC"}]}]},{"description":"Shave skin lesion 0.5 cm/<","code_information":[{"code":"11310","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":191.77,"maximum":478.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":191.77,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":195.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":193.69,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":197.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":478.85,"additional_payer_notes":"APC"}]}]},{"description":"Shave skin lesion 0.6-1.0 cm","code_information":[{"code":"11311","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":191.77,"maximum":478.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":191.77,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":195.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":193.69,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":197.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":478.85,"additional_payer_notes":"APC"}]}]},{"description":"Removal of nail plate","code_information":[{"code":"11730","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":191.77,"maximum":478.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":191.77,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":195.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":193.69,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":197.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":478.85,"additional_payer_notes":"APC"}]}]},{"description":"Inject skin lesions <=w 7","code_information":[{"code":"11900","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":191.77,"maximum":478.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":191.77,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":195.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":193.69,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":197.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":478.85,"additional_payer_notes":"APC"}]}]},{"description":"Inject skin lesions >7","code_information":[{"code":"11901","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":191.77,"maximum":478.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":191.77,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":195.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":193.69,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":197.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":478.85,"additional_payer_notes":"APC"}]}]},{"description":"Tx contour defects 1 cc/<","code_information":[{"code":"11950","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":191.77,"maximum":478.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":191.77,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":195.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":193.69,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":197.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":478.85,"additional_payer_notes":"APC"}]}]},{"description":"Rpr s/n/ax/gen/trnk 2.5cm/<","code_information":[{"code":"12001","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":191.77,"maximum":478.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":191.77,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":195.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":193.69,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":197.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":478.85,"additional_payer_notes":"APC"}]}]},{"description":"Rpr s/n/ax/gen/trnk2.6-7.5cm","code_information":[{"code":"12002","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":191.77,"maximum":478.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":191.77,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":195.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":193.69,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":197.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":478.85,"additional_payer_notes":"APC"}]}]},{"description":"Rpr s/n/ax/gen/trk7.6-12.5cm","code_information":[{"code":"12004","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":191.77,"maximum":478.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":191.77,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":195.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":193.69,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":197.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":478.85,"additional_payer_notes":"APC"}]}]},{"description":"Rpr s/n/ax/gen/trnk >30.0 cm","code_information":[{"code":"12007","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":191.77,"maximum":478.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":191.77,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":195.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":193.69,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":197.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":478.85,"additional_payer_notes":"APC"}]}]},{"description":"Rpr f/e/e/n/l/m 2.5 cm/<","code_information":[{"code":"12011","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":191.77,"maximum":478.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":191.77,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":195.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":193.69,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":197.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":478.85,"additional_payer_notes":"APC"}]}]},{"description":"Rpr f/e/e/n/l/m 2.6-5.0 cm","code_information":[{"code":"12013","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":191.77,"maximum":478.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":191.77,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":195.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":193.69,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":197.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":478.85,"additional_payer_notes":"APC"}]}]},{"description":"Rpr f/e/e/n/l/m 5.1-7.5 cm","code_information":[{"code":"12014","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":191.77,"maximum":478.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":191.77,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":195.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":193.69,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":197.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":478.85,"additional_payer_notes":"APC"}]}]},{"description":"Rpr f/e/e/n/l/m 7.6-12.5 cm","code_information":[{"code":"12015","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":191.77,"maximum":478.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":191.77,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":195.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":193.69,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":197.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":478.85,"additional_payer_notes":"APC"}]}]},{"description":"Rpr f/e/e/n/l/m >30.0 cm","code_information":[{"code":"12018","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":191.77,"maximum":478.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":191.77,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":195.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":193.69,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":197.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":478.85,"additional_payer_notes":"APC"}]}]},{"description":"Abrasion lesion single","code_information":[{"code":"15786","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":191.77,"maximum":478.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":191.77,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":195.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":193.69,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":197.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":478.85,"additional_payer_notes":"APC"}]}]},{"description":"Initial treatment of burn(s)","code_information":[{"code":"16000","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":191.77,"maximum":478.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":191.77,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":195.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":193.69,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":197.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":478.85,"additional_payer_notes":"APC"}]}]},{"description":"Dress/debrid p-thick burn s","code_information":[{"code":"16020","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":191.77,"maximum":478.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":191.77,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":195.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":193.69,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":197.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":478.85,"additional_payer_notes":"APC"}]}]},{"description":"Dress/debrid p-thick burn m","code_information":[{"code":"16025","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":191.77,"maximum":478.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":191.77,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":195.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":193.69,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":197.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":478.85,"additional_payer_notes":"APC"}]}]},{"description":"Destruct premalg lesion","code_information":[{"code":"17000","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":191.77,"maximum":478.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":191.77,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":195.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":193.69,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":197.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":478.85,"additional_payer_notes":"APC"}]}]},{"description":"Destruct b9 lesion 1-14","code_information":[{"code":"17110","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":191.77,"maximum":478.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":191.77,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":195.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":193.69,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":197.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":478.85,"additional_payer_notes":"APC"}]}]},{"description":"Destruct lesion 15 or more","code_information":[{"code":"17111","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":191.77,"maximum":478.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":191.77,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":195.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":193.69,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":197.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":478.85,"additional_payer_notes":"APC"}]}]},{"description":"Chemical cautery tissue","code_information":[{"code":"17250","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":191.77,"maximum":478.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":191.77,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":195.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":193.69,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":197.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":478.85,"additional_payer_notes":"APC"}]}]},{"description":"Destruction of skin lesions","code_information":[{"code":"17260","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":191.77,"maximum":478.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":191.77,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":195.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":193.69,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":197.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":478.85,"additional_payer_notes":"APC"}]}]},{"description":"Destruction of skin lesions","code_information":[{"code":"17261","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":191.77,"maximum":478.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":191.77,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":195.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":193.69,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":197.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":478.85,"additional_payer_notes":"APC"}]}]},{"description":"Destruction of skin lesions","code_information":[{"code":"17262","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":191.77,"maximum":478.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":191.77,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":195.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":193.69,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":197.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":478.85,"additional_payer_notes":"APC"}]}]},{"description":"Destruction of skin lesions","code_information":[{"code":"17263","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":191.77,"maximum":478.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":191.77,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":195.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":193.69,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":197.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":478.85,"additional_payer_notes":"APC"}]}]},{"description":"Destruction of skin lesions","code_information":[{"code":"17270","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":191.77,"maximum":478.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":191.77,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":195.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":193.69,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":197.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":478.85,"additional_payer_notes":"APC"}]}]},{"description":"Destruction of skin lesions","code_information":[{"code":"17271","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":191.77,"maximum":478.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":191.77,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":195.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":193.69,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":197.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":478.85,"additional_payer_notes":"APC"}]}]},{"description":"Destruction of skin lesions","code_information":[{"code":"17272","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":191.77,"maximum":478.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":191.77,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":195.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":193.69,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":197.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":478.85,"additional_payer_notes":"APC"}]}]},{"description":"Destruction of skin lesions","code_information":[{"code":"17280","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":191.77,"maximum":478.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":191.77,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":195.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":193.69,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":197.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":478.85,"additional_payer_notes":"APC"}]}]},{"description":"Destruction of skin lesions","code_information":[{"code":"17281","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":191.77,"maximum":478.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":191.77,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":195.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":193.69,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":197.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":478.85,"additional_payer_notes":"APC"}]}]},{"description":"Destruction of skin lesions","code_information":[{"code":"17282","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":191.77,"maximum":478.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":191.77,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":195.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":193.69,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":197.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":478.85,"additional_payer_notes":"APC"}]}]},{"description":"Skin peel therapy","code_information":[{"code":"17360","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":191.77,"maximum":478.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":191.77,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":195.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":193.69,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":197.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":478.85,"additional_payer_notes":"APC"}]}]},{"description":"Skin tissue procedure","code_information":[{"code":"17999","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":191.77,"maximum":478.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":191.77,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":195.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":193.69,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":197.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":478.85,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of finger abscess","code_information":[{"code":"26010","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":191.77,"maximum":478.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":191.77,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":195.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":193.69,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":197.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":478.85,"additional_payer_notes":"APC"}]}]},{"description":"Cryosurgery anal lesion(s)","code_information":[{"code":"46916","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":191.77,"maximum":478.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":191.77,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":195.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":193.69,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":197.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":478.85,"additional_payer_notes":"APC"}]}]},{"description":"Cryosurgery penis lesion(s)","code_information":[{"code":"54056","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":191.77,"maximum":478.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":191.77,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":195.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":193.69,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":197.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":478.85,"additional_payer_notes":"APC"}]}]},{"description":"Clean out mastoid cavity","code_information":[{"code":"69220","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":191.77,"maximum":478.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":191.77,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":195.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":193.69,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":197.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":478.85,"additional_payer_notes":"APC"}]}]},{"description":"Photodynamic tx skin","code_information":[{"code":"96567","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":191.77,"maximum":478.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":191.77,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":195.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":193.69,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":197.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":478.85,"additional_payer_notes":"APC"}]}]},{"description":"Pdt dstr prmlg les phys/qhp","code_information":[{"code":"96573","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":191.77,"maximum":478.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":191.77,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":195.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":193.69,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":197.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":478.85,"additional_payer_notes":"APC"}]}]},{"description":"Dbrdmt prmlg les w/pdt","code_information":[{"code":"96574","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":191.77,"maximum":478.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":191.77,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":195.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":193.69,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":197.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":478.85,"additional_payer_notes":"APC"}]}]},{"description":"Laser tx skin < 250 sq cm","code_information":[{"code":"96920","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":191.77,"maximum":478.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":191.77,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":195.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":193.69,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":197.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":478.85,"additional_payer_notes":"APC"}]}]},{"description":"Laser tx skin 250-500 sq cm","code_information":[{"code":"96921","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":191.77,"maximum":478.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":191.77,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":195.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":193.69,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":197.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":478.85,"additional_payer_notes":"APC"}]}]},{"description":"Dermatological procedure","code_information":[{"code":"96999","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":191.77,"maximum":478.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":191.77,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":195.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":193.69,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":197.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":478.85,"additional_payer_notes":"APC"}]}]},{"description":"Rmvl devital tis 20 cm/<","code_information":[{"code":"97597","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":191.77,"maximum":478.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":191.77,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":195.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":193.69,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":197.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":478.85,"additional_payer_notes":"APC"}]}]},{"description":"Wound(s) care non-selective","code_information":[{"code":"97602","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":191.77,"maximum":478.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":191.77,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":195.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":193.69,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":197.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":478.85,"additional_payer_notes":"APC"}]}]},{"description":"Neg press wound tx <=50 cm","code_information":[{"code":"97605","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":191.77,"maximum":478.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":191.77,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":195.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":193.69,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":197.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":478.85,"additional_payer_notes":"APC"}]}]},{"description":"Low frequency non-thermal us","code_information":[{"code":"97610","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":191.77,"maximum":478.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":191.77,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":195.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":193.69,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":197.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":478.85,"additional_payer_notes":"APC"}]}]},{"description":"Routine footcare pt w lops","code_information":[{"code":"G0247","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":191.77,"maximum":478.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":191.77,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":195.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":193.69,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":197.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":478.85,"additional_payer_notes":"APC"}]}]},{"description":"Slctv nzmtc dbrdmt t/a/l 1st","code_information":[{"code":"0973T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":388.56,"maximum":970.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":388.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":396.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":392.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":400.21,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":970.23,"additional_payer_notes":"APC"}]}]},{"description":"Slctv nzmtc dbrdmt s/n/hf 1","code_information":[{"code":"0975T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":388.56,"maximum":970.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":388.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":396.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":392.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":400.21,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":970.23,"additional_payer_notes":"APC"}]}]},{"description":"Fna w/o image","code_information":[{"code":"10021","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":388.56,"maximum":970.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":388.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":396.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":392.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":400.21,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":970.23,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of skin abscess","code_information":[{"code":"10061","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":388.56,"maximum":970.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":388.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":396.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":392.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":400.21,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":970.23,"additional_payer_notes":"APC"}]}]},{"description":"Remove foreign body","code_information":[{"code":"10120","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":388.56,"maximum":970.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":388.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":396.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":392.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":400.21,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":970.23,"additional_payer_notes":"APC"}]}]},{"description":"Puncture drainage of lesion","code_information":[{"code":"10160","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":388.56,"maximum":970.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":388.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":396.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":392.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":400.21,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":970.23,"additional_payer_notes":"APC"}]}]},{"description":"Debride infected skin","code_information":[{"code":"11000","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":388.56,"maximum":970.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":388.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":396.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":392.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":400.21,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":970.23,"additional_payer_notes":"APC"}]}]},{"description":"Deb subq tissue 20 sq cm/<","code_information":[{"code":"11042","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":388.56,"maximum":970.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":388.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":396.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":392.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":400.21,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":970.23,"additional_payer_notes":"APC"}]}]},{"description":"Tangntl bx skin single les","code_information":[{"code":"11102","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":388.56,"maximum":970.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":388.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":396.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":392.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":400.21,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":970.23,"additional_payer_notes":"APC"}]}]},{"description":"Punch bx skin single lesion","code_information":[{"code":"11104","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":388.56,"maximum":970.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":388.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":396.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":392.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":400.21,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":970.23,"additional_payer_notes":"APC"}]}]},{"description":"Shave skin lesion 0.5 cm/<","code_information":[{"code":"11300","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":388.56,"maximum":970.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":388.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":396.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":392.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":400.21,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":970.23,"additional_payer_notes":"APC"}]}]},{"description":"Shave skin lesion >2.0 cm","code_information":[{"code":"11303","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":388.56,"maximum":970.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":388.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":396.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":392.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":400.21,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":970.23,"additional_payer_notes":"APC"}]}]},{"description":"Shave skin lesion >2.0 cm","code_information":[{"code":"11308","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":388.56,"maximum":970.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":388.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":396.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":392.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":400.21,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":970.23,"additional_payer_notes":"APC"}]}]},{"description":"Shave skin lesion 1.1-2.0 cm","code_information":[{"code":"11312","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":388.56,"maximum":970.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":388.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":396.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":392.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":400.21,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":970.23,"additional_payer_notes":"APC"}]}]},{"description":"Shave skin lesion >2.0 cm","code_information":[{"code":"11313","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":388.56,"maximum":970.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":388.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":396.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":392.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":400.21,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":970.23,"additional_payer_notes":"APC"}]}]},{"description":"Exc tr-ext b9+marg 0.6-1 cm","code_information":[{"code":"11401","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":388.56,"maximum":970.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":388.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":396.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":392.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":400.21,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":970.23,"additional_payer_notes":"APC"}]}]},{"description":"Exc tr-ext mal+marg 1.1-2 cm","code_information":[{"code":"11602","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":388.56,"maximum":970.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":388.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":396.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":392.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":400.21,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":970.23,"additional_payer_notes":"APC"}]}]},{"description":"Removal of nail bed","code_information":[{"code":"11750","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":388.56,"maximum":970.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":388.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":396.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":392.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":400.21,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":970.23,"additional_payer_notes":"APC"}]}]},{"description":"Excision of nail fold toe","code_information":[{"code":"11765","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":388.56,"maximum":970.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":388.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":396.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":392.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":400.21,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":970.23,"additional_payer_notes":"APC"}]}]},{"description":"Rpr s/n/a/gen/trk12.6-20.0cm","code_information":[{"code":"12005","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":388.56,"maximum":970.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":388.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":396.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":392.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":400.21,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":970.23,"additional_payer_notes":"APC"}]}]},{"description":"Rpr s/n/a/gen/trk20.1-30.0cm","code_information":[{"code":"12006","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":388.56,"maximum":970.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":388.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":396.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":392.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":400.21,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":970.23,"additional_payer_notes":"APC"}]}]},{"description":"Rpr fe/e/en/l/m 12.6-20.0 cm","code_information":[{"code":"12016","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":388.56,"maximum":970.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":388.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":396.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":392.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":400.21,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":970.23,"additional_payer_notes":"APC"}]}]},{"description":"Rpr fe/e/en/l/m 20.1-30.0 cm","code_information":[{"code":"12017","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":388.56,"maximum":970.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":388.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":396.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":392.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":400.21,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":970.23,"additional_payer_notes":"APC"}]}]},{"description":"Closure of split wound","code_information":[{"code":"12021","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":388.56,"maximum":970.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":388.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":396.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":392.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":400.21,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":970.23,"additional_payer_notes":"APC"}]}]},{"description":"Intmd rpr s/a/t/ext 2.5 cm/<","code_information":[{"code":"12031","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":388.56,"maximum":970.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":388.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":396.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":392.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":400.21,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":970.23,"additional_payer_notes":"APC"}]}]},{"description":"Intmd rpr s/a/t/ext 2.6-7.5","code_information":[{"code":"12032","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":388.56,"maximum":970.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":388.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":396.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":392.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":400.21,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":970.23,"additional_payer_notes":"APC"}]}]},{"description":"Intmd rpr s/tr/ext 7.6-12.5","code_information":[{"code":"12034","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":388.56,"maximum":970.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":388.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":396.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":392.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":400.21,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":970.23,"additional_payer_notes":"APC"}]}]},{"description":"Intmd rpr s/a/t/ext 12.6-20","code_information":[{"code":"12035","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":388.56,"maximum":970.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":388.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":396.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":392.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":400.21,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":970.23,"additional_payer_notes":"APC"}]}]},{"description":"Intmd rpr n-hf/genit 2.5cm/<","code_information":[{"code":"12041","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":388.56,"maximum":970.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":388.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":396.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":392.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":400.21,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":970.23,"additional_payer_notes":"APC"}]}]},{"description":"Intmd rpr n-hf/genit2.6-7.5","code_information":[{"code":"12042","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":388.56,"maximum":970.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":388.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":396.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":392.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":400.21,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":970.23,"additional_payer_notes":"APC"}]}]},{"description":"Intmd rpr face/mm 2.5 cm/<","code_information":[{"code":"12051","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":388.56,"maximum":970.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":388.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":396.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":392.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":400.21,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":970.23,"additional_payer_notes":"APC"}]}]},{"description":"Intmd rpr face/mm 2.6-5.0 cm","code_information":[{"code":"12052","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":388.56,"maximum":970.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":388.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":396.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":392.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":400.21,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":970.23,"additional_payer_notes":"APC"}]}]},{"description":"Intmd rpr face/mm 5.1-7.5 cm","code_information":[{"code":"12053","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":388.56,"maximum":970.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":388.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":396.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":392.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":400.21,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":970.23,"additional_payer_notes":"APC"}]}]},{"description":"Intmd rpr face/mm 7.6-12.5cm","code_information":[{"code":"12054","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":388.56,"maximum":970.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":388.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":396.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":392.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":400.21,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":970.23,"additional_payer_notes":"APC"}]}]},{"description":"Intmd rpr face/mm 12.6-20 cm","code_information":[{"code":"12055","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":388.56,"maximum":970.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":388.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":396.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":392.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":400.21,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":970.23,"additional_payer_notes":"APC"}]}]},{"description":"Intmd rpr face/mm 20.1-30.0","code_information":[{"code":"12056","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":388.56,"maximum":970.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":388.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":396.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":392.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":400.21,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":970.23,"additional_payer_notes":"APC"}]}]},{"description":"Intmd rpr face/mm >30.0 cm","code_information":[{"code":"12057","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":388.56,"maximum":970.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":388.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":396.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":392.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":400.21,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":970.23,"additional_payer_notes":"APC"}]}]},{"description":"Cmplx rpr s/a/l 1.1-2.5 cm","code_information":[{"code":"13120","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":388.56,"maximum":970.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":388.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":396.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":392.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":400.21,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":970.23,"additional_payer_notes":"APC"}]}]},{"description":"Cmplx rpr s/a/l 2.6-7.5 cm","code_information":[{"code":"13121","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":388.56,"maximum":970.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":388.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":396.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":392.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":400.21,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":970.23,"additional_payer_notes":"APC"}]}]},{"description":"Cmplx rpr f/c/c/m/n/ax/g/h/f","code_information":[{"code":"13131","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":388.56,"maximum":970.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":388.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":396.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":392.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":400.21,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":970.23,"additional_payer_notes":"APC"}]}]},{"description":"Cmplx rpr f/c/c/m/n/ax/g/h/f","code_information":[{"code":"13132","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":388.56,"maximum":970.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":388.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":396.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":392.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":400.21,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":970.23,"additional_payer_notes":"APC"}]}]},{"description":"Wound prep f/n/hf/g","code_information":[{"code":"15004","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":388.56,"maximum":970.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":388.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":396.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":392.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":400.21,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":970.23,"additional_payer_notes":"APC"}]}]},{"description":"Hair trnspl 1-15 punch grfts","code_information":[{"code":"15775","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":388.56,"maximum":970.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":388.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":396.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":392.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":400.21,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":970.23,"additional_payer_notes":"APC"}]}]},{"description":"Hair trnspl >15 punch grafts","code_information":[{"code":"15776","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":388.56,"maximum":970.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":388.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":396.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":392.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":400.21,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":970.23,"additional_payer_notes":"APC"}]}]},{"description":"Dermabrasion suprfl any site","code_information":[{"code":"15783","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":388.56,"maximum":970.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":388.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":396.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":392.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":400.21,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":970.23,"additional_payer_notes":"APC"}]}]},{"description":"Chemical peel face epiderm","code_information":[{"code":"15788","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":388.56,"maximum":970.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":388.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":396.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":392.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":400.21,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":970.23,"additional_payer_notes":"APC"}]}]},{"description":"Chemical peel nonfacial","code_information":[{"code":"15793","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":388.56,"maximum":970.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":388.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":396.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":392.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":400.21,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":970.23,"additional_payer_notes":"APC"}]}]},{"description":"Dress/debrid p-thick burn l","code_information":[{"code":"16030","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":388.56,"maximum":970.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":388.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":396.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":392.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":400.21,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":970.23,"additional_payer_notes":"APC"}]}]},{"description":"Incision of burn scab initi","code_information":[{"code":"16035","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":388.56,"maximum":970.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":388.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":396.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":392.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":400.21,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":970.23,"additional_payer_notes":"APC"}]}]},{"description":"Destroy premal lesions 15/>","code_information":[{"code":"17004","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":388.56,"maximum":970.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":388.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":396.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":392.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":400.21,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":970.23,"additional_payer_notes":"APC"}]}]},{"description":"Destruction of skin lesions","code_information":[{"code":"17106","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":388.56,"maximum":970.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":388.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":396.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":392.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":400.21,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":970.23,"additional_payer_notes":"APC"}]}]},{"description":"Destruction of skin lesions","code_information":[{"code":"17264","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":388.56,"maximum":970.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":388.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":396.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":392.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":400.21,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":970.23,"additional_payer_notes":"APC"}]}]},{"description":"Destruction of skin lesions","code_information":[{"code":"17266","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":388.56,"maximum":970.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":388.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":396.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":392.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":400.21,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":970.23,"additional_payer_notes":"APC"}]}]},{"description":"Destruction of skin lesions","code_information":[{"code":"17273","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":388.56,"maximum":970.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":388.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":396.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":392.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":400.21,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":970.23,"additional_payer_notes":"APC"}]}]},{"description":"Destruction of skin lesions","code_information":[{"code":"17274","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":388.56,"maximum":970.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":388.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":396.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":392.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":400.21,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":970.23,"additional_payer_notes":"APC"}]}]},{"description":"Destruction of skin lesions","code_information":[{"code":"17276","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":388.56,"maximum":970.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":388.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":396.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":392.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":400.21,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":970.23,"additional_payer_notes":"APC"}]}]},{"description":"Destruction of skin lesions","code_information":[{"code":"17283","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":388.56,"maximum":970.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":388.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":396.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":392.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":400.21,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":970.23,"additional_payer_notes":"APC"}]}]},{"description":"Injection(s) spider veins","code_information":[{"code":"36468","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":388.56,"maximum":970.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":388.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":396.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":392.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":400.21,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":970.23,"additional_payer_notes":"APC"}]}]},{"description":"Injection therapy of vein","code_information":[{"code":"36470","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":388.56,"maximum":970.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":388.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":396.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":392.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":400.21,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":970.23,"additional_payer_notes":"APC"}]}]},{"description":"Injection therapy of veins","code_information":[{"code":"36471","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":388.56,"maximum":970.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":388.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":396.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":392.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":400.21,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":970.23,"additional_payer_notes":"APC"}]}]},{"description":"Destruction anal lesion(s)","code_information":[{"code":"46900","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":388.56,"maximum":970.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":388.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":396.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":392.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":400.21,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":970.23,"additional_payer_notes":"APC"}]}]},{"description":"Destruction penis lesion(s)","code_information":[{"code":"54050","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":388.56,"maximum":970.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":388.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":396.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":392.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":400.21,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":970.23,"additional_payer_notes":"APC"}]}]},{"description":"Photochemotherapy uv-a or b","code_information":[{"code":"96913","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":388.56,"maximum":970.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":388.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":396.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":392.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":400.21,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":970.23,"additional_payer_notes":"APC"}]}]},{"description":"Laser tx skin >500 sq cm","code_information":[{"code":"96922","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":388.56,"maximum":970.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":388.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":396.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":392.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":400.21,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":970.23,"additional_payer_notes":"APC"}]}]},{"description":"Neg press wound tx >50 cm","code_information":[{"code":"97606","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":388.56,"maximum":970.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":388.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":396.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":392.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":400.21,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":970.23,"additional_payer_notes":"APC"}]}]},{"description":"Neg press wnd tx <=50 sq cm","code_information":[{"code":"97607","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":388.56,"maximum":970.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":388.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":396.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":392.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":400.21,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":970.23,"additional_payer_notes":"APC"}]}]},{"description":"Neg press wound tx >50 cm","code_information":[{"code":"97608","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":388.56,"maximum":970.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":388.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":396.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":392.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":400.21,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":970.23,"additional_payer_notes":"APC"}]}]},{"description":"Reloc skin pocket pls gen","code_information":[{"code":"0416T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1972.13,"maximum":4924.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1972.13,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2011.58,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1991.85,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2031.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4924.41,"additional_payer_notes":"APC"}]}]},{"description":"Rlcj pg wcs lv battery only","code_information":[{"code":"0862T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1972.13,"maximum":4924.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1972.13,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2011.58,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1991.85,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2031.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4924.41,"additional_payer_notes":"APC"}]}]},{"description":"Rlcj pg wcs lv trnsmtr only","code_information":[{"code":"0863T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1972.13,"maximum":4924.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1972.13,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2011.58,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1991.85,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2031.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4924.41,"additional_payer_notes":"APC"}]}]},{"description":"Rlcj skin pocket ccm-d pg","code_information":[{"code":"0925T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1972.13,"maximum":4924.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1972.13,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2011.58,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1991.85,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2031.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4924.41,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruction of nail bed","code_information":[{"code":"11762","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1972.13,"maximum":4924.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1972.13,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2011.58,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1991.85,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2031.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4924.41,"additional_payer_notes":"APC"}]}]},{"description":"Intmd rpr s/tr/ext >30.0 cm","code_information":[{"code":"12037","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1972.13,"maximum":4924.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1972.13,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2011.58,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1991.85,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2031.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4924.41,"additional_payer_notes":"APC"}]}]},{"description":"Intmd rpr n-hf/genit >30.0cm","code_information":[{"code":"12047","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1972.13,"maximum":4924.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1972.13,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2011.58,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1991.85,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2031.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4924.41,"additional_payer_notes":"APC"}]}]},{"description":"Tis trnfr trunk 10 sq cm/<","code_information":[{"code":"14000","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1972.13,"maximum":4924.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1972.13,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2011.58,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1991.85,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2031.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4924.41,"additional_payer_notes":"APC"}]}]},{"description":"Tis trnfr trunk 10.1-30sqcm","code_information":[{"code":"14001","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1972.13,"maximum":4924.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1972.13,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2011.58,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1991.85,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2031.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4924.41,"additional_payer_notes":"APC"}]}]},{"description":"Tis trnfr s/a/l 10 sq cm/<","code_information":[{"code":"14020","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1972.13,"maximum":4924.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1972.13,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2011.58,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1991.85,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2031.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4924.41,"additional_payer_notes":"APC"}]}]},{"description":"Tis trnfr s/a/l 10.1-30 sqcm","code_information":[{"code":"14021","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1972.13,"maximum":4924.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1972.13,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2011.58,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1991.85,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2031.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4924.41,"additional_payer_notes":"APC"}]}]},{"description":"Tis trnfr f/c/c/m/n/a/g/h/f","code_information":[{"code":"14040","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1972.13,"maximum":4924.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1972.13,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2011.58,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1991.85,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2031.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4924.41,"additional_payer_notes":"APC"}]}]},{"description":"Tis trnfr f/c/c/m/n/a/g/h/f","code_information":[{"code":"14041","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1972.13,"maximum":4924.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1972.13,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2011.58,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1991.85,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2031.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4924.41,"additional_payer_notes":"APC"}]}]},{"description":"Tis trnfr e/n/e/l 10 sq cm/<","code_information":[{"code":"14060","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1972.13,"maximum":4924.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1972.13,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2011.58,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1991.85,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2031.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4924.41,"additional_payer_notes":"APC"}]}]},{"description":"Tis trnfr e/n/e/l10.1-30sqcm","code_information":[{"code":"14061","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1972.13,"maximum":4924.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1972.13,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2011.58,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1991.85,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2031.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4924.41,"additional_payer_notes":"APC"}]}]},{"description":"Filleted finger/toe flap","code_information":[{"code":"14350","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1972.13,"maximum":4924.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1972.13,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2011.58,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1991.85,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2031.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4924.41,"additional_payer_notes":"APC"}]}]},{"description":"Hrv skn cll ssp agrft 1st 25","code_information":[{"code":"15011","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1972.13,"maximum":4924.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1972.13,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2011.58,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1991.85,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2031.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4924.41,"additional_payer_notes":"APC"}]}]},{"description":"App skn cl ssp agrft t/a/l 1","code_information":[{"code":"15015","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1972.13,"maximum":4924.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1972.13,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2011.58,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1991.85,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2031.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4924.41,"additional_payer_notes":"APC"}]}]},{"description":"App skn cll ssp f/n/g/hf 1st","code_information":[{"code":"15017","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1972.13,"maximum":4924.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1972.13,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2011.58,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1991.85,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2031.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4924.41,"additional_payer_notes":"APC"}]}]},{"description":"Harvest cultured skin graft","code_information":[{"code":"15040","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1972.13,"maximum":4924.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1972.13,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2011.58,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1991.85,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2031.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4924.41,"additional_payer_notes":"APC"}]}]},{"description":"Skin splt grft trnk/arm/leg","code_information":[{"code":"15100","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1972.13,"maximum":4924.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1972.13,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2011.58,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1991.85,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2031.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4924.41,"additional_payer_notes":"APC"}]}]},{"description":"Epidrm autogrft trnk/arm/leg","code_information":[{"code":"15110","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1972.13,"maximum":4924.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1972.13,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2011.58,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1991.85,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2031.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4924.41,"additional_payer_notes":"APC"}]}]},{"description":"Epidrm a-grft face/nck/hf/g","code_information":[{"code":"15115","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1972.13,"maximum":4924.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1972.13,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2011.58,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1991.85,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2031.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4924.41,"additional_payer_notes":"APC"}]}]},{"description":"Derm autograft trnk/arm/leg","code_information":[{"code":"15130","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1972.13,"maximum":4924.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1972.13,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2011.58,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1991.85,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2031.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4924.41,"additional_payer_notes":"APC"}]}]},{"description":"Cult skin grft t/arm/leg","code_information":[{"code":"15150","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1972.13,"maximum":4924.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1972.13,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2011.58,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1991.85,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2031.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4924.41,"additional_payer_notes":"APC"}]}]},{"description":"Skin full graft trunk","code_information":[{"code":"15200","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1972.13,"maximum":4924.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1972.13,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2011.58,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1991.85,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2031.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4924.41,"additional_payer_notes":"APC"}]}]},{"description":"Skin full graft sclp/arm/leg","code_information":[{"code":"15220","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1972.13,"maximum":4924.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1972.13,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2011.58,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1991.85,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2031.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4924.41,"additional_payer_notes":"APC"}]}]},{"description":"Skin full grft face/genit/hf","code_information":[{"code":"15240","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1972.13,"maximum":4924.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1972.13,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2011.58,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1991.85,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2031.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4924.41,"additional_payer_notes":"APC"}]}]},{"description":"Skin full graft een & lips","code_information":[{"code":"15260","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1972.13,"maximum":4924.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1972.13,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2011.58,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1991.85,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2031.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4924.41,"additional_payer_notes":"APC"}]}]},{"description":"Skin sub grft t/arm/lg child","code_information":[{"code":"15273","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1972.13,"maximum":4924.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1972.13,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2011.58,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1991.85,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2031.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4924.41,"additional_payer_notes":"APC"}]}]},{"description":"Skn sub grft f/n/hf/g child","code_information":[{"code":"15277","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1972.13,"maximum":4924.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1972.13,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2011.58,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1991.85,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2031.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4924.41,"additional_payer_notes":"APC"}]}]},{"description":"Skin pedicle flap trunk","code_information":[{"code":"15570","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1972.13,"maximum":4924.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1972.13,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2011.58,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1991.85,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2031.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4924.41,"additional_payer_notes":"APC"}]}]},{"description":"Pedcle fh/ch/ch/m/n/ax/g/h/f","code_information":[{"code":"15574","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1972.13,"maximum":4924.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1972.13,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2011.58,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1991.85,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2031.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4924.41,"additional_payer_notes":"APC"}]}]},{"description":"Pedicle e/n/e/l/ntroral","code_information":[{"code":"15576","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1972.13,"maximum":4924.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1972.13,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2011.58,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1991.85,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2031.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4924.41,"additional_payer_notes":"APC"}]}]},{"description":"Delay flap arms/legs","code_information":[{"code":"15610","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1972.13,"maximum":4924.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1972.13,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2011.58,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1991.85,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2031.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4924.41,"additional_payer_notes":"APC"}]}]},{"description":"Delay flap f/c/c/n/ax/g/h/f","code_information":[{"code":"15620","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1972.13,"maximum":4924.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1972.13,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2011.58,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1991.85,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2031.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4924.41,"additional_payer_notes":"APC"}]}]},{"description":"Delay flap eye/nos/ear/lip","code_information":[{"code":"15630","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1972.13,"maximum":4924.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1972.13,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2011.58,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1991.85,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2031.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4924.41,"additional_payer_notes":"APC"}]}]},{"description":"Transfer skin pedicle flap","code_information":[{"code":"15650","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1972.13,"maximum":4924.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1972.13,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2011.58,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1991.85,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2031.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4924.41,"additional_payer_notes":"APC"}]}]},{"description":"Muscle-skin graft arm","code_information":[{"code":"15736","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1972.13,"maximum":4924.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1972.13,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2011.58,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1991.85,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2031.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4924.41,"additional_payer_notes":"APC"}]}]},{"description":"Island pedicle flap graft","code_information":[{"code":"15740","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1972.13,"maximum":4924.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1972.13,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2011.58,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1991.85,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2031.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4924.41,"additional_payer_notes":"APC"}]}]},{"description":"Composite skin graft","code_information":[{"code":"15760","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1972.13,"maximum":4924.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1972.13,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2011.58,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1991.85,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2031.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4924.41,"additional_payer_notes":"APC"}]}]},{"description":"Grfg autol fat lipo 25 cc/<","code_information":[{"code":"15773","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1972.13,"maximum":4924.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1972.13,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2011.58,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1991.85,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2031.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4924.41,"additional_payer_notes":"APC"}]}]},{"description":"Revision of lower eyelid","code_information":[{"code":"15820","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1972.13,"maximum":4924.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1972.13,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2011.58,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1991.85,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2031.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4924.41,"additional_payer_notes":"APC"}]}]},{"description":"Revision of lower eyelid","code_information":[{"code":"15821","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1972.13,"maximum":4924.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1972.13,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2011.58,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1991.85,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2031.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4924.41,"additional_payer_notes":"APC"}]}]},{"description":"Revision of upper eyelid","code_information":[{"code":"15822","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1972.13,"maximum":4924.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1972.13,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2011.58,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1991.85,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2031.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4924.41,"additional_payer_notes":"APC"}]}]},{"description":"Revision of upper eyelid","code_information":[{"code":"15823","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1972.13,"maximum":4924.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1972.13,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2011.58,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1991.85,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2031.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4924.41,"additional_payer_notes":"APC"}]}]},{"description":"Removal of forehead wrinkles","code_information":[{"code":"15824","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1972.13,"maximum":4924.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1972.13,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2011.58,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1991.85,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2031.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4924.41,"additional_payer_notes":"APC"}]}]},{"description":"Nerve palsy microsurg graft","code_information":[{"code":"15842","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1972.13,"maximum":4924.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1972.13,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2011.58,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1991.85,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2031.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4924.41,"additional_payer_notes":"APC"}]}]},{"description":"Remove sutures diff surgeon","code_information":[{"code":"15851","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1972.13,"maximum":4924.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1972.13,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2011.58,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1991.85,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2031.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4924.41,"additional_payer_notes":"APC"}]}]},{"description":"Suction lipectomy upr extrem","code_information":[{"code":"15878","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1972.13,"maximum":4924.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1972.13,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2011.58,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1991.85,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2031.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4924.41,"additional_payer_notes":"APC"}]}]},{"description":"Remove sacrum pressure sore","code_information":[{"code":"15936","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1972.13,"maximum":4924.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1972.13,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2011.58,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1991.85,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2031.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4924.41,"additional_payer_notes":"APC"}]}]},{"description":"Remove sacrum pressure sore","code_information":[{"code":"15937","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1972.13,"maximum":4924.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1972.13,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2011.58,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1991.85,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2031.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4924.41,"additional_payer_notes":"APC"}]}]},{"description":"Remove hip pressure sore","code_information":[{"code":"15945","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1972.13,"maximum":4924.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1972.13,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2011.58,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1991.85,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2031.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4924.41,"additional_payer_notes":"APC"}]}]},{"description":"Remove hip pressure sore","code_information":[{"code":"15946","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1972.13,"maximum":4924.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1972.13,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2011.58,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1991.85,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2031.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4924.41,"additional_payer_notes":"APC"}]}]},{"description":"Remove thigh pressure sore","code_information":[{"code":"15952","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1972.13,"maximum":4924.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1972.13,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2011.58,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1991.85,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2031.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4924.41,"additional_payer_notes":"APC"}]}]},{"description":"Remove thigh pressure sore","code_information":[{"code":"15956","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1972.13,"maximum":4924.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1972.13,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2011.58,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1991.85,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2031.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4924.41,"additional_payer_notes":"APC"}]}]},{"description":"Destruction of skin lesions","code_information":[{"code":"17108","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1972.13,"maximum":4924.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1972.13,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2011.58,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1991.85,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2031.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4924.41,"additional_payer_notes":"APC"}]}]},{"description":"Explore wound chest","code_information":[{"code":"20101","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1972.13,"maximum":4924.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1972.13,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2011.58,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1991.85,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2031.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4924.41,"additional_payer_notes":"APC"}]}]},{"description":"Explore wound abdomen","code_information":[{"code":"20102","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1972.13,"maximum":4924.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1972.13,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2011.58,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1991.85,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2031.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4924.41,"additional_payer_notes":"APC"}]}]},{"description":"Removal of fascia for graft","code_information":[{"code":"20920","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1972.13,"maximum":4924.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1972.13,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2011.58,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1991.85,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2031.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4924.41,"additional_payer_notes":"APC"}]}]},{"description":"Removal of fascia for graft","code_information":[{"code":"20922","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1972.13,"maximum":4924.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1972.13,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2011.58,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1991.85,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2031.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4924.41,"additional_payer_notes":"APC"}]}]},{"description":"Amputation follow-up surgery","code_information":[{"code":"23921","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1972.13,"maximum":4924.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1972.13,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2011.58,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1991.85,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2031.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4924.41,"additional_payer_notes":"APC"}]}]},{"description":"Amputation follow-up surgery","code_information":[{"code":"25929","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1972.13,"maximum":4924.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1972.13,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2011.58,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1991.85,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2031.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4924.41,"additional_payer_notes":"APC"}]}]},{"description":"Relocation pocket pacemaker","code_information":[{"code":"33222","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1972.13,"maximum":4924.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1972.13,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2011.58,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1991.85,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2031.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4924.41,"additional_payer_notes":"APC"}]}]},{"description":"Relocate pocket for defib","code_information":[{"code":"33223","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1972.13,"maximum":4924.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1972.13,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2011.58,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1991.85,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2031.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4924.41,"additional_payer_notes":"APC"}]}]},{"description":"Njx noncmpnd sclrsnt 1 vein","code_information":[{"code":"36465","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1972.13,"maximum":4924.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1972.13,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2011.58,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1991.85,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2031.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4924.41,"additional_payer_notes":"APC"}]}]},{"description":"Njx noncmpnd sclrsnt mlt vn","code_information":[{"code":"36466","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1972.13,"maximum":4924.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1972.13,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2011.58,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1991.85,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2031.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4924.41,"additional_payer_notes":"APC"}]}]},{"description":"Remove gastric port open","code_information":[{"code":"43887","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1972.13,"maximum":4924.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1972.13,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2011.58,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1991.85,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2031.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4924.41,"additional_payer_notes":"APC"}]}]},{"description":"Destruction anal lesion(s)","code_information":[{"code":"46910","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1972.13,"maximum":4924.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1972.13,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2011.58,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1991.85,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2031.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4924.41,"additional_payer_notes":"APC"}]}]},{"description":"Destruction penis lesion(s)","code_information":[{"code":"54055","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1972.13,"maximum":4924.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1972.13,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2011.58,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1991.85,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2031.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4924.41,"additional_payer_notes":"APC"}]}]},{"description":"Laser surg penis lesion(s)","code_information":[{"code":"54057","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1972.13,"maximum":4924.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1972.13,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2011.58,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1991.85,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2031.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4924.41,"additional_payer_notes":"APC"}]}]},{"description":"Excision of penis lesion(s)","code_information":[{"code":"54060","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1972.13,"maximum":4924.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1972.13,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2011.58,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1991.85,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2031.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4924.41,"additional_payer_notes":"APC"}]}]},{"description":"Destruction penis lesion(s)","code_information":[{"code":"54065","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1972.13,"maximum":4924.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1972.13,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2011.58,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1991.85,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2031.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4924.41,"additional_payer_notes":"APC"}]}]},{"description":"Destroy vulva lesions sim","code_information":[{"code":"56501","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1972.13,"maximum":4924.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1972.13,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2011.58,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1991.85,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2031.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4924.41,"additional_payer_notes":"APC"}]}]},{"description":"Destroy vulva lesion/s compl","code_information":[{"code":"56515","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1972.13,"maximum":4924.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1972.13,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2011.58,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1991.85,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2031.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4924.41,"additional_payer_notes":"APC"}]}]},{"description":"Dermal filler injection(s)","code_information":[{"code":"G0429","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1972.13,"maximum":4924.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1972.13,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2011.58,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1991.85,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2031.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4924.41,"additional_payer_notes":"APC"}]}]},{"description":"Autologous PRP for ulcers","code_information":[{"code":"G0460","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1972.13,"maximum":4924.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1972.13,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2011.58,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1991.85,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2031.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4924.41,"additional_payer_notes":"APC"}]}]},{"description":"Hbot, full body chamber, 30m","code_information":[{"code":"G0277","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":131.53,"maximum":328.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":131.53,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":134.16,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":132.85,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":135.48,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":328.43,"additional_payer_notes":"APC"}]}]},{"description":"Fna bx w/us gdn 1st les","code_information":[{"code":"10005","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":676.85,"maximum":1690.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":676.85,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":690.39,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":683.62,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":697.16,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1690.09,"additional_payer_notes":"APC"}]}]},{"description":"Fna bx w/fluor gdn 1st les","code_information":[{"code":"10007","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":676.85,"maximum":1690.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":676.85,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":690.39,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":683.62,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":697.16,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1690.09,"additional_payer_notes":"APC"}]}]},{"description":"Fna bx w/ct gdn 1st les","code_information":[{"code":"10009","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":676.85,"maximum":1690.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":676.85,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":690.39,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":683.62,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":697.16,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1690.09,"additional_payer_notes":"APC"}]}]},{"description":"Fna bx w/mr gdn 1st les","code_information":[{"code":"10011","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":676.85,"maximum":1690.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":676.85,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":690.39,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":683.62,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":697.16,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1690.09,"additional_payer_notes":"APC"}]}]},{"description":"Guide cathet fluid drainage","code_information":[{"code":"10030","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":676.85,"maximum":1690.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":676.85,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":690.39,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":683.62,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":697.16,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1690.09,"additional_payer_notes":"APC"}]}]},{"description":"Perq dev soft tiss 1st imag","code_information":[{"code":"10035","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":676.85,"maximum":1690.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":676.85,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":690.39,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":683.62,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":697.16,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1690.09,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of pilonidal cyst","code_information":[{"code":"10080","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":676.85,"maximum":1690.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":676.85,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":690.39,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":683.62,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":697.16,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1690.09,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of pilonidal cyst","code_information":[{"code":"10081","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":676.85,"maximum":1690.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":676.85,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":690.39,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":683.62,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":697.16,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1690.09,"additional_payer_notes":"APC"}]}]},{"description":"Debride skin at fx site","code_information":[{"code":"11010","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":676.85,"maximum":1690.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":676.85,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":690.39,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":683.62,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":697.16,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1690.09,"additional_payer_notes":"APC"}]}]},{"description":"Debride skin musc at fx site","code_information":[{"code":"11011","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":676.85,"maximum":1690.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":676.85,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":690.39,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":683.62,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":697.16,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1690.09,"additional_payer_notes":"APC"}]}]},{"description":"Exc tr-ext b9+marg 0.5 cm<","code_information":[{"code":"11400","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":676.85,"maximum":1690.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":676.85,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":690.39,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":683.62,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":697.16,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1690.09,"additional_payer_notes":"APC"}]}]},{"description":"Exc tr-ext b9+marg 1.1-2 cm","code_information":[{"code":"11402","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":676.85,"maximum":1690.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":676.85,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":690.39,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":683.62,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":697.16,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1690.09,"additional_payer_notes":"APC"}]}]},{"description":"Exc tr-ext b9+marg 2.1-3cm/<","code_information":[{"code":"11403","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":676.85,"maximum":1690.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":676.85,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":690.39,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":683.62,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":697.16,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1690.09,"additional_payer_notes":"APC"}]}]},{"description":"Exc h-f-nk-sp b9+marg 0.6-1","code_information":[{"code":"11421","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":676.85,"maximum":1690.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":676.85,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":690.39,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":683.62,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":697.16,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1690.09,"additional_payer_notes":"APC"}]}]},{"description":"Exc face-mm b9+marg 0.5 cm/<","code_information":[{"code":"11440","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":676.85,"maximum":1690.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":676.85,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":690.39,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":683.62,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":697.16,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1690.09,"additional_payer_notes":"APC"}]}]},{"description":"Exc face-mm b9+marg 0.6-1 cm","code_information":[{"code":"11441","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":676.85,"maximum":1690.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":676.85,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":690.39,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":683.62,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":697.16,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1690.09,"additional_payer_notes":"APC"}]}]},{"description":"Exc face-mm b9+marg 1.1-2 cm","code_information":[{"code":"11442","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":676.85,"maximum":1690.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":676.85,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":690.39,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":683.62,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":697.16,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1690.09,"additional_payer_notes":"APC"}]}]},{"description":"Exc tr-ext mal+marg 0.5 cm/<","code_information":[{"code":"11600","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":676.85,"maximum":1690.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":676.85,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":690.39,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":683.62,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":697.16,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1690.09,"additional_payer_notes":"APC"}]}]},{"description":"Exc tr-ext mal+marg 0.6-1 cm","code_information":[{"code":"11601","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":676.85,"maximum":1690.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":676.85,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":690.39,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":683.62,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":697.16,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1690.09,"additional_payer_notes":"APC"}]}]},{"description":"Exc tr-ext mal+marg 2.1-3 cm","code_information":[{"code":"11603","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":676.85,"maximum":1690.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":676.85,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":690.39,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":683.62,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":697.16,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1690.09,"additional_payer_notes":"APC"}]}]},{"description":"Exc tr-ext mal+marg 3.1-4 cm","code_information":[{"code":"11604","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":676.85,"maximum":1690.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":676.85,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":690.39,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":683.62,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":697.16,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1690.09,"additional_payer_notes":"APC"}]}]},{"description":"Exc s/n/h/f/g mal+mrg 0.6-1","code_information":[{"code":"11621","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":676.85,"maximum":1690.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":676.85,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":690.39,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":683.62,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":697.16,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1690.09,"additional_payer_notes":"APC"}]}]},{"description":"Exc s/n/h/f/g mal+mrg 1.1-2","code_information":[{"code":"11622","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":676.85,"maximum":1690.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":676.85,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":690.39,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":683.62,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":697.16,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1690.09,"additional_payer_notes":"APC"}]}]},{"description":"Exc f/e/e/n/l mal+mrg 0.5cm<","code_information":[{"code":"11640","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":676.85,"maximum":1690.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":676.85,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":690.39,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":683.62,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":697.16,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1690.09,"additional_payer_notes":"APC"}]}]},{"description":"Exc f/e/e/n/l mal+mrg 0.6-1","code_information":[{"code":"11641","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":676.85,"maximum":1690.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":676.85,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":690.39,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":683.62,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":697.16,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1690.09,"additional_payer_notes":"APC"}]}]},{"description":"Exc f/e/e/n/l mal+mrg 1.1-2","code_information":[{"code":"11642","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":676.85,"maximum":1690.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":676.85,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":690.39,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":683.62,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":697.16,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1690.09,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy nail unit","code_information":[{"code":"11755","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":676.85,"maximum":1690.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":676.85,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":690.39,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":683.62,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":697.16,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1690.09,"additional_payer_notes":"APC"}]}]},{"description":"Remove contraceptive capsule","code_information":[{"code":"11976","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":676.85,"maximum":1690.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":676.85,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":690.39,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":683.62,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":697.16,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1690.09,"additional_payer_notes":"APC"}]}]},{"description":"Dermabrasion segmental face","code_information":[{"code":"15781","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":676.85,"maximum":1690.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":676.85,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":690.39,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":683.62,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":697.16,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1690.09,"additional_payer_notes":"APC"}]}]},{"description":"Removal of pressure sore","code_information":[{"code":"15999","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":676.85,"maximum":1690.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":676.85,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":690.39,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":683.62,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":697.16,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1690.09,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of breast lesion","code_information":[{"code":"19000","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":676.85,"maximum":1690.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":676.85,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":690.39,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":683.62,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":697.16,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1690.09,"additional_payer_notes":"APC"}]}]},{"description":"Perq dev breast 1st strtctc","code_information":[{"code":"19283","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":676.85,"maximum":1690.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":676.85,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":690.39,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":683.62,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":697.16,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1690.09,"additional_payer_notes":"APC"}]}]},{"description":"Perq dev breast 1st us imag","code_information":[{"code":"19285","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":676.85,"maximum":1690.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":676.85,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":690.39,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":683.62,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":697.16,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1690.09,"additional_payer_notes":"APC"}]}]},{"description":"Perq dev breast 1st mr guide","code_information":[{"code":"19287","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":676.85,"maximum":1690.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":676.85,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":690.39,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":683.62,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":697.16,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1690.09,"additional_payer_notes":"APC"}]}]},{"description":"Treatment of bone cyst","code_information":[{"code":"20615","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":676.85,"maximum":1690.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":676.85,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":690.39,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":683.62,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":697.16,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1690.09,"additional_payer_notes":"APC"}]}]},{"description":"Fluid pressure muscle","code_information":[{"code":"20950","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":676.85,"maximum":1690.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":676.85,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":690.39,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":683.62,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":697.16,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1690.09,"additional_payer_notes":"APC"}]}]},{"description":"Revision of neck muscle","code_information":[{"code":"21725","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":676.85,"maximum":1690.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":676.85,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":690.39,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":683.62,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":697.16,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1690.09,"additional_payer_notes":"APC"}]}]},{"description":"Removal of foot foreign body","code_information":[{"code":"28190","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":676.85,"maximum":1690.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":676.85,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":690.39,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":683.62,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":697.16,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1690.09,"additional_payer_notes":"APC"}]}]},{"description":"Rmvl subq car rhythm mntr","code_information":[{"code":"33286","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":676.85,"maximum":1690.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":676.85,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":690.39,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":683.62,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":697.16,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1690.09,"additional_payer_notes":"APC"}]}]},{"description":"Repair blood vessel lesion","code_information":[{"code":"35226","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":676.85,"maximum":1690.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":676.85,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":690.39,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":683.62,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":697.16,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1690.09,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of mouth lesion","code_information":[{"code":"40800","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":676.85,"maximum":1690.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":676.85,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":690.39,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":683.62,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":697.16,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1690.09,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy of salivary gland","code_information":[{"code":"42400","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":676.85,"maximum":1690.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":676.85,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":690.39,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":683.62,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":697.16,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1690.09,"additional_payer_notes":"APC"}]}]},{"description":"Liver surgery procedure","code_information":[{"code":"47399","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":676.85,"maximum":1690.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":676.85,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":690.39,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":683.62,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":697.16,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1690.09,"additional_payer_notes":"APC"}]}]},{"description":"Pancreas surgery procedure","code_information":[{"code":"48999","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":676.85,"maximum":1690.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":676.85,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":690.39,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":683.62,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":697.16,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1690.09,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of kidney lesion","code_information":[{"code":"50390","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":676.85,"maximum":1690.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":676.85,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":690.39,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":683.62,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":697.16,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1690.09,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of hydrocele","code_information":[{"code":"55000","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":676.85,"maximum":1690.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":676.85,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":690.39,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":683.62,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":697.16,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1690.09,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy of thyroid","code_information":[{"code":"60100","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":676.85,"maximum":1690.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":676.85,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":690.39,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":683.62,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":697.16,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1690.09,"additional_payer_notes":"APC"}]}]},{"description":"Aspir/inj thyroid cyst","code_information":[{"code":"60300","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":676.85,"maximum":1690.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":676.85,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":690.39,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":683.62,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":697.16,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1690.09,"additional_payer_notes":"APC"}]}]},{"description":"Interdiscal perq aspir dx","code_information":[{"code":"62267","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":676.85,"maximum":1690.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":676.85,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":690.39,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":683.62,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":697.16,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1690.09,"additional_payer_notes":"APC"}]}]},{"description":"Drain external ear lesion","code_information":[{"code":"69000","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":676.85,"maximum":1690.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":676.85,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":690.39,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":683.62,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":697.16,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1690.09,"additional_payer_notes":"APC"}]}]},{"description":"Drain outer ear canal lesion","code_information":[{"code":"69020","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":676.85,"maximum":1690.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":676.85,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":690.39,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":683.62,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":697.16,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1690.09,"additional_payer_notes":"APC"}]}]},{"description":"I&d absc intraoral soft tiss","code_information":[{"code":"D7510","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":676.85,"maximum":1690.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":676.85,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":690.39,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":683.62,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":697.16,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1690.09,"additional_payer_notes":"APC"}]}]},{"description":"Incision/drain abscess intra","code_information":[{"code":"D7511","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":676.85,"maximum":1690.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":676.85,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":690.39,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":683.62,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":697.16,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1690.09,"additional_payer_notes":"APC"}]}]},{"description":"I&d abscess extraoral","code_information":[{"code":"D7520","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":676.85,"maximum":1690.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":676.85,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":690.39,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":683.62,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":697.16,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1690.09,"additional_payer_notes":"APC"}]}]},{"description":"Incision/drain abscess extra","code_information":[{"code":"D7521","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":676.85,"maximum":1690.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":676.85,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":690.39,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":683.62,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":697.16,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1690.09,"additional_payer_notes":"APC"}]}]},{"description":"Abltj b9 thyr ndul perq lasr","code_information":[{"code":"0673T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1578.64,"maximum":3941.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1578.64,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1610.21,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1594.42,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1625.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3941.85,"additional_payer_notes":"APC"}]}]},{"description":"Rmv/rplc magnet coil assem","code_information":[{"code":"0959T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1578.64,"maximum":3941.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1578.64,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1610.21,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1594.42,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1625.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3941.85,"additional_payer_notes":"APC"}]}]},{"description":"Remove foreign body","code_information":[{"code":"10121","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1578.64,"maximum":3941.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1578.64,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1610.21,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1594.42,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1625.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3941.85,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of hematoma/fluid","code_information":[{"code":"10140","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1578.64,"maximum":3941.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1578.64,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1610.21,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1594.42,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1625.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3941.85,"additional_payer_notes":"APC"}]}]},{"description":"Deb bone 20 sq cm/<","code_information":[{"code":"11044","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1578.64,"maximum":3941.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1578.64,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1610.21,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1594.42,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1625.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3941.85,"additional_payer_notes":"APC"}]}]},{"description":"Exc tr-ext b9+marg 3.1-4 cm","code_information":[{"code":"11404","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1578.64,"maximum":3941.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1578.64,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1610.21,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1594.42,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1625.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3941.85,"additional_payer_notes":"APC"}]}]},{"description":"Exc tr-ext b9+marg >4.0 cm","code_information":[{"code":"11406","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1578.64,"maximum":3941.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1578.64,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1610.21,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1594.42,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1625.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3941.85,"additional_payer_notes":"APC"}]}]},{"description":"Exc h-f-nk-sp b9+marg 0.5/<","code_information":[{"code":"11420","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1578.64,"maximum":3941.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1578.64,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1610.21,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1594.42,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1625.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3941.85,"additional_payer_notes":"APC"}]}]},{"description":"Exc h-f-nk-sp b9+marg 1.1-2","code_information":[{"code":"11422","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1578.64,"maximum":3941.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1578.64,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1610.21,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1594.42,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1625.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3941.85,"additional_payer_notes":"APC"}]}]},{"description":"Exc h-f-nk-sp b9+marg 2.1-3","code_information":[{"code":"11423","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1578.64,"maximum":3941.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1578.64,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1610.21,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1594.42,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1625.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3941.85,"additional_payer_notes":"APC"}]}]},{"description":"Exc h-f-nk-sp b9+marg 3.1-4","code_information":[{"code":"11424","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1578.64,"maximum":3941.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1578.64,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1610.21,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1594.42,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1625.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3941.85,"additional_payer_notes":"APC"}]}]},{"description":"Exc face-mm b9+marg 2.1-3 cm","code_information":[{"code":"11443","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1578.64,"maximum":3941.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1578.64,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1610.21,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1594.42,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1625.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3941.85,"additional_payer_notes":"APC"}]}]},{"description":"Exc face-mm b9+marg 3.1-4 cm","code_information":[{"code":"11444","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1578.64,"maximum":3941.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1578.64,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1610.21,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1594.42,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1625.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3941.85,"additional_payer_notes":"APC"}]}]},{"description":"Exc tr-ext mal+marg >4 cm","code_information":[{"code":"11606","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1578.64,"maximum":3941.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1578.64,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1610.21,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1594.42,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1625.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3941.85,"additional_payer_notes":"APC"}]}]},{"description":"Exc h-f-nk-sp mal+marg 0.5/<","code_information":[{"code":"11620","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1578.64,"maximum":3941.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1578.64,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1610.21,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1594.42,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1625.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3941.85,"additional_payer_notes":"APC"}]}]},{"description":"Exc s/n/h/f/g mal+mrg 2.1-3","code_information":[{"code":"11623","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1578.64,"maximum":3941.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1578.64,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1610.21,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1594.42,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1625.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3941.85,"additional_payer_notes":"APC"}]}]},{"description":"Exc s/n/h/f/g mal+mrg 3.1-4","code_information":[{"code":"11624","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1578.64,"maximum":3941.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1578.64,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1610.21,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1594.42,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1625.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3941.85,"additional_payer_notes":"APC"}]}]},{"description":"Exc f/e/e/n/l mal+mrg 2.1-3","code_information":[{"code":"11643","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1578.64,"maximum":3941.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1578.64,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1610.21,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1594.42,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1625.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3941.85,"additional_payer_notes":"APC"}]}]},{"description":"Exc f/e/e/n/l mal+mrg 3.1-4","code_information":[{"code":"11644","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1578.64,"maximum":3941.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1578.64,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1610.21,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1594.42,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1625.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3941.85,"additional_payer_notes":"APC"}]}]},{"description":"Remove thigh pressure sore","code_information":[{"code":"15950","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1578.64,"maximum":3941.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1578.64,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1610.21,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1594.42,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1625.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3941.85,"additional_payer_notes":"APC"}]}]},{"description":"Incision of breast lesion","code_information":[{"code":"19020","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1578.64,"maximum":3941.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1578.64,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1610.21,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1594.42,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1625.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3941.85,"additional_payer_notes":"APC"}]}]},{"description":"Bx breast 1st lesion strtctc","code_information":[{"code":"19081","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1578.64,"maximum":3941.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1578.64,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1610.21,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1594.42,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1625.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3941.85,"additional_payer_notes":"APC"}]}]},{"description":"Bx breast 1st lesion us imag","code_information":[{"code":"19083","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1578.64,"maximum":3941.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1578.64,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1610.21,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1594.42,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1625.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3941.85,"additional_payer_notes":"APC"}]}]},{"description":"Bx breast 1st lesion mr imag","code_information":[{"code":"19085","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1578.64,"maximum":3941.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1578.64,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1610.21,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1594.42,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1625.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3941.85,"additional_payer_notes":"APC"}]}]},{"description":"Bx breast percut w/o image","code_information":[{"code":"19100","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1578.64,"maximum":3941.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1578.64,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1610.21,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1594.42,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1625.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3941.85,"additional_payer_notes":"APC"}]}]},{"description":"Perq device breast 1st imag","code_information":[{"code":"19281","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1578.64,"maximum":3941.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1578.64,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1610.21,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1594.42,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1625.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3941.85,"additional_payer_notes":"APC"}]}]},{"description":"Explore wound extremity","code_information":[{"code":"20103","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1578.64,"maximum":3941.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1578.64,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1610.21,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1594.42,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1625.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3941.85,"additional_payer_notes":"APC"}]}]},{"description":"Muscle biopsy","code_information":[{"code":"20200","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1578.64,"maximum":3941.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1578.64,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1610.21,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1594.42,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1625.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3941.85,"additional_payer_notes":"APC"}]}]},{"description":"Needle biopsy muscle","code_information":[{"code":"20206","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1578.64,"maximum":3941.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1578.64,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1610.21,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1594.42,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1625.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3941.85,"additional_payer_notes":"APC"}]}]},{"description":"Bone biopsy trocar/needle","code_information":[{"code":"20220","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1578.64,"maximum":3941.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1578.64,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1610.21,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1594.42,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1625.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3941.85,"additional_payer_notes":"APC"}]}]},{"description":"Bone biopsy trocar/needle","code_information":[{"code":"20225","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1578.64,"maximum":3941.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1578.64,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1610.21,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1594.42,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1625.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3941.85,"additional_payer_notes":"APC"}]}]},{"description":"Removal of foreign body","code_information":[{"code":"20520","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1578.64,"maximum":3941.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1578.64,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1610.21,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1594.42,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1625.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3941.85,"additional_payer_notes":"APC"}]}]},{"description":"Removal of support implant","code_information":[{"code":"20670","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1578.64,"maximum":3941.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1578.64,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1610.21,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1594.42,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1625.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3941.85,"additional_payer_notes":"APC"}]}]},{"description":"Exc face les sc <2 cm","code_information":[{"code":"21011","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1578.64,"maximum":3941.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1578.64,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1610.21,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1594.42,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1625.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3941.85,"additional_payer_notes":"APC"}]}]},{"description":"Exc face les sbq 2 cm/>","code_information":[{"code":"21012","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1578.64,"maximum":3941.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1578.64,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1610.21,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1594.42,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1625.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3941.85,"additional_payer_notes":"APC"}]}]},{"description":"Exc face tum deep < 2 cm","code_information":[{"code":"21013","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1578.64,"maximum":3941.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1578.64,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1610.21,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1594.42,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1625.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3941.85,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy of neck/chest","code_information":[{"code":"21550","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1578.64,"maximum":3941.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1578.64,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1610.21,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1594.42,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1625.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3941.85,"additional_payer_notes":"APC"}]}]},{"description":"Exc neck les sc < 3 cm","code_information":[{"code":"21555","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1578.64,"maximum":3941.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1578.64,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1610.21,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1594.42,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1625.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3941.85,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy soft tissue of back","code_information":[{"code":"21920","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1578.64,"maximum":3941.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1578.64,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1610.21,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1594.42,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1625.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3941.85,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy soft tissue of back","code_information":[{"code":"21925","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1578.64,"maximum":3941.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1578.64,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1610.21,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1594.42,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1625.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3941.85,"additional_payer_notes":"APC"}]}]},{"description":"Exc back les sc < 3 cm","code_information":[{"code":"21930","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1578.64,"maximum":3941.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1578.64,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1610.21,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1594.42,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1625.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3941.85,"additional_payer_notes":"APC"}]}]},{"description":"Exc back les sc 3 cm/>","code_information":[{"code":"21931","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1578.64,"maximum":3941.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1578.64,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1610.21,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1594.42,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1625.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3941.85,"additional_payer_notes":"APC"}]}]},{"description":"Exc abd les sc < 3 cm","code_information":[{"code":"22902","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1578.64,"maximum":3941.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1578.64,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1610.21,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1594.42,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1625.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3941.85,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy shoulder tissues","code_information":[{"code":"23065","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1578.64,"maximum":3941.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1578.64,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1610.21,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1594.42,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1625.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3941.85,"additional_payer_notes":"APC"}]}]},{"description":"Exc shoulder les sc 3 cm/>","code_information":[{"code":"23071","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1578.64,"maximum":3941.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1578.64,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1610.21,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1594.42,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1625.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3941.85,"additional_payer_notes":"APC"}]}]},{"description":"Exc shoulder les sc < 3 cm","code_information":[{"code":"23075","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1578.64,"maximum":3941.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1578.64,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1610.21,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1594.42,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1625.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3941.85,"additional_payer_notes":"APC"}]}]},{"description":"Remove shoulder foreign body","code_information":[{"code":"23330","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1578.64,"maximum":3941.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1578.64,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1610.21,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1594.42,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1625.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3941.85,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of arm bursa","code_information":[{"code":"23931","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1578.64,"maximum":3941.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1578.64,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1610.21,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1594.42,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1625.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3941.85,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy arm/elbow soft tissue","code_information":[{"code":"24065","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1578.64,"maximum":3941.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1578.64,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1610.21,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1594.42,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1625.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3941.85,"additional_payer_notes":"APC"}]}]},{"description":"Exc arm/elbow les sc < 3 cm","code_information":[{"code":"24075","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1578.64,"maximum":3941.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1578.64,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1610.21,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1594.42,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1625.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3941.85,"additional_payer_notes":"APC"}]}]},{"description":"Removal of arm foreign body","code_information":[{"code":"24200","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1578.64,"maximum":3941.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1578.64,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1610.21,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1594.42,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1625.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3941.85,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy forearm soft tissues","code_information":[{"code":"25065","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1578.64,"maximum":3941.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1578.64,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1610.21,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1594.42,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1625.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3941.85,"additional_payer_notes":"APC"}]}]},{"description":"Exc forearm les sc 3 cm/>","code_information":[{"code":"25071","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1578.64,"maximum":3941.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1578.64,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1610.21,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1594.42,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1625.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3941.85,"additional_payer_notes":"APC"}]}]},{"description":"Exc forearm les sc < 3 cm","code_information":[{"code":"25075","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1578.64,"maximum":3941.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1578.64,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1610.21,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1594.42,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1625.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3941.85,"additional_payer_notes":"APC"}]}]},{"description":"Exc forearm tum deep < 3 cm","code_information":[{"code":"25076","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1578.64,"maximum":3941.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1578.64,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1610.21,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1594.42,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1625.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3941.85,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of finger abscess","code_information":[{"code":"26011","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1578.64,"maximum":3941.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1578.64,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1610.21,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1594.42,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1625.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3941.85,"additional_payer_notes":"APC"}]}]},{"description":"Exc hand les sc 1.5 cm/>","code_information":[{"code":"26111","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1578.64,"maximum":3941.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1578.64,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1610.21,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1594.42,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1625.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3941.85,"additional_payer_notes":"APC"}]}]},{"description":"Exc hand tum deep 1.5 cm/>","code_information":[{"code":"26113","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1578.64,"maximum":3941.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1578.64,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1610.21,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1594.42,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1625.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3941.85,"additional_payer_notes":"APC"}]}]},{"description":"Exc hand les sc < 1.5 cm","code_information":[{"code":"26115","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1578.64,"maximum":3941.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1578.64,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1610.21,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1594.42,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1625.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3941.85,"additional_payer_notes":"APC"}]}]},{"description":"Exc hand tum deep < 1.5 cm","code_information":[{"code":"26116","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1578.64,"maximum":3941.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1578.64,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1610.21,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1594.42,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1625.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3941.85,"additional_payer_notes":"APC"}]}]},{"description":"Removal of implant from hand","code_information":[{"code":"26320","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1578.64,"maximum":3941.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1578.64,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1610.21,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1594.42,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1625.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3941.85,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy of soft tissues","code_information":[{"code":"27040","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1578.64,"maximum":3941.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1578.64,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1610.21,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1594.42,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1625.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3941.85,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy of soft tissues","code_information":[{"code":"27041","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1578.64,"maximum":3941.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1578.64,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1610.21,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1594.42,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1625.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3941.85,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy thigh soft tissues","code_information":[{"code":"27323","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1578.64,"maximum":3941.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1578.64,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1610.21,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1594.42,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1625.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3941.85,"additional_payer_notes":"APC"}]}]},{"description":"Exc thigh/knee les sc < 3 cm","code_information":[{"code":"27327","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1578.64,"maximum":3941.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1578.64,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1610.21,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1594.42,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1625.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3941.85,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy lower leg soft tissue","code_information":[{"code":"27613","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1578.64,"maximum":3941.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1578.64,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1610.21,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1594.42,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1625.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3941.85,"additional_payer_notes":"APC"}]}]},{"description":"Exc leg/ankle tum < 3 cm","code_information":[{"code":"27618","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1578.64,"maximum":3941.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1578.64,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1610.21,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1594.42,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1625.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3941.85,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of bursa of foot","code_information":[{"code":"28001","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1578.64,"maximum":3941.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1578.64,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1610.21,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1594.42,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1625.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3941.85,"additional_payer_notes":"APC"}]}]},{"description":"Exc foot/toe tum sc < 1.5 cm","code_information":[{"code":"28043","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1578.64,"maximum":3941.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1578.64,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1610.21,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1594.42,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1625.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3941.85,"additional_payer_notes":"APC"}]}]},{"description":"Removal of foot foreign body","code_information":[{"code":"28192","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1578.64,"maximum":3941.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1578.64,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1610.21,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1594.42,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1625.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3941.85,"additional_payer_notes":"APC"}]}]},{"description":"Removal of foot foreign body","code_information":[{"code":"28193","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1578.64,"maximum":3941.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1578.64,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1610.21,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1594.42,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1625.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3941.85,"additional_payer_notes":"APC"}]}]},{"description":"Needle biopsy chest lining","code_information":[{"code":"32400","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1578.64,"maximum":3941.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1578.64,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1610.21,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1594.42,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1625.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3941.85,"additional_payer_notes":"APC"}]}]},{"description":"Core ndl bx lng/med perq","code_information":[{"code":"32408","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1578.64,"maximum":3941.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1578.64,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1610.21,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1594.42,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1625.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3941.85,"additional_payer_notes":"APC"}]}]},{"description":"Temporal artery procedure","code_information":[{"code":"37609","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1578.64,"maximum":3941.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1578.64,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1610.21,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1594.42,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1625.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3941.85,"additional_payer_notes":"APC"}]}]},{"description":"Bone marrow aspiration","code_information":[{"code":"38220","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1578.64,"maximum":3941.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1578.64,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1610.21,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1594.42,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1625.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3941.85,"additional_payer_notes":"APC"}]}]},{"description":"Bone marrow biopsy","code_information":[{"code":"38221","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1578.64,"maximum":3941.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1578.64,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1610.21,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1594.42,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1625.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3941.85,"additional_payer_notes":"APC"}]}]},{"description":"Needle biopsy lymph nodes","code_information":[{"code":"38505","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1578.64,"maximum":3941.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1578.64,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1610.21,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1594.42,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1625.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3941.85,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy of floor of mouth","code_information":[{"code":"41108","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1578.64,"maximum":3941.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1578.64,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1610.21,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1594.42,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1625.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3941.85,"additional_payer_notes":"APC"}]}]},{"description":"Needle biopsy of liver","code_information":[{"code":"47000","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1578.64,"maximum":3941.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1578.64,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1610.21,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1594.42,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1625.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3941.85,"additional_payer_notes":"APC"}]}]},{"description":"Needle biopsy pancreas","code_information":[{"code":"48102","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1578.64,"maximum":3941.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1578.64,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1610.21,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1594.42,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1625.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3941.85,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy abdominal mass","code_information":[{"code":"49180","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1578.64,"maximum":3941.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1578.64,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1610.21,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1594.42,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1625.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3941.85,"additional_payer_notes":"APC"}]}]},{"description":"Sclerotx fluid collection","code_information":[{"code":"49185","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1578.64,"maximum":3941.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1578.64,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1610.21,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1594.42,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1625.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3941.85,"additional_payer_notes":"APC"}]}]},{"description":"Image cath fluid colxn visc","code_information":[{"code":"49405","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1578.64,"maximum":3941.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1578.64,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1610.21,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1594.42,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1625.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3941.85,"additional_payer_notes":"APC"}]}]},{"description":"Image cath fluid peri/retro","code_information":[{"code":"49406","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1578.64,"maximum":3941.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1578.64,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1610.21,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1594.42,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1625.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3941.85,"additional_payer_notes":"APC"}]}]},{"description":"Image cath fluid trns/vgnl","code_information":[{"code":"49407","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1578.64,"maximum":3941.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1578.64,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1610.21,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1594.42,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1625.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3941.85,"additional_payer_notes":"APC"}]}]},{"description":"Renal biopsy perq","code_information":[{"code":"50200","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1578.64,"maximum":3941.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1578.64,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1610.21,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1594.42,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1625.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3941.85,"additional_payer_notes":"APC"}]}]},{"description":"Drain penis lesion","code_information":[{"code":"54015","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1578.64,"maximum":3941.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1578.64,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1610.21,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1594.42,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1625.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3941.85,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy of penis","code_information":[{"code":"54100","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1578.64,"maximum":3941.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1578.64,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1610.21,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1594.42,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1625.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3941.85,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy of epididymis","code_information":[{"code":"54800","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1578.64,"maximum":3941.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1578.64,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1610.21,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1594.42,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1625.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3941.85,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of scrotum abscess","code_information":[{"code":"55100","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1578.64,"maximum":3941.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1578.64,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1610.21,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1594.42,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1625.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3941.85,"additional_payer_notes":"APC"}]}]},{"description":"Abltj 1/+thyr ndul 1lobe prq","code_information":[{"code":"60660","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1578.64,"maximum":3941.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1578.64,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1610.21,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1594.42,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1625.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3941.85,"additional_payer_notes":"APC"}]}]},{"description":"Needle biopsy spinal cord","code_information":[{"code":"62269","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1578.64,"maximum":3941.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1578.64,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1610.21,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1594.42,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1625.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3941.85,"additional_payer_notes":"APC"}]}]},{"description":"Drain external ear lesion","code_information":[{"code":"69005","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1578.64,"maximum":3941.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1578.64,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1610.21,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1594.42,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1625.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3941.85,"additional_payer_notes":"APC"}]}]},{"description":"Clear outer ear canal","code_information":[{"code":"69205","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1578.64,"maximum":3941.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1578.64,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1610.21,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1594.42,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1625.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3941.85,"additional_payer_notes":"APC"}]}]},{"description":"Complex drainage wound","code_information":[{"code":"10180","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2776.40,"maximum":6932.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2776.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2831.92,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2804.16,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2859.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":6932.66,"additional_payer_notes":"APC"}]}]},{"description":"Deb skin bone at fx site","code_information":[{"code":"11012","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2776.40,"maximum":6932.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2776.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2831.92,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2804.16,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2859.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":6932.66,"additional_payer_notes":"APC"}]}]},{"description":"Exc h-f-nk-sp b9+marg >4 cm","code_information":[{"code":"11426","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2776.40,"maximum":6932.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2776.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2831.92,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2804.16,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2859.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":6932.66,"additional_payer_notes":"APC"}]}]},{"description":"Exc face-mm b9+marg >4 cm","code_information":[{"code":"11446","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2776.40,"maximum":6932.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2776.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2831.92,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2804.16,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2859.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":6932.66,"additional_payer_notes":"APC"}]}]},{"description":"Removal sweat gland lesion","code_information":[{"code":"11450","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2776.40,"maximum":6932.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2776.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2831.92,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2804.16,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2859.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":6932.66,"additional_payer_notes":"APC"}]}]},{"description":"Removal sweat gland lesion","code_information":[{"code":"11451","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2776.40,"maximum":6932.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2776.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2831.92,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2804.16,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2859.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":6932.66,"additional_payer_notes":"APC"}]}]},{"description":"Removal sweat gland lesion","code_information":[{"code":"11462","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2776.40,"maximum":6932.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2776.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2831.92,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2804.16,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2859.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":6932.66,"additional_payer_notes":"APC"}]}]},{"description":"Removal sweat gland lesion","code_information":[{"code":"11463","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2776.40,"maximum":6932.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2776.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2831.92,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2804.16,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2859.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":6932.66,"additional_payer_notes":"APC"}]}]},{"description":"Removal sweat gland lesion","code_information":[{"code":"11470","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2776.40,"maximum":6932.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2776.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2831.92,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2804.16,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2859.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":6932.66,"additional_payer_notes":"APC"}]}]},{"description":"Removal sweat gland lesion","code_information":[{"code":"11471","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2776.40,"maximum":6932.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2776.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2831.92,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2804.16,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2859.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":6932.66,"additional_payer_notes":"APC"}]}]},{"description":"Exc s/n/h/f/g mal+mrg >4 cm","code_information":[{"code":"11626","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2776.40,"maximum":6932.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2776.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2831.92,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2804.16,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2859.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":6932.66,"additional_payer_notes":"APC"}]}]},{"description":"Exc f/e/e/n/l mal+mrg >4 cm","code_information":[{"code":"11646","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2776.40,"maximum":6932.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2776.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2831.92,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2804.16,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2859.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":6932.66,"additional_payer_notes":"APC"}]}]},{"description":"Remove pilonidal cyst simple","code_information":[{"code":"11770","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2776.40,"maximum":6932.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2776.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2831.92,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2804.16,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2859.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":6932.66,"additional_payer_notes":"APC"}]}]},{"description":"Remove pilonidal cyst exten","code_information":[{"code":"11771","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2776.40,"maximum":6932.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2776.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2831.92,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2804.16,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2859.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":6932.66,"additional_payer_notes":"APC"}]}]},{"description":"Remove pilonidal cyst compl","code_information":[{"code":"11772","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2776.40,"maximum":6932.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2776.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2831.92,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2804.16,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2859.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":6932.66,"additional_payer_notes":"APC"}]}]},{"description":"Remove tissue expander(s)","code_information":[{"code":"11971","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2776.40,"maximum":6932.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2776.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2831.92,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2804.16,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2859.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":6932.66,"additional_payer_notes":"APC"}]}]},{"description":"Dermabrasion total face","code_information":[{"code":"15780","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2776.40,"maximum":6932.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2776.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2831.92,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2804.16,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2859.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":6932.66,"additional_payer_notes":"APC"}]}]},{"description":"Dermabrasion other than face","code_information":[{"code":"15782","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2776.40,"maximum":6932.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2776.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2831.92,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2804.16,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2859.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":6932.66,"additional_payer_notes":"APC"}]}]},{"description":"Excise excessive skin thigh","code_information":[{"code":"15832","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2776.40,"maximum":6932.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2776.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2831.92,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2804.16,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2859.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":6932.66,"additional_payer_notes":"APC"}]}]},{"description":"Excise excessive skin leg","code_information":[{"code":"15833","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2776.40,"maximum":6932.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2776.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2831.92,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2804.16,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2859.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":6932.66,"additional_payer_notes":"APC"}]}]},{"description":"Excise excessive skin hip","code_information":[{"code":"15834","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2776.40,"maximum":6932.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2776.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2831.92,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2804.16,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2859.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":6932.66,"additional_payer_notes":"APC"}]}]},{"description":"Excise excessive skin buttck","code_information":[{"code":"15835","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2776.40,"maximum":6932.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2776.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2831.92,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2804.16,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2859.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":6932.66,"additional_payer_notes":"APC"}]}]},{"description":"Excise excessive skin arm","code_information":[{"code":"15836","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2776.40,"maximum":6932.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2776.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2831.92,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2804.16,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2859.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":6932.66,"additional_payer_notes":"APC"}]}]},{"description":"Excise excess skin arm/hand","code_information":[{"code":"15837","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2776.40,"maximum":6932.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2776.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2831.92,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2804.16,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2859.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":6932.66,"additional_payer_notes":"APC"}]}]},{"description":"Excise excess skin fat pad","code_information":[{"code":"15838","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2776.40,"maximum":6932.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2776.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2831.92,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2804.16,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2859.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":6932.66,"additional_payer_notes":"APC"}]}]},{"description":"Excise excess skin & tissue","code_information":[{"code":"15839","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2776.40,"maximum":6932.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2776.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2831.92,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2804.16,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2859.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":6932.66,"additional_payer_notes":"APC"}]}]},{"description":"Removal of tail bone ulcer","code_information":[{"code":"15920","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2776.40,"maximum":6932.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2776.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2831.92,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2804.16,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2859.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":6932.66,"additional_payer_notes":"APC"}]}]},{"description":"Remove sacrum pressure sore","code_information":[{"code":"15931","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2776.40,"maximum":6932.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2776.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2831.92,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2804.16,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2859.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":6932.66,"additional_payer_notes":"APC"}]}]},{"description":"Remove sacrum pressure sore","code_information":[{"code":"15933","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2776.40,"maximum":6932.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2776.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2831.92,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2804.16,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2859.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":6932.66,"additional_payer_notes":"APC"}]}]},{"description":"Remove hip pressure sore","code_information":[{"code":"15940","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2776.40,"maximum":6932.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2776.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2831.92,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2804.16,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2859.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":6932.66,"additional_payer_notes":"APC"}]}]},{"description":"Remove hip pressure sore","code_information":[{"code":"15941","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2776.40,"maximum":6932.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2776.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2831.92,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2804.16,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2859.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":6932.66,"additional_payer_notes":"APC"}]}]},{"description":"Remove thigh pressure sore","code_information":[{"code":"15951","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2776.40,"maximum":6932.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2776.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2831.92,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2804.16,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2859.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":6932.66,"additional_payer_notes":"APC"}]}]},{"description":"Deep muscle biopsy","code_information":[{"code":"20205","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2776.40,"maximum":6932.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2776.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2831.92,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2804.16,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2859.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":6932.66,"additional_payer_notes":"APC"}]}]},{"description":"Bone biopsy open superficial","code_information":[{"code":"20240","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2776.40,"maximum":6932.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2776.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2831.92,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2804.16,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2859.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":6932.66,"additional_payer_notes":"APC"}]}]},{"description":"Bone biopsy open deep","code_information":[{"code":"20245","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2776.40,"maximum":6932.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2776.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2831.92,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2804.16,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2859.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":6932.66,"additional_payer_notes":"APC"}]}]},{"description":"Removal of foreign body","code_information":[{"code":"20525","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2776.40,"maximum":6932.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2776.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2831.92,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2804.16,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2859.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":6932.66,"additional_payer_notes":"APC"}]}]},{"description":"Removal of support implant","code_information":[{"code":"20680","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2776.40,"maximum":6932.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2776.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2831.92,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2804.16,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2859.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":6932.66,"additional_payer_notes":"APC"}]}]},{"description":"Exc face tum deep 2 cm/>","code_information":[{"code":"21014","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2776.40,"maximum":6932.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2776.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2831.92,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2804.16,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2859.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":6932.66,"additional_payer_notes":"APC"}]}]},{"description":"Resect face/scalp tum < 2 cm","code_information":[{"code":"21015","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2776.40,"maximum":6932.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2776.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2831.92,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2804.16,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2859.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":6932.66,"additional_payer_notes":"APC"}]}]},{"description":"Resect face/scalp tum 2 cm/>","code_information":[{"code":"21016","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2776.40,"maximum":6932.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2776.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2831.92,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2804.16,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2859.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":6932.66,"additional_payer_notes":"APC"}]}]},{"description":"Drain neck/chest lesion","code_information":[{"code":"21501","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2776.40,"maximum":6932.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2776.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2831.92,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2804.16,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2859.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":6932.66,"additional_payer_notes":"APC"}]}]},{"description":"Exc neck les sc 3 cm/>","code_information":[{"code":"21552","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2776.40,"maximum":6932.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2776.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2831.92,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2804.16,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2859.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":6932.66,"additional_payer_notes":"APC"}]}]},{"description":"Exc neck tum deep 5 cm/>","code_information":[{"code":"21554","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2776.40,"maximum":6932.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2776.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2831.92,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2804.16,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2859.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":6932.66,"additional_payer_notes":"APC"}]}]},{"description":"Exc neck tum deep < 5 cm","code_information":[{"code":"21556","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2776.40,"maximum":6932.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2776.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2831.92,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2804.16,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2859.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":6932.66,"additional_payer_notes":"APC"}]}]},{"description":"Resect neck thorax tumor<5cm","code_information":[{"code":"21557","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2776.40,"maximum":6932.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2776.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2831.92,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2804.16,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2859.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":6932.66,"additional_payer_notes":"APC"}]}]},{"description":"Resect neck tumor 5 cm/>","code_information":[{"code":"21558","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2776.40,"maximum":6932.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2776.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2831.92,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2804.16,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2859.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":6932.66,"additional_payer_notes":"APC"}]}]},{"description":"Exc chest wall tumor w/ribs","code_information":[{"code":"21601","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2776.40,"maximum":6932.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2776.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2831.92,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2804.16,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2859.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":6932.66,"additional_payer_notes":"APC"}]}]},{"description":"Exc back tum deep < 5 cm","code_information":[{"code":"21932","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2776.40,"maximum":6932.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2776.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2831.92,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2804.16,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2859.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":6932.66,"additional_payer_notes":"APC"}]}]},{"description":"Exc back tum deep 5 cm/>","code_information":[{"code":"21933","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2776.40,"maximum":6932.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2776.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2831.92,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2804.16,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2859.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":6932.66,"additional_payer_notes":"APC"}]}]},{"description":"Resect back tum < 5 cm","code_information":[{"code":"21935","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2776.40,"maximum":6932.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2776.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2831.92,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2804.16,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2859.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":6932.66,"additional_payer_notes":"APC"}]}]},{"description":"Resect back tum 5 cm/>","code_information":[{"code":"21936","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2776.40,"maximum":6932.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2776.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2831.92,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2804.16,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2859.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":6932.66,"additional_payer_notes":"APC"}]}]},{"description":"Exc abdl tum deep < 5 cm","code_information":[{"code":"22900","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2776.40,"maximum":6932.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2776.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2831.92,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2804.16,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2859.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":6932.66,"additional_payer_notes":"APC"}]}]},{"description":"Exc abdl tum deep 5 cm/>","code_information":[{"code":"22901","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2776.40,"maximum":6932.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2776.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2831.92,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2804.16,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2859.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":6932.66,"additional_payer_notes":"APC"}]}]},{"description":"Exc abd les sc 3 cm/>","code_information":[{"code":"22903","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2776.40,"maximum":6932.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2776.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2831.92,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2804.16,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2859.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":6932.66,"additional_payer_notes":"APC"}]}]},{"description":"Radical resect abd tumor<5cm","code_information":[{"code":"22904","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2776.40,"maximum":6932.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2776.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2831.92,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2804.16,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2859.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":6932.66,"additional_payer_notes":"APC"}]}]},{"description":"Rad resect abd tumor 5 cm/>","code_information":[{"code":"22905","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2776.40,"maximum":6932.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2776.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2831.92,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2804.16,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2859.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":6932.66,"additional_payer_notes":"APC"}]}]},{"description":"Removal of calcium deposits","code_information":[{"code":"23000","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2776.40,"maximum":6932.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2776.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2831.92,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2804.16,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2859.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":6932.66,"additional_payer_notes":"APC"}]}]},{"description":"Drain shoulder lesion","code_information":[{"code":"23030","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2776.40,"maximum":6932.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2776.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2831.92,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2804.16,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2859.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":6932.66,"additional_payer_notes":"APC"}]}]},{"description":"Drain shoulder bursa","code_information":[{"code":"23031","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2776.40,"maximum":6932.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2776.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2831.92,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2804.16,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2859.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":6932.66,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy shoulder tissues","code_information":[{"code":"23066","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2776.40,"maximum":6932.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2776.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2831.92,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2804.16,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2859.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":6932.66,"additional_payer_notes":"APC"}]}]},{"description":"Exc shoulder tum deep 5 cm/>","code_information":[{"code":"23073","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2776.40,"maximum":6932.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2776.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2831.92,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2804.16,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2859.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":6932.66,"additional_payer_notes":"APC"}]}]},{"description":"Exc shoulder tum deep < 5 cm","code_information":[{"code":"23076","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2776.40,"maximum":6932.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2776.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2831.92,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2804.16,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2859.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":6932.66,"additional_payer_notes":"APC"}]}]},{"description":"Resect shoulder tumor < 5 cm","code_information":[{"code":"23077","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2776.40,"maximum":6932.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2776.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2831.92,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2804.16,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2859.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":6932.66,"additional_payer_notes":"APC"}]}]},{"description":"Resect shoulder tumor 5 cm/>","code_information":[{"code":"23078","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2776.40,"maximum":6932.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2776.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2831.92,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2804.16,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2859.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":6932.66,"additional_payer_notes":"APC"}]}]},{"description":"Remove shoulder fb deep","code_information":[{"code":"23333","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2776.40,"maximum":6932.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2776.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2831.92,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2804.16,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2859.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":6932.66,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of arm lesion","code_information":[{"code":"23930","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2776.40,"maximum":6932.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2776.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2831.92,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2804.16,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2859.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":6932.66,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy arm/elbow soft tissue","code_information":[{"code":"24066","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2776.40,"maximum":6932.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2776.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2831.92,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2804.16,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2859.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":6932.66,"additional_payer_notes":"APC"}]}]},{"description":"Exc arm/elbow les sc 3 cm/>","code_information":[{"code":"24071","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2776.40,"maximum":6932.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2776.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2831.92,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2804.16,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2859.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":6932.66,"additional_payer_notes":"APC"}]}]},{"description":"Ex arm/elbow tum deep 5 cm/>","code_information":[{"code":"24073","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2776.40,"maximum":6932.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2776.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2831.92,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2804.16,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2859.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":6932.66,"additional_payer_notes":"APC"}]}]},{"description":"Ex arm/elbow tum deep < 5 cm","code_information":[{"code":"24076","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2776.40,"maximum":6932.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2776.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2831.92,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2804.16,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2859.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":6932.66,"additional_payer_notes":"APC"}]}]},{"description":"Resect arm/elbow tum < 5 cm","code_information":[{"code":"24077","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2776.40,"maximum":6932.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2776.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2831.92,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2804.16,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2859.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":6932.66,"additional_payer_notes":"APC"}]}]},{"description":"Resect arm/elbow tum 5 cm/>","code_information":[{"code":"24079","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2776.40,"maximum":6932.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2776.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2831.92,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2804.16,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2859.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":6932.66,"additional_payer_notes":"APC"}]}]},{"description":"Removal of arm foreign body","code_information":[{"code":"24201","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2776.40,"maximum":6932.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2776.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2831.92,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2804.16,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2859.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":6932.66,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy forearm soft tissues","code_information":[{"code":"25066","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2776.40,"maximum":6932.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2776.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2831.92,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2804.16,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2859.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":6932.66,"additional_payer_notes":"APC"}]}]},{"description":"Exc forearm tum deep 3 cm/>","code_information":[{"code":"25073","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2776.40,"maximum":6932.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2776.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2831.92,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2804.16,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2859.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":6932.66,"additional_payer_notes":"APC"}]}]},{"description":"Resect forearm/wrist tum<3cm","code_information":[{"code":"25077","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2776.40,"maximum":6932.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2776.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2831.92,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2804.16,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2859.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":6932.66,"additional_payer_notes":"APC"}]}]},{"description":"Resect forarm/wrist tum 3cm>","code_information":[{"code":"25078","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2776.40,"maximum":6932.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2776.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2831.92,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2804.16,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2859.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":6932.66,"additional_payer_notes":"APC"}]}]},{"description":"Rad resect hand tumor < 3 cm","code_information":[{"code":"26117","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2776.40,"maximum":6932.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2776.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2831.92,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2804.16,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2859.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":6932.66,"additional_payer_notes":"APC"}]}]},{"description":"Rad resect hand tumor 3 cm/>","code_information":[{"code":"26118","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2776.40,"maximum":6932.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2776.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2831.92,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2804.16,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2859.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":6932.66,"additional_payer_notes":"APC"}]}]},{"description":"Exc hip pelvis les sc 3 cm/>","code_information":[{"code":"27043","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2776.40,"maximum":6932.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2776.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2831.92,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2804.16,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2859.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":6932.66,"additional_payer_notes":"APC"}]}]},{"description":"Exc hip/pelv tum deep 5 cm/>","code_information":[{"code":"27045","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2776.40,"maximum":6932.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2776.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2831.92,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2804.16,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2859.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":6932.66,"additional_payer_notes":"APC"}]}]},{"description":"Exc hip/pelvis les sc < 3 cm","code_information":[{"code":"27047","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2776.40,"maximum":6932.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2776.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2831.92,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2804.16,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2859.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":6932.66,"additional_payer_notes":"APC"}]}]},{"description":"Exc hip/pelv tum deep < 5 cm","code_information":[{"code":"27048","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2776.40,"maximum":6932.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2776.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2831.92,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2804.16,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2859.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":6932.66,"additional_payer_notes":"APC"}]}]},{"description":"Resect hip/pelv tum < 5 cm","code_information":[{"code":"27049","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2776.40,"maximum":6932.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2776.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2831.92,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2804.16,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2859.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":6932.66,"additional_payer_notes":"APC"}]}]},{"description":"Resect hip/pelv tum 5 cm/>","code_information":[{"code":"27059","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2776.40,"maximum":6932.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2776.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2831.92,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2804.16,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2859.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":6932.66,"additional_payer_notes":"APC"}]}]},{"description":"Remove hip foreign body","code_information":[{"code":"27086","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2776.40,"maximum":6932.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2776.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2831.92,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2804.16,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2859.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":6932.66,"additional_payer_notes":"APC"}]}]},{"description":"Drain thigh/knee lesion","code_information":[{"code":"27301","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2776.40,"maximum":6932.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2776.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2831.92,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2804.16,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2859.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":6932.66,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy thigh soft tissues","code_information":[{"code":"27324","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2776.40,"maximum":6932.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2776.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2831.92,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2804.16,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2859.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":6932.66,"additional_payer_notes":"APC"}]}]},{"description":"Exc thigh/knee tum deep <5cm","code_information":[{"code":"27328","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2776.40,"maximum":6932.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2776.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2831.92,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2804.16,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2859.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":6932.66,"additional_payer_notes":"APC"}]}]},{"description":"Resect thigh/knee tum < 5 cm","code_information":[{"code":"27329","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2776.40,"maximum":6932.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2776.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2831.92,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2804.16,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2859.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":6932.66,"additional_payer_notes":"APC"}]}]},{"description":"Exc thigh/knee les sc 3 cm/>","code_information":[{"code":"27337","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2776.40,"maximum":6932.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2776.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2831.92,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2804.16,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2859.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":6932.66,"additional_payer_notes":"APC"}]}]},{"description":"Exc thigh/knee tum dep 5cm/>","code_information":[{"code":"27339","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2776.40,"maximum":6932.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2776.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2831.92,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2804.16,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2859.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":6932.66,"additional_payer_notes":"APC"}]}]},{"description":"Resect thigh/knee tum 5 cm/>","code_information":[{"code":"27364","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2776.40,"maximum":6932.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2776.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2831.92,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2804.16,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2859.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":6932.66,"additional_payer_notes":"APC"}]}]},{"description":"Removal of foreign body","code_information":[{"code":"27372","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2776.40,"maximum":6932.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2776.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2831.92,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2804.16,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2859.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":6932.66,"additional_payer_notes":"APC"}]}]},{"description":"Drain lower leg lesion","code_information":[{"code":"27603","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2776.40,"maximum":6932.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2776.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2831.92,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2804.16,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2859.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":6932.66,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy lower leg soft tissue","code_information":[{"code":"27614","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2776.40,"maximum":6932.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2776.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2831.92,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2804.16,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2859.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":6932.66,"additional_payer_notes":"APC"}]}]},{"description":"Resect leg/ankle tum < 5 cm","code_information":[{"code":"27615","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2776.40,"maximum":6932.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2776.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2831.92,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2804.16,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2859.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":6932.66,"additional_payer_notes":"APC"}]}]},{"description":"Resect leg/ankle tum 5 cm/>","code_information":[{"code":"27616","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2776.40,"maximum":6932.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2776.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2831.92,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2804.16,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2859.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":6932.66,"additional_payer_notes":"APC"}]}]},{"description":"Exc leg/ankle tum deep <5 cm","code_information":[{"code":"27619","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2776.40,"maximum":6932.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2776.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2831.92,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2804.16,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2859.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":6932.66,"additional_payer_notes":"APC"}]}]},{"description":"Exc leg/ankle les sc 3 cm/>","code_information":[{"code":"27632","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2776.40,"maximum":6932.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2776.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2831.92,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2804.16,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2859.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":6932.66,"additional_payer_notes":"APC"}]}]},{"description":"Exc leg/ankle tum dep 5 cm/>","code_information":[{"code":"27634","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2776.40,"maximum":6932.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2776.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2831.92,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2804.16,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2859.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":6932.66,"additional_payer_notes":"APC"}]}]},{"description":"Exc foot/toe tum sc 1.5 cm/>","code_information":[{"code":"28039","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2776.40,"maximum":6932.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2776.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2831.92,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2804.16,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2859.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":6932.66,"additional_payer_notes":"APC"}]}]},{"description":"Exc foot/toe tum dep 1.5cm/>","code_information":[{"code":"28041","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2776.40,"maximum":6932.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2776.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2831.92,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2804.16,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2859.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":6932.66,"additional_payer_notes":"APC"}]}]},{"description":"Exc foot/toe tum deep <1.5cm","code_information":[{"code":"28045","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2776.40,"maximum":6932.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2776.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2831.92,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2804.16,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2859.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":6932.66,"additional_payer_notes":"APC"}]}]},{"description":"Resect foot/toe tumor < 3 cm","code_information":[{"code":"28046","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2776.40,"maximum":6932.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2776.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2831.92,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2804.16,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2859.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":6932.66,"additional_payer_notes":"APC"}]}]},{"description":"Resect foot/toe tumor 3 cm/>","code_information":[{"code":"28047","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2776.40,"maximum":6932.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2776.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2831.92,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2804.16,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2859.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":6932.66,"additional_payer_notes":"APC"}]}]},{"description":"Dx bone marrow bx & aspir","code_information":[{"code":"38222","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2776.40,"maximum":6932.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2776.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2831.92,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2804.16,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2859.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":6932.66,"additional_payer_notes":"APC"}]}]},{"description":"Drainage lymph node lesion","code_information":[{"code":"38300","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2776.40,"maximum":6932.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2776.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2831.92,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2804.16,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2859.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":6932.66,"additional_payer_notes":"APC"}]}]},{"description":"Drainage lymph node lesion","code_information":[{"code":"38305","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2776.40,"maximum":6932.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2776.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2831.92,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2804.16,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2859.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":6932.66,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of bladder abscess","code_information":[{"code":"51080","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2776.40,"maximum":6932.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2776.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2831.92,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2804.16,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2859.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":6932.66,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy of penis","code_information":[{"code":"54105","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2776.40,"maximum":6932.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2776.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2831.92,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2804.16,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2859.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":6932.66,"additional_payer_notes":"APC"}]}]},{"description":"Treatment of penis lesion","code_information":[{"code":"54115","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2776.40,"maximum":6932.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2776.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2831.92,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2804.16,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2859.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":6932.66,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy of testis","code_information":[{"code":"54500","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2776.40,"maximum":6932.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2776.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2831.92,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2804.16,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2859.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":6932.66,"additional_payer_notes":"APC"}]}]},{"description":"I & d vaginal hematoma pp","code_information":[{"code":"57022","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2776.40,"maximum":6932.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2776.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2831.92,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2804.16,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2859.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":6932.66,"additional_payer_notes":"APC"}]}]},{"description":"I & d vag hematoma non-ob","code_information":[{"code":"57023","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2776.40,"maximum":6932.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2776.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2831.92,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2804.16,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2859.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":6932.66,"additional_payer_notes":"APC"}]}]},{"description":"Remove external ear partial","code_information":[{"code":"69110","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2776.40,"maximum":6932.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2776.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2831.92,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2804.16,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2859.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":6932.66,"additional_payer_notes":"APC"}]}]},{"description":"Remove ear canal lesion(s)","code_information":[{"code":"69145","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2776.40,"maximum":6932.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2776.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2831.92,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2804.16,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2859.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":6932.66,"additional_payer_notes":"APC"}]}]},{"description":"Abltj mal brst tum perq crtx","code_information":[{"code":"0581T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3742.46,"maximum":9344.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3742.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3817.31,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3779.89,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3854.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":9344.93,"additional_payer_notes":"APC"}]}]},{"description":"Ablt b9 brst tum perq lsr ea","code_information":[{"code":"0970T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3742.46,"maximum":9344.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3742.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3817.31,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3779.89,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3854.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":9344.93,"additional_payer_notes":"APC"}]}]},{"description":"Ablt mal brst tum pq lsr uni","code_information":[{"code":"0971T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3742.46,"maximum":9344.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3742.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3817.31,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3779.89,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3854.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":9344.93,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy of breast open","code_information":[{"code":"19101","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3742.46,"maximum":9344.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3742.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3817.31,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3779.89,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3854.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":9344.93,"additional_payer_notes":"APC"}]}]},{"description":"Cryosurg ablate fa each","code_information":[{"code":"19105","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3742.46,"maximum":9344.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3742.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3817.31,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3779.89,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3854.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":9344.93,"additional_payer_notes":"APC"}]}]},{"description":"Nipple exploration","code_information":[{"code":"19110","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3742.46,"maximum":9344.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3742.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3817.31,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3779.89,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3854.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":9344.93,"additional_payer_notes":"APC"}]}]},{"description":"Excise breast duct fistula","code_information":[{"code":"19112","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3742.46,"maximum":9344.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3742.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3817.31,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3779.89,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3854.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":9344.93,"additional_payer_notes":"APC"}]}]},{"description":"Removal of breast lesion","code_information":[{"code":"19120","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3742.46,"maximum":9344.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3742.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3817.31,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3779.89,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3854.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":9344.93,"additional_payer_notes":"APC"}]}]},{"description":"Excision breast lesion","code_information":[{"code":"19125","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3742.46,"maximum":9344.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3742.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3817.31,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3779.89,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3854.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":9344.93,"additional_payer_notes":"APC"}]}]},{"description":"Removal of Breast Tissue","code_information":[{"code":"19300","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3742.46,"maximum":9344.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3742.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3817.31,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3779.89,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3854.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":9344.93,"additional_payer_notes":"APC"}]}]},{"description":"Partial Mastectomy","code_information":[{"code":"19301","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3742.46,"maximum":9344.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3742.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3817.31,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3779.89,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3854.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":9344.93,"additional_payer_notes":"APC"}]}]},{"description":"Removal of breast implant","code_information":[{"code":"19328","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3742.46,"maximum":9344.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3742.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3817.31,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3779.89,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3854.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":9344.93,"additional_payer_notes":"APC"}]}]},{"description":"Removal of implant material","code_information":[{"code":"19330","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3742.46,"maximum":9344.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3742.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3817.31,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3779.89,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3854.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":9344.93,"additional_payer_notes":"APC"}]}]},{"description":"Breast reconstruction","code_information":[{"code":"19350","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3742.46,"maximum":9344.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3742.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3817.31,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3779.89,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3854.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":9344.93,"additional_payer_notes":"APC"}]}]},{"description":"Correct inverted nipple(s)","code_information":[{"code":"19355","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3742.46,"maximum":9344.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3742.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3817.31,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3779.89,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3854.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":9344.93,"additional_payer_notes":"APC"}]}]},{"description":"Surgery of breast capsule","code_information":[{"code":"19370","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3742.46,"maximum":9344.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3742.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3817.31,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3779.89,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3854.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":9344.93,"additional_payer_notes":"APC"}]}]},{"description":"Removal of breast capsule","code_information":[{"code":"19371","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3742.46,"maximum":9344.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3742.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3817.31,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3779.89,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3854.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":9344.93,"additional_payer_notes":"APC"}]}]},{"description":"Design custom breast implant","code_information":[{"code":"19396","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3742.46,"maximum":9344.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3742.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3817.31,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3779.89,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3854.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":9344.93,"additional_payer_notes":"APC"}]}]},{"description":"Breast surgery procedure","code_information":[{"code":"19499","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3742.46,"maximum":9344.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3742.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3817.31,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3779.89,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3854.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":9344.93,"additional_payer_notes":"APC"}]}]},{"description":"Incision of lymph channels","code_information":[{"code":"38308","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3742.46,"maximum":9344.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3742.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3817.31,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3779.89,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3854.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":9344.93,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy/removal lymph nodes","code_information":[{"code":"38500","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3742.46,"maximum":9344.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3742.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3817.31,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3779.89,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3854.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":9344.93,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy/removal lymph nodes","code_information":[{"code":"38510","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3742.46,"maximum":9344.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3742.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3817.31,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3779.89,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3854.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":9344.93,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy/removal lymph nodes","code_information":[{"code":"38520","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3742.46,"maximum":9344.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3742.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3817.31,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3779.89,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3854.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":9344.93,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy/removal lymph nodes","code_information":[{"code":"38525","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3742.46,"maximum":9344.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3742.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3817.31,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3779.89,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3854.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":9344.93,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy/removal lymph nodes","code_information":[{"code":"38530","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3742.46,"maximum":9344.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3742.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3817.31,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3779.89,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3854.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":9344.93,"additional_payer_notes":"APC"}]}]},{"description":"Open bx/exc inguinofem nodes","code_information":[{"code":"38531","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3742.46,"maximum":9344.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3742.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3817.31,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3779.89,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3854.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":9344.93,"additional_payer_notes":"APC"}]}]},{"description":"Removal neck/armpit lesion","code_information":[{"code":"38550","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3742.46,"maximum":9344.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3742.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3817.31,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3779.89,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3854.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":9344.93,"additional_payer_notes":"APC"}]}]},{"description":"Lymphovenous bypass per xtr","code_information":[{"code":"1019T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6346.83,"maximum":15848.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6346.83,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6473.77,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6410.3,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6537.23,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":15848.03,"additional_payer_notes":"APC"}]}]},{"description":"Exc Skin Abd","code_information":[{"code":"15830","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6346.83,"maximum":15848.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6346.83,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6473.77,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6410.3,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6537.23,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":15848.03,"additional_payer_notes":"APC"}]}]},{"description":"P-Mastectomy w/LN Removal","code_information":[{"code":"19302","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6346.83,"maximum":15848.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6346.83,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6473.77,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6410.3,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6537.23,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":15848.03,"additional_payer_notes":"APC"}]}]},{"description":"Mast simple complete","code_information":[{"code":"19303","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6346.83,"maximum":15848.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6346.83,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6473.77,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6410.3,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6537.23,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":15848.03,"additional_payer_notes":"APC"}]}]},{"description":"Mast mod rad","code_information":[{"code":"19307","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6346.83,"maximum":15848.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6346.83,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6473.77,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6410.3,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6537.23,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":15848.03,"additional_payer_notes":"APC"}]}]},{"description":"Suspension of breast","code_information":[{"code":"19316","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6346.83,"maximum":15848.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6346.83,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6473.77,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6410.3,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6537.23,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":15848.03,"additional_payer_notes":"APC"}]}]},{"description":"Reduction of large breast","code_information":[{"code":"19318","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6346.83,"maximum":15848.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6346.83,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6473.77,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6410.3,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6537.23,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":15848.03,"additional_payer_notes":"APC"}]}]},{"description":"Revise breast reconstruction","code_information":[{"code":"19380","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6346.83,"maximum":15848.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6346.83,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6473.77,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6410.3,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6537.23,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":15848.03,"additional_payer_notes":"APC"}]}]},{"description":"Removal neck/armpit lesion","code_information":[{"code":"38555","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6346.83,"maximum":15848.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6346.83,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6473.77,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6410.3,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6537.23,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":15848.03,"additional_payer_notes":"APC"}]}]},{"description":"Removal of lymph nodes neck","code_information":[{"code":"38700","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6346.83,"maximum":15848.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6346.83,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6473.77,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6410.3,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6537.23,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":15848.03,"additional_payer_notes":"APC"}]}]},{"description":"Removal of lymph nodes neck","code_information":[{"code":"38720","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6346.83,"maximum":15848.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6346.83,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6473.77,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6410.3,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6537.23,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":15848.03,"additional_payer_notes":"APC"}]}]},{"description":"Remove groin lymph nodes","code_information":[{"code":"38760","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6346.83,"maximum":15848.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6346.83,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6473.77,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6410.3,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6537.23,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":15848.03,"additional_payer_notes":"APC"}]}]},{"description":"Application of body cast","code_information":[{"code":"29044","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":155.32,"maximum":387.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":155.32,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":158.43,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":156.87,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":159.98,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":387.84,"additional_payer_notes":"APC"}]}]},{"description":"Apply hand/wrist cast","code_information":[{"code":"29085","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":155.32,"maximum":387.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":155.32,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":158.43,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":156.87,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":159.98,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":387.84,"additional_payer_notes":"APC"}]}]},{"description":"Apply finger cast","code_information":[{"code":"29086","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":155.32,"maximum":387.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":155.32,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":158.43,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":156.87,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":159.98,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":387.84,"additional_payer_notes":"APC"}]}]},{"description":"Apply long arm splint","code_information":[{"code":"29105","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":155.32,"maximum":387.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":155.32,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":158.43,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":156.87,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":159.98,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":387.84,"additional_payer_notes":"APC"}]}]},{"description":"Strapping of chest","code_information":[{"code":"29200","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":155.32,"maximum":387.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":155.32,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":158.43,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":156.87,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":159.98,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":387.84,"additional_payer_notes":"APC"}]}]},{"description":"Addition of walker to cast","code_information":[{"code":"29440","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":155.32,"maximum":387.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":155.32,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":158.43,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":156.87,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":159.98,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":387.84,"additional_payer_notes":"APC"}]}]},{"description":"Application of leg cast","code_information":[{"code":"29450","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":155.32,"maximum":387.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":155.32,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":158.43,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":156.87,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":159.98,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":387.84,"additional_payer_notes":"APC"}]}]},{"description":"Application long leg splint","code_information":[{"code":"29505","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":155.32,"maximum":387.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":155.32,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":158.43,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":156.87,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":159.98,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":387.84,"additional_payer_notes":"APC"}]}]},{"description":"Application lower leg splint","code_information":[{"code":"29515","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":155.32,"maximum":387.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":155.32,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":158.43,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":156.87,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":159.98,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":387.84,"additional_payer_notes":"APC"}]}]},{"description":"Strapping of ankle and/or ft","code_information":[{"code":"29540","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":155.32,"maximum":387.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":155.32,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":158.43,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":156.87,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":159.98,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":387.84,"additional_payer_notes":"APC"}]}]},{"description":"Application of paste boot","code_information":[{"code":"29580","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":155.32,"maximum":387.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":155.32,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":158.43,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":156.87,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":159.98,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":387.84,"additional_payer_notes":"APC"}]}]},{"description":"Apply multlay comprs lwr leg","code_information":[{"code":"29581","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":155.32,"maximum":387.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":155.32,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":158.43,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":156.87,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":159.98,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":387.84,"additional_payer_notes":"APC"}]}]},{"description":"Appl multlay comprs arm/hand","code_information":[{"code":"29584","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":155.32,"maximum":387.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":155.32,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":158.43,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":156.87,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":159.98,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":387.84,"additional_payer_notes":"APC"}]}]},{"description":"Repair of body cast","code_information":[{"code":"29720","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":155.32,"maximum":387.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":155.32,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":158.43,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":156.87,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":159.98,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":387.84,"additional_payer_notes":"APC"}]}]},{"description":"Windowing of cast","code_information":[{"code":"29730","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":155.32,"maximum":387.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":155.32,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":158.43,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":156.87,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":159.98,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":387.84,"additional_payer_notes":"APC"}]}]},{"description":"Casting/strapping procedure","code_information":[{"code":"29799","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":155.32,"maximum":387.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":155.32,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":158.43,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":156.87,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":159.98,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":387.84,"additional_payer_notes":"APC"}]}]},{"description":"Treat finger dislocation","code_information":[{"code":"26775","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":267.34,"maximum":667.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":267.34,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":272.68,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":270.01,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":275.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":667.54,"additional_payer_notes":"APC"}]}]},{"description":"Treat toe dislocation","code_information":[{"code":"28665","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":267.34,"maximum":667.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":267.34,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":272.68,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":270.01,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":275.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":667.54,"additional_payer_notes":"APC"}]}]},{"description":"Application of body cast","code_information":[{"code":"29000","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":267.34,"maximum":667.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":267.34,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":272.68,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":270.01,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":275.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":667.54,"additional_payer_notes":"APC"}]}]},{"description":"Application of body cast","code_information":[{"code":"29010","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":267.34,"maximum":667.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":267.34,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":272.68,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":270.01,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":275.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":667.54,"additional_payer_notes":"APC"}]}]},{"description":"Application of body cast","code_information":[{"code":"29015","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":267.34,"maximum":667.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":267.34,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":272.68,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":270.01,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":275.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":667.54,"additional_payer_notes":"APC"}]}]},{"description":"Application of body cast","code_information":[{"code":"29035","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":267.34,"maximum":667.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":267.34,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":272.68,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":270.01,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":275.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":667.54,"additional_payer_notes":"APC"}]}]},{"description":"Application of body cast","code_information":[{"code":"29040","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":267.34,"maximum":667.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":267.34,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":272.68,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":270.01,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":275.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":667.54,"additional_payer_notes":"APC"}]}]},{"description":"Application of body cast","code_information":[{"code":"29046","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":267.34,"maximum":667.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":267.34,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":272.68,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":270.01,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":275.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":667.54,"additional_payer_notes":"APC"}]}]},{"description":"Application of figure eight","code_information":[{"code":"29049","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":267.34,"maximum":667.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":267.34,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":272.68,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":270.01,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":275.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":667.54,"additional_payer_notes":"APC"}]}]},{"description":"Application of shoulder cast","code_information":[{"code":"29055","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":267.34,"maximum":667.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":267.34,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":272.68,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":270.01,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":275.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":667.54,"additional_payer_notes":"APC"}]}]},{"description":"Application of shoulder cast","code_information":[{"code":"29058","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":267.34,"maximum":667.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":267.34,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":272.68,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":270.01,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":275.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":667.54,"additional_payer_notes":"APC"}]}]},{"description":"Application of long arm cast","code_information":[{"code":"29065","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":267.34,"maximum":667.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":267.34,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":272.68,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":270.01,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":275.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":667.54,"additional_payer_notes":"APC"}]}]},{"description":"Application of forearm cast","code_information":[{"code":"29075","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":267.34,"maximum":667.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":267.34,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":272.68,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":270.01,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":275.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":667.54,"additional_payer_notes":"APC"}]}]},{"description":"Application of hip cast","code_information":[{"code":"29305","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":267.34,"maximum":667.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":267.34,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":272.68,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":270.01,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":275.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":667.54,"additional_payer_notes":"APC"}]}]},{"description":"Application of hip casts","code_information":[{"code":"29325","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":267.34,"maximum":667.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":267.34,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":272.68,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":270.01,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":275.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":667.54,"additional_payer_notes":"APC"}]}]},{"description":"Application of long leg cast","code_information":[{"code":"29345","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":267.34,"maximum":667.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":267.34,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":272.68,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":270.01,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":275.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":667.54,"additional_payer_notes":"APC"}]}]},{"description":"Application of long leg cast","code_information":[{"code":"29355","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":267.34,"maximum":667.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":267.34,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":272.68,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":270.01,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":275.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":667.54,"additional_payer_notes":"APC"}]}]},{"description":"Apply long leg cast brace","code_information":[{"code":"29358","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":267.34,"maximum":667.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":267.34,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":272.68,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":270.01,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":275.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":667.54,"additional_payer_notes":"APC"}]}]},{"description":"Application of long leg cast","code_information":[{"code":"29365","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":267.34,"maximum":667.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":267.34,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":272.68,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":270.01,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":275.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":667.54,"additional_payer_notes":"APC"}]}]},{"description":"Apply short leg cast","code_information":[{"code":"29405","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":267.34,"maximum":667.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":267.34,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":272.68,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":270.01,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":275.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":667.54,"additional_payer_notes":"APC"}]}]},{"description":"Apply short leg cast","code_information":[{"code":"29425","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":267.34,"maximum":667.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":267.34,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":272.68,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":270.01,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":275.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":667.54,"additional_payer_notes":"APC"}]}]},{"description":"Apply short leg cast","code_information":[{"code":"29435","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":267.34,"maximum":667.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":267.34,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":272.68,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":270.01,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":275.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":667.54,"additional_payer_notes":"APC"}]}]},{"description":"Apply rigid leg cast","code_information":[{"code":"29445","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":267.34,"maximum":667.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":267.34,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":272.68,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":270.01,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":275.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":667.54,"additional_payer_notes":"APC"}]}]},{"description":"Removal/revision of cast","code_information":[{"code":"29700","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":267.34,"maximum":667.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":267.34,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":272.68,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":270.01,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":275.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":667.54,"additional_payer_notes":"APC"}]}]},{"description":"Removal/revision of cast","code_information":[{"code":"29705","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":267.34,"maximum":667.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":267.34,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":272.68,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":270.01,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":275.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":667.54,"additional_payer_notes":"APC"}]}]},{"description":"Removal/revision of cast","code_information":[{"code":"29710","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":267.34,"maximum":667.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":267.34,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":272.68,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":270.01,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":275.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":667.54,"additional_payer_notes":"APC"}]}]},{"description":"Wedging of cast","code_information":[{"code":"29740","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":267.34,"maximum":667.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":267.34,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":272.68,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":270.01,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":275.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":667.54,"additional_payer_notes":"APC"}]}]},{"description":"Wedging of clubfoot cast","code_information":[{"code":"29750","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":267.34,"maximum":667.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":267.34,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":272.68,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":270.01,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":275.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":667.54,"additional_payer_notes":"APC"}]}]},{"description":"Rev s-sclp eltr ra rcvr&tlmt","code_information":[{"code":"0957T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1536.96,"maximum":3837.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1536.96,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1567.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1552.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1583.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3837.78,"additional_payer_notes":"APC"}]}]},{"description":"Apply rem fixation device","code_information":[{"code":"20660","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1536.96,"maximum":3837.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1536.96,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1567.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1552.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1583.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3837.78,"additional_payer_notes":"APC"}]}]},{"description":"Application of head brace","code_information":[{"code":"20661","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1536.96,"maximum":3837.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1536.96,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1567.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1552.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1583.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3837.78,"additional_payer_notes":"APC"}]}]},{"description":"Application of pelvis brace","code_information":[{"code":"20662","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1536.96,"maximum":3837.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1536.96,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1567.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1552.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1583.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3837.78,"additional_payer_notes":"APC"}]}]},{"description":"Application of halo","code_information":[{"code":"20664","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1536.96,"maximum":3837.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1536.96,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1567.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1552.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1583.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3837.78,"additional_payer_notes":"APC"}]}]},{"description":"Remove bone fixation device","code_information":[{"code":"20694","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1536.96,"maximum":3837.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1536.96,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1567.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1552.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1583.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3837.78,"additional_payer_notes":"APC"}]}]},{"description":"Comp ext fixate strut change","code_information":[{"code":"20697","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1536.96,"maximum":3837.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1536.96,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1567.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1552.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1583.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3837.78,"additional_payer_notes":"APC"}]}]},{"description":"Replantation digit complete","code_information":[{"code":"20816","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1536.96,"maximum":3837.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1536.96,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1567.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1552.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1583.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3837.78,"additional_payer_notes":"APC"}]}]},{"description":"Replantation digit complete","code_information":[{"code":"20822","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1536.96,"maximum":3837.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1536.96,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1567.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1552.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1583.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3837.78,"additional_payer_notes":"APC"}]}]},{"description":"Replantation thumb complete","code_information":[{"code":"20824","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1536.96,"maximum":3837.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1536.96,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1567.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1552.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1583.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3837.78,"additional_payer_notes":"APC"}]}]},{"description":"Replantation thumb complete","code_information":[{"code":"20827","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1536.96,"maximum":3837.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1536.96,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1567.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1552.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1583.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3837.78,"additional_payer_notes":"APC"}]}]},{"description":"Treatment of rib fracture","code_information":[{"code":"21813","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1536.96,"maximum":3837.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1536.96,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1567.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1552.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1583.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3837.78,"additional_payer_notes":"APC"}]}]},{"description":"Manipulation of spine","code_information":[{"code":"22505","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1536.96,"maximum":3837.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1536.96,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1567.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1552.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1583.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3837.78,"additional_payer_notes":"APC"}]}]},{"description":"Drain shoulder bone lesion","code_information":[{"code":"23035","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1536.96,"maximum":3837.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1536.96,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1567.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1552.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1583.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3837.78,"additional_payer_notes":"APC"}]}]},{"description":"Treat clavicle fracture","code_information":[{"code":"23505","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1536.96,"maximum":3837.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1536.96,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1567.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1552.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1583.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3837.78,"additional_payer_notes":"APC"}]}]},{"description":"Treat clavicle dislocation","code_information":[{"code":"23520","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1536.96,"maximum":3837.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1536.96,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1567.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1552.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1583.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3837.78,"additional_payer_notes":"APC"}]}]},{"description":"Treat shoulder blade fx","code_information":[{"code":"23575","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1536.96,"maximum":3837.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1536.96,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1567.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1552.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1583.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3837.78,"additional_payer_notes":"APC"}]}]},{"description":"Treat humerus fracture","code_information":[{"code":"23605","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1536.96,"maximum":3837.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1536.96,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1567.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1552.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1583.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3837.78,"additional_payer_notes":"APC"}]}]},{"description":"Treat humerus fracture","code_information":[{"code":"23625","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1536.96,"maximum":3837.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1536.96,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1567.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1552.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1583.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3837.78,"additional_payer_notes":"APC"}]}]},{"description":"Treat shoulder dislocation","code_information":[{"code":"23655","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1536.96,"maximum":3837.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1536.96,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1567.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1552.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1583.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3837.78,"additional_payer_notes":"APC"}]}]},{"description":"Treat dislocation/fracture","code_information":[{"code":"23665","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1536.96,"maximum":3837.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1536.96,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1567.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1552.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1583.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3837.78,"additional_payer_notes":"APC"}]}]},{"description":"Treat dislocation/fracture","code_information":[{"code":"23675","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1536.96,"maximum":3837.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1536.96,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1567.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1552.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1583.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3837.78,"additional_payer_notes":"APC"}]}]},{"description":"Fixation of shoulder","code_information":[{"code":"23700","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1536.96,"maximum":3837.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1536.96,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1567.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1552.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1583.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3837.78,"additional_payer_notes":"APC"}]}]},{"description":"Manipulate elbow w/anesth","code_information":[{"code":"24300","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1536.96,"maximum":3837.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1536.96,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1567.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1552.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1583.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3837.78,"additional_payer_notes":"APC"}]}]},{"description":"Treat humerus fracture","code_information":[{"code":"24505","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1536.96,"maximum":3837.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1536.96,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1567.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1552.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1583.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3837.78,"additional_payer_notes":"APC"}]}]},{"description":"Treat humerus fracture","code_information":[{"code":"24535","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1536.96,"maximum":3837.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1536.96,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1567.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1552.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1583.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3837.78,"additional_payer_notes":"APC"}]}]},{"description":"Treat humerus fracture","code_information":[{"code":"24565","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1536.96,"maximum":3837.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1536.96,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1567.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1552.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1583.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3837.78,"additional_payer_notes":"APC"}]}]},{"description":"Treat humerus fracture","code_information":[{"code":"24566","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1536.96,"maximum":3837.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1536.96,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1567.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1552.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1583.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3837.78,"additional_payer_notes":"APC"}]}]},{"description":"Treat humerus fracture","code_information":[{"code":"24577","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1536.96,"maximum":3837.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1536.96,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1567.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1552.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1583.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3837.78,"additional_payer_notes":"APC"}]}]},{"description":"Treat elbow dislocation","code_information":[{"code":"24605","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1536.96,"maximum":3837.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1536.96,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1567.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1552.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1583.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3837.78,"additional_payer_notes":"APC"}]}]},{"description":"Treat elbow fracture","code_information":[{"code":"24620","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1536.96,"maximum":3837.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1536.96,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1567.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1552.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1583.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3837.78,"additional_payer_notes":"APC"}]}]},{"description":"Treat radius fracture","code_information":[{"code":"24655","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1536.96,"maximum":3837.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1536.96,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1567.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1552.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1583.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3837.78,"additional_payer_notes":"APC"}]}]},{"description":"Treat ulnar fracture","code_information":[{"code":"24675","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1536.96,"maximum":3837.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1536.96,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1567.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1552.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1583.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3837.78,"additional_payer_notes":"APC"}]}]},{"description":"Incision of tendon sheath","code_information":[{"code":"25000","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1536.96,"maximum":3837.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1536.96,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1567.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1552.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1583.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3837.78,"additional_payer_notes":"APC"}]}]},{"description":"Decompress forearm 1 space","code_information":[{"code":"25020","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1536.96,"maximum":3837.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1536.96,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1567.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1552.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1583.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3837.78,"additional_payer_notes":"APC"}]}]},{"description":"Decompress forearm 2 spaces","code_information":[{"code":"25025","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1536.96,"maximum":3837.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1536.96,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1567.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1552.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1583.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3837.78,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of forearm bursa","code_information":[{"code":"25031","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1536.96,"maximum":3837.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1536.96,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1567.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1552.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1583.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3837.78,"additional_payer_notes":"APC"}]}]},{"description":"Remove wrist tendon lesion","code_information":[{"code":"25110","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1536.96,"maximum":3837.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1536.96,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1567.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1552.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1583.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3837.78,"additional_payer_notes":"APC"}]}]},{"description":"Remove wrist tendon lesion","code_information":[{"code":"25111","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1536.96,"maximum":3837.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1536.96,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1567.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1552.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1583.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3837.78,"additional_payer_notes":"APC"}]}]},{"description":"Reremove wrist tendon lesion","code_information":[{"code":"25112","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1536.96,"maximum":3837.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1536.96,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1567.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1552.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1583.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3837.78,"additional_payer_notes":"APC"}]}]},{"description":"Remove wrist/forearm lesion","code_information":[{"code":"25115","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1536.96,"maximum":3837.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1536.96,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1567.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1552.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1583.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3837.78,"additional_payer_notes":"APC"}]}]},{"description":"Excise wrist tendon sheath","code_information":[{"code":"25118","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1536.96,"maximum":3837.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1536.96,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1567.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1552.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1583.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3837.78,"additional_payer_notes":"APC"}]}]},{"description":"Remove/graft forearm lesion","code_information":[{"code":"25125","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1536.96,"maximum":3837.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1536.96,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1567.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1552.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1583.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3837.78,"additional_payer_notes":"APC"}]}]},{"description":"Remove forearm foreign body","code_information":[{"code":"25248","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1536.96,"maximum":3837.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1536.96,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1567.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1552.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1583.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3837.78,"additional_payer_notes":"APC"}]}]},{"description":"Removal of wrist prosthesis","code_information":[{"code":"25250","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1536.96,"maximum":3837.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1536.96,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1567.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1552.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1583.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3837.78,"additional_payer_notes":"APC"}]}]},{"description":"Manipulate wrist w/anesthes","code_information":[{"code":"25259","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1536.96,"maximum":3837.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1536.96,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1567.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1552.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1583.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3837.78,"additional_payer_notes":"APC"}]}]},{"description":"Treat fracture of radius","code_information":[{"code":"25505","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1536.96,"maximum":3837.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1536.96,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1567.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1552.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1583.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3837.78,"additional_payer_notes":"APC"}]}]},{"description":"Treat fracture of radius","code_information":[{"code":"25520","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1536.96,"maximum":3837.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1536.96,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1567.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1552.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1583.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3837.78,"additional_payer_notes":"APC"}]}]},{"description":"Treat fracture radius & ulna","code_information":[{"code":"25565","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1536.96,"maximum":3837.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1536.96,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1567.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1552.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1583.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3837.78,"additional_payer_notes":"APC"}]}]},{"description":"Treat fracture radius/ulna","code_information":[{"code":"25605","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1536.96,"maximum":3837.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1536.96,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1567.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1552.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1583.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3837.78,"additional_payer_notes":"APC"}]}]},{"description":"Treat wrist bone fracture","code_information":[{"code":"25624","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1536.96,"maximum":3837.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1536.96,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1567.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1552.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1583.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3837.78,"additional_payer_notes":"APC"}]}]},{"description":"Treat wrist bone fracture","code_information":[{"code":"25635","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1536.96,"maximum":3837.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1536.96,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1567.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1552.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1583.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3837.78,"additional_payer_notes":"APC"}]}]},{"description":"Treat wrist dislocation","code_information":[{"code":"25690","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1536.96,"maximum":3837.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1536.96,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1567.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1552.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1583.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3837.78,"additional_payer_notes":"APC"}]}]},{"description":"Amputate hand at wrist","code_information":[{"code":"25922","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1536.96,"maximum":3837.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1536.96,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1567.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1552.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1583.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3837.78,"additional_payer_notes":"APC"}]}]},{"description":"Treat hand bone lesion","code_information":[{"code":"26034","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1536.96,"maximum":3837.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1536.96,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1567.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1552.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1583.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3837.78,"additional_payer_notes":"APC"}]}]},{"description":"Release palm contracture","code_information":[{"code":"26040","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1536.96,"maximum":3837.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1536.96,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1567.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1552.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1583.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3837.78,"additional_payer_notes":"APC"}]}]},{"description":"Incise finger tendon sheath","code_information":[{"code":"26055","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1536.96,"maximum":3837.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1536.96,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1567.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1552.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1583.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3837.78,"additional_payer_notes":"APC"}]}]},{"description":"Incision of finger tendon","code_information":[{"code":"26060","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1536.96,"maximum":3837.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1536.96,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1567.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1552.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1583.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3837.78,"additional_payer_notes":"APC"}]}]},{"description":"Explore/treat hand joint","code_information":[{"code":"26070","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1536.96,"maximum":3837.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1536.96,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1567.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1552.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1583.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3837.78,"additional_payer_notes":"APC"}]}]},{"description":"Explore/treat finger joint","code_information":[{"code":"26080","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1536.96,"maximum":3837.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1536.96,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1567.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1552.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1583.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3837.78,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy finger joint lining","code_information":[{"code":"26110","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1536.96,"maximum":3837.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1536.96,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1567.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1552.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1583.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3837.78,"additional_payer_notes":"APC"}]}]},{"description":"Revise finger joint each","code_information":[{"code":"26140","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1536.96,"maximum":3837.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1536.96,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1567.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1552.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1583.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3837.78,"additional_payer_notes":"APC"}]}]},{"description":"Tendon excision palm/finger","code_information":[{"code":"26145","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1536.96,"maximum":3837.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1536.96,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1567.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1552.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1583.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3837.78,"additional_payer_notes":"APC"}]}]},{"description":"Remove tendon sheath lesion","code_information":[{"code":"26160","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1536.96,"maximum":3837.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1536.96,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1567.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1552.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1583.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3837.78,"additional_payer_notes":"APC"}]}]},{"description":"Removal of palm tendon each","code_information":[{"code":"26170","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1536.96,"maximum":3837.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1536.96,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1567.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1552.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1583.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3837.78,"additional_payer_notes":"APC"}]}]},{"description":"Removal of finger tendon","code_information":[{"code":"26180","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1536.96,"maximum":3837.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1536.96,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1567.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1552.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1583.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3837.78,"additional_payer_notes":"APC"}]}]},{"description":"Remove finger bone","code_information":[{"code":"26185","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1536.96,"maximum":3837.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1536.96,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1567.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1552.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1583.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3837.78,"additional_payer_notes":"APC"}]}]},{"description":"Remove hand bone lesion","code_information":[{"code":"26200","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1536.96,"maximum":3837.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1536.96,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1567.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1552.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1583.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3837.78,"additional_payer_notes":"APC"}]}]},{"description":"Removal of finger lesion","code_information":[{"code":"26210","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1536.96,"maximum":3837.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1536.96,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1567.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1552.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1583.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3837.78,"additional_payer_notes":"APC"}]}]},{"description":"Partial removal finger bone","code_information":[{"code":"26235","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1536.96,"maximum":3837.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1536.96,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1567.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1552.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1583.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3837.78,"additional_payer_notes":"APC"}]}]},{"description":"Partial removal finger bone","code_information":[{"code":"26236","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1536.96,"maximum":3837.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1536.96,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1567.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1552.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1583.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3837.78,"additional_payer_notes":"APC"}]}]},{"description":"Resect distal finger tumor","code_information":[{"code":"26262","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1536.96,"maximum":3837.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1536.96,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1567.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1552.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1583.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3837.78,"additional_payer_notes":"APC"}]}]},{"description":"Manipulate finger w/anesth","code_information":[{"code":"26340","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1536.96,"maximum":3837.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1536.96,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1567.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1552.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1583.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3837.78,"additional_payer_notes":"APC"}]}]},{"description":"Repair hand tendon","code_information":[{"code":"26410","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1536.96,"maximum":3837.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1536.96,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1567.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1552.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1583.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3837.78,"additional_payer_notes":"APC"}]}]},{"description":"Repair finger tendon","code_information":[{"code":"26418","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1536.96,"maximum":3837.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1536.96,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1567.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1552.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1583.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3837.78,"additional_payer_notes":"APC"}]}]},{"description":"Repair finger tendon","code_information":[{"code":"26432","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1536.96,"maximum":3837.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1536.96,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1567.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1552.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1583.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3837.78,"additional_payer_notes":"APC"}]}]},{"description":"Release palm/finger tendon","code_information":[{"code":"26440","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1536.96,"maximum":3837.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1536.96,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1567.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1552.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1583.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3837.78,"additional_payer_notes":"APC"}]}]},{"description":"Incision of finger tendon","code_information":[{"code":"26455","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1536.96,"maximum":3837.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1536.96,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1567.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1552.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1583.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3837.78,"additional_payer_notes":"APC"}]}]},{"description":"Incise hand/finger tendon","code_information":[{"code":"26460","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1536.96,"maximum":3837.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1536.96,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1567.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1552.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1583.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3837.78,"additional_payer_notes":"APC"}]}]},{"description":"Fusion of finger tendons","code_information":[{"code":"26474","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1536.96,"maximum":3837.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1536.96,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1567.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1552.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1583.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3837.78,"additional_payer_notes":"APC"}]}]},{"description":"Release finger contracture","code_information":[{"code":"26525","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1536.96,"maximum":3837.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1536.96,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1567.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1552.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1583.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3837.78,"additional_payer_notes":"APC"}]}]},{"description":"Repair of web finger","code_information":[{"code":"26560","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1536.96,"maximum":3837.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1536.96,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1567.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1552.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1583.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3837.78,"additional_payer_notes":"APC"}]}]},{"description":"Repair finger deformity","code_information":[{"code":"26590","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1536.96,"maximum":3837.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1536.96,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1567.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1552.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1583.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3837.78,"additional_payer_notes":"APC"}]}]},{"description":"Treat thumb fracture","code_information":[{"code":"26645","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1536.96,"maximum":3837.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1536.96,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1567.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1552.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1583.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3837.78,"additional_payer_notes":"APC"}]}]},{"description":"Treat hand dislocation","code_information":[{"code":"26675","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1536.96,"maximum":3837.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1536.96,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1567.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1552.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1583.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3837.78,"additional_payer_notes":"APC"}]}]},{"description":"Treat knuckle dislocation","code_information":[{"code":"26705","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1536.96,"maximum":3837.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1536.96,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1567.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1552.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1583.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3837.78,"additional_payer_notes":"APC"}]}]},{"description":"Treat finger fracture each","code_information":[{"code":"26742","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1536.96,"maximum":3837.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1536.96,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1567.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1552.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1583.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3837.78,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of pelvis bursa","code_information":[{"code":"26991","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1536.96,"maximum":3837.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1536.96,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1567.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1552.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1583.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3837.78,"additional_payer_notes":"APC"}]}]},{"description":"Incision of hip tendon","code_information":[{"code":"27000","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1536.96,"maximum":3837.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1536.96,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1567.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1552.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1583.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3837.78,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy of sacroiliac joint","code_information":[{"code":"27050","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1536.96,"maximum":3837.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1536.96,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1567.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1552.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1583.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3837.78,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy of hip joint","code_information":[{"code":"27052","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1536.96,"maximum":3837.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1536.96,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1567.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1552.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1583.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3837.78,"additional_payer_notes":"APC"}]}]},{"description":"Buttock fasciotomy w/dbrdmt","code_information":[{"code":"27057","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1536.96,"maximum":3837.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1536.96,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1567.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1552.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1583.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3837.78,"additional_payer_notes":"APC"}]}]},{"description":"Treat thigh fracture","code_information":[{"code":"27232","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1536.96,"maximum":3837.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1536.96,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1567.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1552.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1583.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3837.78,"additional_payer_notes":"APC"}]}]},{"description":"Treat thigh fracture","code_information":[{"code":"27238","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1536.96,"maximum":3837.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1536.96,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1567.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1552.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1583.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3837.78,"additional_payer_notes":"APC"}]}]},{"description":"Treat thigh fracture","code_information":[{"code":"27240","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1536.96,"maximum":3837.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1536.96,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1567.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1552.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1583.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3837.78,"additional_payer_notes":"APC"}]}]},{"description":"Treat hip dislocation","code_information":[{"code":"27252","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1536.96,"maximum":3837.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1536.96,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1567.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1552.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1583.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3837.78,"additional_payer_notes":"APC"}]}]},{"description":"Treat hip dislocation","code_information":[{"code":"27257","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1536.96,"maximum":3837.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1536.96,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1567.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1552.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1583.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3837.78,"additional_payer_notes":"APC"}]}]},{"description":"Treat hip dislocation","code_information":[{"code":"27266","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1536.96,"maximum":3837.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1536.96,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1567.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1552.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1583.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3837.78,"additional_payer_notes":"APC"}]}]},{"description":"Cltx thigh fx w/mnpj","code_information":[{"code":"27268","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1536.96,"maximum":3837.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1536.96,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1567.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1552.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1583.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3837.78,"additional_payer_notes":"APC"}]}]},{"description":"Manipulation of hip joint","code_information":[{"code":"27275","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1536.96,"maximum":3837.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1536.96,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1567.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1552.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1583.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3837.78,"additional_payer_notes":"APC"}]}]},{"description":"Decompression of thigh/knee","code_information":[{"code":"27498","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1536.96,"maximum":3837.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1536.96,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1567.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1552.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1583.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3837.78,"additional_payer_notes":"APC"}]}]},{"description":"Treatment of thigh fracture","code_information":[{"code":"27502","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1536.96,"maximum":3837.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1536.96,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1567.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1552.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1583.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3837.78,"additional_payer_notes":"APC"}]}]},{"description":"Treatment of thigh fracture","code_information":[{"code":"27503","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1536.96,"maximum":3837.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1536.96,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1567.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1552.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1583.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3837.78,"additional_payer_notes":"APC"}]}]},{"description":"Treatment of thigh fracture","code_information":[{"code":"27510","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1536.96,"maximum":3837.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1536.96,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1567.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1552.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1583.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3837.78,"additional_payer_notes":"APC"}]}]},{"description":"Treat thigh fx growth plate","code_information":[{"code":"27517","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1536.96,"maximum":3837.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1536.96,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1567.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1552.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1583.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3837.78,"additional_payer_notes":"APC"}]}]},{"description":"Treat knee dislocation","code_information":[{"code":"27552","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1536.96,"maximum":3837.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1536.96,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1567.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1552.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1583.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3837.78,"additional_payer_notes":"APC"}]}]},{"description":"Fixation of knee joint","code_information":[{"code":"27570","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1536.96,"maximum":3837.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1536.96,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1567.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1552.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1583.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3837.78,"additional_payer_notes":"APC"}]}]},{"description":"Incision of achilles tendon","code_information":[{"code":"27605","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1536.96,"maximum":3837.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1536.96,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1567.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1552.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1583.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3837.78,"additional_payer_notes":"APC"}]}]},{"description":"Treatment of tibia fracture","code_information":[{"code":"27752","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1536.96,"maximum":3837.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1536.96,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1567.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1552.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1583.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3837.78,"additional_payer_notes":"APC"}]}]},{"description":"Cltx med ankle fx w/mnpj","code_information":[{"code":"27762","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1536.96,"maximum":3837.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1536.96,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1567.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1552.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1583.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3837.78,"additional_payer_notes":"APC"}]}]},{"description":"Cltx post ankle fx w/mnpj","code_information":[{"code":"27768","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1536.96,"maximum":3837.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1536.96,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1567.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1552.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1583.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3837.78,"additional_payer_notes":"APC"}]}]},{"description":"Treatment of fibula fracture","code_information":[{"code":"27781","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1536.96,"maximum":3837.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1536.96,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1567.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1552.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1583.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3837.78,"additional_payer_notes":"APC"}]}]},{"description":"Treatment of ankle fracture","code_information":[{"code":"27810","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1536.96,"maximum":3837.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1536.96,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1567.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1552.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1583.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3837.78,"additional_payer_notes":"APC"}]}]},{"description":"Treatment of ankle fracture","code_information":[{"code":"27818","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1536.96,"maximum":3837.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1536.96,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1567.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1552.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1583.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3837.78,"additional_payer_notes":"APC"}]}]},{"description":"Treat lower leg fracture","code_information":[{"code":"27825","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1536.96,"maximum":3837.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1536.96,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1567.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1552.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1583.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3837.78,"additional_payer_notes":"APC"}]}]},{"description":"Treat ankle dislocation","code_information":[{"code":"27842","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1536.96,"maximum":3837.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1536.96,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1567.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1552.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1583.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3837.78,"additional_payer_notes":"APC"}]}]},{"description":"Treatment of foot infection","code_information":[{"code":"28002","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1536.96,"maximum":3837.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1536.96,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1567.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1552.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1583.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3837.78,"additional_payer_notes":"APC"}]}]},{"description":"Incision of toe tendon","code_information":[{"code":"28010","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1536.96,"maximum":3837.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1536.96,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1567.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1552.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1583.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3837.78,"additional_payer_notes":"APC"}]}]},{"description":"Incision of toe tendons","code_information":[{"code":"28011","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1536.96,"maximum":3837.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1536.96,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1567.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1552.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1583.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3837.78,"additional_payer_notes":"APC"}]}]},{"description":"Exploration of toe joint","code_information":[{"code":"28024","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1536.96,"maximum":3837.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1536.96,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1567.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1552.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1583.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3837.78,"additional_payer_notes":"APC"}]}]},{"description":"Removal of foot lesion","code_information":[{"code":"28080","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1536.96,"maximum":3837.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1536.96,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1567.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1552.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1583.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3837.78,"additional_payer_notes":"APC"}]}]},{"description":"Removal of foot lesion","code_information":[{"code":"28090","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1536.96,"maximum":3837.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1536.96,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1567.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1552.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1583.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3837.78,"additional_payer_notes":"APC"}]}]},{"description":"Removal of toe lesions","code_information":[{"code":"28092","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1536.96,"maximum":3837.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1536.96,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1567.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1552.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1583.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3837.78,"additional_payer_notes":"APC"}]}]},{"description":"Removal of toe lesions","code_information":[{"code":"28108","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1536.96,"maximum":3837.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1536.96,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1567.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1552.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1583.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3837.78,"additional_payer_notes":"APC"}]}]},{"description":"Resect phalanx of toe tumor","code_information":[{"code":"28175","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1536.96,"maximum":3837.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1536.96,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1567.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1552.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1583.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3837.78,"additional_payer_notes":"APC"}]}]},{"description":"Release of foot tendon","code_information":[{"code":"28220","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1536.96,"maximum":3837.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1536.96,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1567.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1552.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1583.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3837.78,"additional_payer_notes":"APC"}]}]},{"description":"Incision of foot tendon(s)","code_information":[{"code":"28230","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1536.96,"maximum":3837.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1536.96,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1567.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1552.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1583.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3837.78,"additional_payer_notes":"APC"}]}]},{"description":"Incision of toe tendon","code_information":[{"code":"28232","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1536.96,"maximum":3837.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1536.96,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1567.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1552.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1583.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3837.78,"additional_payer_notes":"APC"}]}]},{"description":"Incision of foot tendon","code_information":[{"code":"28234","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1536.96,"maximum":3837.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1536.96,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1567.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1552.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1583.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3837.78,"additional_payer_notes":"APC"}]}]},{"description":"Revision of foot tendon","code_information":[{"code":"28261","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1536.96,"maximum":3837.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1536.96,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1567.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1552.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1583.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3837.78,"additional_payer_notes":"APC"}]}]},{"description":"Release of midfoot joint","code_information":[{"code":"28264","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1536.96,"maximum":3837.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1536.96,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1567.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1552.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1583.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3837.78,"additional_payer_notes":"APC"}]}]},{"description":"Release of toe joint each","code_information":[{"code":"28272","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1536.96,"maximum":3837.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1536.96,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1567.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1552.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1583.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3837.78,"additional_payer_notes":"APC"}]}]},{"description":"Repair webbed toe(s)","code_information":[{"code":"28345","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1536.96,"maximum":3837.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1536.96,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1567.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1552.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1583.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3837.78,"additional_payer_notes":"APC"}]}]},{"description":"Treatment of ankle fracture","code_information":[{"code":"28435","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1536.96,"maximum":3837.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1536.96,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1567.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1552.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1583.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3837.78,"additional_payer_notes":"APC"}]}]},{"description":"Treat midfoot fracture each","code_information":[{"code":"28455","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1536.96,"maximum":3837.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1536.96,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1567.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1552.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1583.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3837.78,"additional_payer_notes":"APC"}]}]},{"description":"Treat foot dislocation","code_information":[{"code":"28546","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1536.96,"maximum":3837.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1536.96,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1567.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1552.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1583.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3837.78,"additional_payer_notes":"APC"}]}]},{"description":"Treat toe dislocation","code_information":[{"code":"28635","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1536.96,"maximum":3837.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1536.96,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1567.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1552.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1583.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3837.78,"additional_payer_notes":"APC"}]}]},{"description":"Hi enrgy eswt plantar fascia","code_information":[{"code":"28890","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1536.96,"maximum":3837.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1536.96,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1567.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1552.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1583.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3837.78,"additional_payer_notes":"APC"}]}]},{"description":"Wrist endoscopy/surgery","code_information":[{"code":"29848","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1536.96,"maximum":3837.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1536.96,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1567.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1552.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1583.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3837.78,"additional_payer_notes":"APC"}]}]},{"description":"Knee arthroscopy/surgery","code_information":[{"code":"29850","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1536.96,"maximum":3837.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1536.96,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1567.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1552.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1583.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3837.78,"additional_payer_notes":"APC"}]}]},{"description":"Knee arthroscopy/surgery","code_information":[{"code":"29851","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1536.96,"maximum":3837.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1536.96,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1567.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1552.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1583.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3837.78,"additional_payer_notes":"APC"}]}]},{"description":"Mcp joint arthroscopy surg","code_information":[{"code":"29902","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1536.96,"maximum":3837.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1536.96,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1567.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1552.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1583.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3837.78,"additional_payer_notes":"APC"}]}]},{"description":"Extracorp shockwv tx anesth","code_information":[{"code":"0102T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Rmvl sinus tarsi implant","code_information":[{"code":"0510T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Njx b1 sub mtrl sbchdrl dfct","code_information":[{"code":"0707T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Njx b1 sub mtrl hw fixj aug","code_information":[{"code":"0869T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Rmv s-sclp eltr ra rcvr&tlmt","code_information":[{"code":"0958T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Excise epiphyseal bar","code_information":[{"code":"20150","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Open bone biopsy","code_information":[{"code":"20250","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Place ndl musc/tis for rt","code_information":[{"code":"20555","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Insert and remove bone pin","code_information":[{"code":"20650","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Application of thigh brace","code_information":[{"code":"20663","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Open tx septal fx w/wo stabj","code_information":[{"code":"21336","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Drain chest lesion","code_information":[{"code":"21502","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of bone lesion","code_information":[{"code":"21510","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Partial removal of rib","code_information":[{"code":"21610","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Partial removal of sternum","code_information":[{"code":"21620","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Sternal debridement","code_information":[{"code":"21627","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Revision of neck muscle","code_information":[{"code":"21720","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Repair stern/nuss w/o scope","code_information":[{"code":"21742","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Repair sternum/nuss w/scope","code_information":[{"code":"21743","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Closed tx vert fx w/manj","code_information":[{"code":"22315","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Perq cervicothoracic inject","code_information":[{"code":"22510","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Perq lumbosacral injection","code_information":[{"code":"22511","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Release shoulder joint","code_information":[{"code":"23020","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Exploratory shoulder surgery","code_information":[{"code":"23040","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Exploratory shoulder surgery","code_information":[{"code":"23044","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy of shoulder joint","code_information":[{"code":"23100","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Shoulder joint surgery","code_information":[{"code":"23101","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Incision of collarbone joint","code_information":[{"code":"23106","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Partial removal collar bone","code_information":[{"code":"23120","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Removal of collar bone","code_information":[{"code":"23125","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Remove shoulder bone part","code_information":[{"code":"23130","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Removal of bone lesion","code_information":[{"code":"23140","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Removal of bone lesion","code_information":[{"code":"23145","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Removal of humerus lesion","code_information":[{"code":"23150","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Remove collar bone lesion","code_information":[{"code":"23170","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Remove shoulder blade lesion","code_information":[{"code":"23172","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Partial removal of scapula","code_information":[{"code":"23190","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Drain arm/elbow bone lesion","code_information":[{"code":"23935","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Exploratory elbow surgery","code_information":[{"code":"24000","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Release elbow joint","code_information":[{"code":"24006","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy elbow joint lining","code_information":[{"code":"24100","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Explore/treat elbow joint","code_information":[{"code":"24101","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Remove elbow joint lining","code_information":[{"code":"24102","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Removal of elbow bursa","code_information":[{"code":"24105","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Remove humerus lesion","code_information":[{"code":"24110","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Remove elbow lesion","code_information":[{"code":"24120","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Remove/graft bone lesion","code_information":[{"code":"24125","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Removal of head of radius","code_information":[{"code":"24130","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Remove radius bone lesion","code_information":[{"code":"24136","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Partial removal of arm bone","code_information":[{"code":"24140","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Partial removal of elbow","code_information":[{"code":"24147","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Removal of elbow joint","code_information":[{"code":"24155","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Remove elbow joint implant","code_information":[{"code":"24160","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Remove radius head implant","code_information":[{"code":"24164","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Arm tendon lengthening","code_information":[{"code":"24305","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Revision of arm tendon","code_information":[{"code":"24310","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Tenolysis triceps","code_information":[{"code":"24332","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Repr elbow lat ligmnt w/tiss","code_information":[{"code":"24343","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Repair elbow perc","code_information":[{"code":"24357","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Repair elbow w/deb open","code_information":[{"code":"24358","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Repair elbow deb/attch open","code_information":[{"code":"24359","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Revision of elbow joint","code_information":[{"code":"24470","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Amputation follow-up surgery","code_information":[{"code":"24925","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Incise flexor carpi radialis","code_information":[{"code":"25001","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Decompress forearm 1 space","code_information":[{"code":"25023","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Decompress forearm 2 spaces","code_information":[{"code":"25024","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of forearm lesion","code_information":[{"code":"25028","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Explore/treat wrist joint","code_information":[{"code":"25040","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Incision of wrist capsule","code_information":[{"code":"25085","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy of wrist joint","code_information":[{"code":"25100","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Explore/treat wrist joint","code_information":[{"code":"25101","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Remove wrist joint lining","code_information":[{"code":"25105","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Remove wrist joint cartilage","code_information":[{"code":"25107","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Excise tendon forearm/wrist","code_information":[{"code":"25109","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Remove wrist/forearm lesion","code_information":[{"code":"25116","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Partial removal of ulna","code_information":[{"code":"25119","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Removal of forearm lesion","code_information":[{"code":"25120","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Remove/graft forearm lesion","code_information":[{"code":"25126","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Removal of wrist lesion","code_information":[{"code":"25130","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Remove forearm bone lesion","code_information":[{"code":"25145","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Partial removal of ulna","code_information":[{"code":"25150","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Partial removal of radius","code_information":[{"code":"25151","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Removal of wrist bone","code_information":[{"code":"25210","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Removal of wrist bones","code_information":[{"code":"25215","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Partial removal of radius","code_information":[{"code":"25230","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Partial removal of ulna","code_information":[{"code":"25240","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Removal of wrist prosthesis","code_information":[{"code":"25251","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Repair forearm tendon/muscle","code_information":[{"code":"25260","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Repair forearm tendon/muscle","code_information":[{"code":"25265","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Repair forearm tendon/muscle","code_information":[{"code":"25270","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Repair forearm tendon/muscle","code_information":[{"code":"25272","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Repair forearm tendon/muscle","code_information":[{"code":"25274","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Repair forearm tendon sheath","code_information":[{"code":"25275","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Revise wrist/forearm tendon","code_information":[{"code":"25280","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Incise wrist/forearm tendon","code_information":[{"code":"25290","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Release wrist/forearm tendon","code_information":[{"code":"25295","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Fusion of tendons at wrist","code_information":[{"code":"25300","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Fusion of tendons at wrist","code_information":[{"code":"25301","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Transplant forearm tendon","code_information":[{"code":"25310","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Transplant forearm tendon","code_information":[{"code":"25312","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Revise wrist joint","code_information":[{"code":"25332","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Realignment of hand","code_information":[{"code":"25335","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Revision of radius","code_information":[{"code":"25355","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Revise radius or ulna","code_information":[{"code":"25370","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Revise radius & ulna","code_information":[{"code":"25375","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Repair carpal bone shorten","code_information":[{"code":"25394","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Repair/graft radius & ulna","code_information":[{"code":"25426","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Vasc graft into carpal bone","code_information":[{"code":"25430","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Repair wrist joints","code_information":[{"code":"25447","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Arthrp ntrcrpl/crp/mtcrp ssp","code_information":[{"code":"25448","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Revision of wrist joint","code_information":[{"code":"25450","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Revision of wrist joint","code_information":[{"code":"25455","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Reinforce radius and ulna","code_information":[{"code":"25492","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Treat Fx Distal Radial","code_information":[{"code":"25606","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Treat wrist bone fracture","code_information":[{"code":"25645","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Pin ulnar styloid fracture","code_information":[{"code":"25651","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Pin radioulnar dislocation","code_information":[{"code":"25671","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Amputation follow-up surgery","code_information":[{"code":"25907","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Amputate hand at wrist","code_information":[{"code":"25920","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Amputation follow-up surgery","code_information":[{"code":"25924","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Amputation of hand","code_information":[{"code":"25927","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Amputation follow-up surgery","code_information":[{"code":"25931","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Drain hand tendon sheath","code_information":[{"code":"26020","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of palm bursa","code_information":[{"code":"26025","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of palm bursas","code_information":[{"code":"26030","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Decompress fingers/hand","code_information":[{"code":"26035","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Decompress fingers/hand","code_information":[{"code":"26037","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Release palm contracture","code_information":[{"code":"26045","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Explore/treat finger joint","code_information":[{"code":"26075","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy hand joint lining","code_information":[{"code":"26100","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy finger joint lining","code_information":[{"code":"26105","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Release palm contracture","code_information":[{"code":"26121","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Release palm contracture","code_information":[{"code":"26123","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Remove wrist joint lining","code_information":[{"code":"26130","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Revise finger joint each","code_information":[{"code":"26135","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Remove/graft finger lesion","code_information":[{"code":"26215","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Partial removal of hand bone","code_information":[{"code":"26230","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Extensive hand surgery","code_information":[{"code":"26250","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Resect prox finger tumor","code_information":[{"code":"26260","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Repair finger/hand tendon","code_information":[{"code":"26350","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Repair finger/hand tendon","code_information":[{"code":"26356","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Repair finger/hand tendon","code_information":[{"code":"26357","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Repair finger/hand tendon","code_information":[{"code":"26370","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Repair finger/hand tendon","code_information":[{"code":"26373","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Repair/graft hand tendon","code_information":[{"code":"26412","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Excision hand/finger tendon","code_information":[{"code":"26415","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Graft hand or finger tendon","code_information":[{"code":"26416","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Repair/graft finger tendon","code_information":[{"code":"26420","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Repair finger/hand tendon","code_information":[{"code":"26426","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Repair/graft finger tendon","code_information":[{"code":"26428","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Repair finger tendon","code_information":[{"code":"26433","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Repair/graft finger tendon","code_information":[{"code":"26434","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Realignment of tendons","code_information":[{"code":"26437","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Release palm & finger tendon","code_information":[{"code":"26442","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Release hand/finger tendon","code_information":[{"code":"26445","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Release forearm/hand tendon","code_information":[{"code":"26449","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Incision of palm tendon","code_information":[{"code":"26450","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Fusion of finger tendons","code_information":[{"code":"26471","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Tendon lengthening","code_information":[{"code":"26476","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Tendon shortening","code_information":[{"code":"26477","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Lengthening of hand tendon","code_information":[{"code":"26478","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Shortening of hand tendon","code_information":[{"code":"26479","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Transplant hand tendon","code_information":[{"code":"26480","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Transplant/graft hand tendon","code_information":[{"code":"26483","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Transplant palm tendon","code_information":[{"code":"26485","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Transplant/graft palm tendon","code_information":[{"code":"26489","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Revise thumb tendon","code_information":[{"code":"26490","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Tendon transfer with graft","code_information":[{"code":"26492","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Hand tendon/muscle transfer","code_information":[{"code":"26494","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Revise thumb tendon","code_information":[{"code":"26496","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Finger tendon transfer","code_information":[{"code":"26497","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Finger tendon transfer","code_information":[{"code":"26498","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Revision of finger","code_information":[{"code":"26499","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Hand tendon reconstruction","code_information":[{"code":"26502","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Release thumb contracture","code_information":[{"code":"26508","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Thumb tendon transfer","code_information":[{"code":"26510","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Fusion of knuckle joint","code_information":[{"code":"26516","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Fusion of knuckle joints","code_information":[{"code":"26517","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Release knuckle contracture","code_information":[{"code":"26520","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Revise finger joint","code_information":[{"code":"26535","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Repair hand joint","code_information":[{"code":"26540","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Repair hand joint with graft","code_information":[{"code":"26541","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Repair hand joint with graft","code_information":[{"code":"26542","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruct finger joint","code_information":[{"code":"26545","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruct finger joint","code_information":[{"code":"26548","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Construct thumb replacement","code_information":[{"code":"26550","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Repair of web finger","code_information":[{"code":"26561","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Repair of web finger","code_information":[{"code":"26562","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Correct metacarpal flaw","code_information":[{"code":"26565","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Correct finger deformity","code_information":[{"code":"26567","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Repair hand deformity","code_information":[{"code":"26580","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruct extra finger","code_information":[{"code":"26587","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Repair muscles of hand","code_information":[{"code":"26591","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Release muscles of hand","code_information":[{"code":"26593","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Excision constricting tissue","code_information":[{"code":"26596","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Treat metacarpal fracture","code_information":[{"code":"26607","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Treat metacarpal fracture","code_information":[{"code":"26608","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Treat metacarpal fracture","code_information":[{"code":"26615","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Treat thumb fracture","code_information":[{"code":"26650","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Treat thumb fracture","code_information":[{"code":"26665","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Pin hand dislocation","code_information":[{"code":"26676","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Treat hand dislocation","code_information":[{"code":"26685","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Treat hand dislocation","code_information":[{"code":"26686","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Pin knuckle dislocation","code_information":[{"code":"26706","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Treat knuckle dislocation","code_information":[{"code":"26715","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Treat finger fracture each","code_information":[{"code":"26727","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Treat finger fracture each","code_information":[{"code":"26735","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Treat finger fracture each","code_information":[{"code":"26746","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Pin finger fracture each","code_information":[{"code":"26756","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Treat finger fracture each","code_information":[{"code":"26765","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Pin finger dislocation","code_information":[{"code":"26776","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Treat finger dislocation","code_information":[{"code":"26785","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Fusion of finger joint","code_information":[{"code":"26860","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Fusion/graft of finger joint","code_information":[{"code":"26862","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Amputate metacarpal bone","code_information":[{"code":"26910","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Amputation of finger/thumb","code_information":[{"code":"26951","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Amputation of finger/thumb","code_information":[{"code":"26952","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of pelvis lesion","code_information":[{"code":"26990","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of bone lesion","code_information":[{"code":"26992","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Incision of hip tendon","code_information":[{"code":"27001","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Incision of hip tendon","code_information":[{"code":"27005","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Incision of hip tendons","code_information":[{"code":"27006","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Incision of hip/thigh fascia","code_information":[{"code":"27025","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Denervation of hip joint","code_information":[{"code":"27035","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Removal of hip joint lining","code_information":[{"code":"27054","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Remove femur lesion/bursa","code_information":[{"code":"27062","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Remove hip bone les deep","code_information":[{"code":"27066","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Part remove hip bone super","code_information":[{"code":"27070","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Part removal hip bone deep","code_information":[{"code":"27071","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Removal of tail bone","code_information":[{"code":"27080","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Remove hip foreign body","code_information":[{"code":"27087","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Revision of hip tendon","code_information":[{"code":"27097","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Transfer tendon to pelvis","code_information":[{"code":"27098","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Transfer of spinal muscle","code_information":[{"code":"27105","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Transfer of iliopsoas muscle","code_information":[{"code":"27111","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Treat slipped epiphysis","code_information":[{"code":"27175","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Treat slipped epiphysis","code_information":[{"code":"27176","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Treat slipped epiphysis","code_information":[{"code":"27177","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Treat slipped epiphysis","code_information":[{"code":"27178","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Revision of femur epiphysis","code_information":[{"code":"27185","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Treat tail bone fracture","code_information":[{"code":"27202","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Treat hip dislocation","code_information":[{"code":"27253","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Treat hip dislocation","code_information":[{"code":"27258","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Treat hip dislocation","code_information":[{"code":"27259","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Cltx thigh fx","code_information":[{"code":"27267","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Fusion of pubic bones","code_information":[{"code":"27282","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of bone lesion","code_information":[{"code":"27303","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Incise thigh tendon & fascia","code_information":[{"code":"27305","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Incision of thigh tendon","code_information":[{"code":"27306","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Incision of thigh tendons","code_information":[{"code":"27307","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Exploration of knee joint","code_information":[{"code":"27310","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy knee joint lining","code_information":[{"code":"27330","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Explore/treat knee joint","code_information":[{"code":"27331","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Removal of knee cartilage","code_information":[{"code":"27332","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Removal of knee cartilage","code_information":[{"code":"27333","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Remove knee joint lining","code_information":[{"code":"27334","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Removal of kneecap bursa","code_information":[{"code":"27340","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Removal of knee cyst","code_information":[{"code":"27345","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Remove knee cyst","code_information":[{"code":"27347","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Remove femur lesion","code_information":[{"code":"27355","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Partial removal leg bone(s)","code_information":[{"code":"27360","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Resect femur/knee tumor","code_information":[{"code":"27365","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Incision of thigh tendon","code_information":[{"code":"27390","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Incision of thigh tendons","code_information":[{"code":"27391","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Incision of thigh tendons","code_information":[{"code":"27392","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Lengthening of thigh tendons","code_information":[{"code":"27395","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Lat retinacular release open","code_information":[{"code":"27425","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Incision of knee joint","code_information":[{"code":"27435","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Decompression of thigh/knee","code_information":[{"code":"27496","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Decompression of thigh/knee","code_information":[{"code":"27497","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Treat knee fracture","code_information":[{"code":"27532","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Amputate leg at thigh","code_information":[{"code":"27590","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Amputate leg at thigh","code_information":[{"code":"27591","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Amputate leg at thigh","code_information":[{"code":"27592","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Amputation follow-up surgery","code_information":[{"code":"27594","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Amputation follow-up surgery","code_information":[{"code":"27596","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Amputate lower leg at knee","code_information":[{"code":"27598","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Decompression of lower leg","code_information":[{"code":"27600","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Decompression of lower leg","code_information":[{"code":"27601","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Decompression of lower leg","code_information":[{"code":"27602","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Drain lower leg bursa","code_information":[{"code":"27604","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Incision of achilles tendon","code_information":[{"code":"27606","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Treat lower leg bone lesion","code_information":[{"code":"27607","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Explore/treat ankle joint","code_information":[{"code":"27610","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Exploration of ankle joint","code_information":[{"code":"27612","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Explore/treat ankle joint","code_information":[{"code":"27620","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Remove ankle joint lining","code_information":[{"code":"27625","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Remove ankle joint lining","code_information":[{"code":"27626","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Removal of tendon lesion","code_information":[{"code":"27630","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Remove lower leg bone lesion","code_information":[{"code":"27635","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Partial removal of tibia","code_information":[{"code":"27640","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Partial removal of fibula","code_information":[{"code":"27641","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Resect tibia tumor","code_information":[{"code":"27645","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Resect fibula tumor","code_information":[{"code":"27646","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Resect talus/calcaneus tum","code_information":[{"code":"27647","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Repair leg fascia defect","code_information":[{"code":"27656","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Repair of leg tendon each","code_information":[{"code":"27658","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Repair lower leg tendons","code_information":[{"code":"27675","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Release of lower leg tendon","code_information":[{"code":"27680","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Release of lower leg tendons","code_information":[{"code":"27681","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Revision of lower leg tendon","code_information":[{"code":"27685","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Revise lower leg tendons","code_information":[{"code":"27686","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Revision of calf tendon","code_information":[{"code":"27687","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Removal of ankle implant","code_information":[{"code":"27704","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Incision of fibula","code_information":[{"code":"27707","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Repair of lower leg","code_information":[{"code":"27727","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Repair of tibia epiphysis","code_information":[{"code":"27730","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Repair of fibula epiphysis","code_information":[{"code":"27732","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Repair lower leg epiphyses","code_information":[{"code":"27734","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Repair of leg epiphyses","code_information":[{"code":"27740","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Repair of leg epiphyses","code_information":[{"code":"27742","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Treat lower leg dislocation","code_information":[{"code":"27831","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Fixation of ankle joint","code_information":[{"code":"27860","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Amputation of lower leg","code_information":[{"code":"27881","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Amputation of lower leg","code_information":[{"code":"27882","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Amputation follow-up surgery","code_information":[{"code":"27884","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Amputation follow-up surgery","code_information":[{"code":"27886","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Amputation of foot at ankle","code_information":[{"code":"27888","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Decompression of leg","code_information":[{"code":"27892","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Decompression of leg","code_information":[{"code":"27894","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Treatment of foot infection","code_information":[{"code":"28003","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Treat foot bone lesion","code_information":[{"code":"28005","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Incision of foot fascia","code_information":[{"code":"28008","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Exploration of foot joint","code_information":[{"code":"28020","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Exploration of foot joint","code_information":[{"code":"28022","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy of foot joint lining","code_information":[{"code":"28050","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy of foot joint lining","code_information":[{"code":"28052","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy of toe joint lining","code_information":[{"code":"28054","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Partial removal foot fascia","code_information":[{"code":"28060","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Removal of foot fascia","code_information":[{"code":"28062","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Removal of foot joint lining","code_information":[{"code":"28072","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Excise foot tendon sheath","code_information":[{"code":"28086","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Excise foot tendon sheath","code_information":[{"code":"28088","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Removal of ankle/heel lesion","code_information":[{"code":"28100","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Removal of foot lesion","code_information":[{"code":"28104","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Part removal of metatarsal","code_information":[{"code":"28110","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Part removal of metatarsal","code_information":[{"code":"28111","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Part removal of metatarsal","code_information":[{"code":"28112","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Part removal of metatarsal","code_information":[{"code":"28113","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Removal of metatarsal heads","code_information":[{"code":"28114","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Revision of foot","code_information":[{"code":"28116","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Removal of heel bone","code_information":[{"code":"28118","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Removal of heel spur","code_information":[{"code":"28119","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Part removal of ankle/heel","code_information":[{"code":"28120","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Partial removal of foot bone","code_information":[{"code":"28122","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Partial removal of toe","code_information":[{"code":"28124","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Partial removal of toe","code_information":[{"code":"28126","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Removal of metatarsal","code_information":[{"code":"28140","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Removal of toe","code_information":[{"code":"28150","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Partial removal of toe","code_information":[{"code":"28153","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Partial removal of toe","code_information":[{"code":"28160","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Resect tarsal tumor","code_information":[{"code":"28171","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Resect metatarsal tumor","code_information":[{"code":"28173","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Repair of foot tendon","code_information":[{"code":"28200","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Repair of foot tendon","code_information":[{"code":"28208","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Release of foot tendons","code_information":[{"code":"28222","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Release of foot tendon","code_information":[{"code":"28225","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Release of foot tendons","code_information":[{"code":"28226","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Release of big toe","code_information":[{"code":"28240","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Revision of foot fascia","code_information":[{"code":"28250","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Release of midfoot joint","code_information":[{"code":"28260","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Release of foot contracture","code_information":[{"code":"28270","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Fusion of toes","code_information":[{"code":"28280","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Repair of hammertoe","code_information":[{"code":"28285","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Repair of hammertoe","code_information":[{"code":"28286","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Partial removal of foot bone","code_information":[{"code":"28288","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Corrj halux rigdus w/o implt","code_information":[{"code":"28289","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Correction hallux valgus","code_information":[{"code":"28292","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Correction hallux valgus","code_information":[{"code":"28295","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Correction hallux valgus","code_information":[{"code":"28296","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Incision of metatarsal","code_information":[{"code":"28308","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Revision of toe","code_information":[{"code":"28312","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Repair deformity of toe","code_information":[{"code":"28313","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Removal of sesamoid bone","code_information":[{"code":"28315","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Resect enlarged toe tissue","code_information":[{"code":"28340","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Resect enlarged toe","code_information":[{"code":"28341","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Repair extra toe(s)","code_information":[{"code":"28344","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Treat metatarsal fracture","code_information":[{"code":"28476","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Treat big toe fracture","code_information":[{"code":"28496","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Treat big toe fracture","code_information":[{"code":"28505","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Treat toe fracture","code_information":[{"code":"28525","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Treat foot dislocation","code_information":[{"code":"28545","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Treat foot dislocation","code_information":[{"code":"28575","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Treat foot dislocation","code_information":[{"code":"28606","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Treat toe dislocation","code_information":[{"code":"28636","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Repair toe dislocation","code_information":[{"code":"28645","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Treat toe dislocation","code_information":[{"code":"28666","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Repair of toe dislocation","code_information":[{"code":"28675","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Amputation of midfoot","code_information":[{"code":"28800","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Amputation thru metatarsal","code_information":[{"code":"28805","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Amputation toe & metatarsal","code_information":[{"code":"28810","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Amputation of toe","code_information":[{"code":"28820","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Partial amputation of toe","code_information":[{"code":"28825","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Jaw arthroscopy/surgery","code_information":[{"code":"29800","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Jaw arthroscopy/surgery","code_information":[{"code":"29804","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Shoulder arthroscopy dx","code_information":[{"code":"29805","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Shoulder arthroscopy/surgery","code_information":[{"code":"29819","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Shoulder arthroscopy/surgery","code_information":[{"code":"29821","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Shoulder arthroscopy/surgery","code_information":[{"code":"29822","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Shoulder arthroscopy/surgery","code_information":[{"code":"29823","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Shoulder arthroscopy/surgery","code_information":[{"code":"29824","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Shoulder arthroscopy/surgery","code_information":[{"code":"29825","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Elbow arthroscopy","code_information":[{"code":"29830","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Elbow arthroscopy/surgery","code_information":[{"code":"29834","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Elbow arthroscopy/surgery","code_information":[{"code":"29835","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Elbow arthroscopy/surgery","code_information":[{"code":"29837","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Elbow arthroscopy/surgery","code_information":[{"code":"29838","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Wrist arthroscopy","code_information":[{"code":"29840","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Wrist arthroscopy/surgery","code_information":[{"code":"29843","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Wrist arthroscopy/surgery","code_information":[{"code":"29844","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Wrist arthroscopy/surgery","code_information":[{"code":"29845","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Wrist arthroscopy/surgery","code_information":[{"code":"29846","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Hip arthr0 w/synovectomy","code_information":[{"code":"29863","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Knee arthroscopy dx","code_information":[{"code":"29870","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Knee arthroscopy/drainage","code_information":[{"code":"29871","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Knee arthroscopy/surgery","code_information":[{"code":"29873","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Knee arthroscopy/surgery","code_information":[{"code":"29874","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Knee arthroscopy/surgery","code_information":[{"code":"29875","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Knee arthroscopy/surgery","code_information":[{"code":"29876","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Knee arthroscopy/surgery","code_information":[{"code":"29877","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Knee arthroscopy/surgery","code_information":[{"code":"29879","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Knee arthroscopy/surgery","code_information":[{"code":"29880","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Knee arthroscopy/surgery","code_information":[{"code":"29881","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Knee arthroscopy/surgery","code_information":[{"code":"29882","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Knee arthroscopy/surgery","code_information":[{"code":"29883","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Knee arthroscopy/surgery","code_information":[{"code":"29884","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Knee arthroscopy/surgery","code_information":[{"code":"29886","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Ankle arthroscopy/surgery","code_information":[{"code":"29891","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Scope plantar fasciotomy","code_information":[{"code":"29893","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Ankle arthroscopy/surgery","code_information":[{"code":"29894","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Ankle arthroscopy/surgery","code_information":[{"code":"29895","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Ankle arthroscopy/surgery","code_information":[{"code":"29897","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Ankle arthroscopy/surgery","code_information":[{"code":"29898","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Mcp joint arthroscopy dx","code_information":[{"code":"29900","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Mcp joint arthroscopy surg","code_information":[{"code":"29901","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Subtalar arthro w/fb rmvl","code_information":[{"code":"29904","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Subtalar arthro w/deb","code_information":[{"code":"29906","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Rmv sk-mnt crnl nstm pg/rcvr","code_information":[{"code":"61892","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Remove sympathetic nerves","code_information":[{"code":"64821","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Remove sympathetic nerves","code_information":[{"code":"64822","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Sympathectomy supfc palmar","code_information":[{"code":"64823","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Rmvl oi implt skl perq esp","code_information":[{"code":"69726","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Rmvl oi implt skl tc esp","code_information":[{"code":"69727","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Rmv ntr oi imp sktc esp>=100","code_information":[{"code":"69728","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Tmj arthroscopy disc reposit","code_information":[{"code":"D7874","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Open tx post pelvic fxcture","code_information":[{"code":"G0415","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.46,"maximum":7809.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3127.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3190.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3221.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7809.26,"additional_payer_notes":"APC"}]}]},{"description":"Perq sacral augmt unilat inj","code_information":[{"code":"0200T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Perq sacral augmt bilat inj","code_information":[{"code":"0201T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Plmt post facet implt lumb","code_information":[{"code":"0221T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Perq lamot/lam crv/thrc","code_information":[{"code":"0274T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Extraosseous joint stblztion","code_information":[{"code":"0335T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Rmvl&rinsj sinus tarsi implt","code_information":[{"code":"0511T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Osteot hum xtrnl lngth dev","code_information":[{"code":"0594T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Replace tissue expander","code_information":[{"code":"11970","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Open bone biopsy","code_information":[{"code":"20251","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Apply bone fixation device","code_information":[{"code":"20690","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Adjust bone fixation device","code_information":[{"code":"20693","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Removal of bone for graft","code_information":[{"code":"20900","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Removal of bone for graft","code_information":[{"code":"20902","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Removal of tendon for graft","code_information":[{"code":"20924","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Fibula bone graft microvasc","code_information":[{"code":"20955","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Iliac bone graft microvasc","code_information":[{"code":"20956","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Mt bone graft microvasc","code_information":[{"code":"20957","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Other bone graft microvasc","code_information":[{"code":"20962","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Bone/skin graft microvasc","code_information":[{"code":"20969","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Bone/skin graft iliac crest","code_information":[{"code":"20970","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Bone/skin graft metatarsal","code_information":[{"code":"20972","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Bone/skin graft great toe","code_information":[{"code":"20973","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Ablate bone tumor(s) perq","code_information":[{"code":"20983","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Partial removal of rib","code_information":[{"code":"21600","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Exc ch wal tum w/o lymphadec","code_information":[{"code":"21602","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Exc ch wal tum w/lymphadec","code_information":[{"code":"21603","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Removal of rib","code_information":[{"code":"21615","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Removal of rib and nerves","code_information":[{"code":"21616","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Extensive sternum surgery","code_information":[{"code":"21630","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Revision of neck muscle","code_information":[{"code":"21700","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Revision of neck muscle/rib","code_information":[{"code":"21705","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruction of sternum","code_information":[{"code":"21740","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Repair of sternum separation","code_information":[{"code":"21750","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Optx of rib fx w/fixj scope","code_information":[{"code":"21811","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Treatment of rib fracture","code_information":[{"code":"21812","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Treat sternum fracture","code_information":[{"code":"21825","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"I&d p-spine c/t/cerv-thor","code_information":[{"code":"22010","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"I&d abscess p-spine l/s/ls","code_information":[{"code":"22015","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Remove part of neck vertebra","code_information":[{"code":"22100","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Remove part thorax vertebra","code_information":[{"code":"22101","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Remove part lumbar vertebra","code_information":[{"code":"22102","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Remove part of neck vertebra","code_information":[{"code":"22110","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Remove part thorax vertebra","code_information":[{"code":"22112","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Remove part lumbar vertebra","code_information":[{"code":"22114","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Incis spine 3 column thorac","code_information":[{"code":"22206","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Incis spine 3 column lumbar","code_information":[{"code":"22207","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Incis 1 vertebral seg cerv","code_information":[{"code":"22210","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Incis 1 vertebral seg thorac","code_information":[{"code":"22212","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Incis 1 vertebral seg lumbar","code_information":[{"code":"22214","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Incis w/discectomy cervical","code_information":[{"code":"22220","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Incis w/discectomy thoracic","code_information":[{"code":"22222","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Incis w/discectomy lumbar","code_information":[{"code":"22224","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Perq vertebral augmentation","code_information":[{"code":"22513","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Perq vertebral augmentation","code_information":[{"code":"22514","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Exploration of spinal fusion","code_information":[{"code":"22830","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Remove spine fixation device","code_information":[{"code":"22850","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Remove spine fixation device","code_information":[{"code":"22852","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Remove spine fixation device","code_information":[{"code":"22855","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Remove cerv artif disc","code_information":[{"code":"22864","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Remove Lumb Artif Disc","code_information":[{"code":"22865","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Remove shoulder joint lining","code_information":[{"code":"23105","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Explore treat shoulder joint","code_information":[{"code":"23107","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Removal of bone lesion","code_information":[{"code":"23146","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Removal of humerus lesion","code_information":[{"code":"23155","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Removal of humerus lesion","code_information":[{"code":"23156","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Remove humerus lesion","code_information":[{"code":"23174","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Remove collar bone lesion","code_information":[{"code":"23180","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Remove shoulder blade lesion","code_information":[{"code":"23182","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Remove humerus lesion","code_information":[{"code":"23184","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Removal of head of humerus","code_information":[{"code":"23195","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Resect clavicle tumor","code_information":[{"code":"23200","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Resect scapula tumor","code_information":[{"code":"23210","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Resect prox humerus tumor","code_information":[{"code":"23220","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Shoulder prosthesis removal","code_information":[{"code":"23334","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Shoulder prosthesis removal","code_information":[{"code":"23335","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Muscle transfer shoulder/arm","code_information":[{"code":"23395","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Muscle transfers","code_information":[{"code":"23397","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Fixation of shoulder blade","code_information":[{"code":"23400","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Incision of tendon & muscle","code_information":[{"code":"23405","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Incise tendon(s) & muscle(s)","code_information":[{"code":"23406","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Repair rotator cuff acute","code_information":[{"code":"23410","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Repair rotator cuff chronic","code_information":[{"code":"23412","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Release of shoulder ligament","code_information":[{"code":"23415","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Repair of shoulder","code_information":[{"code":"23420","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Repair biceps tendon","code_information":[{"code":"23430","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Remove/transplant tendon","code_information":[{"code":"23440","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Repair shoulder capsule","code_information":[{"code":"23450","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Repair shoulder capsule","code_information":[{"code":"23455","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Repair shoulder capsule","code_information":[{"code":"23460","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Repair shoulder capsule","code_information":[{"code":"23462","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Repair shoulder capsule","code_information":[{"code":"23465","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Repair shoulder capsule","code_information":[{"code":"23466","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Revision of collar bone","code_information":[{"code":"23480","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Reinforce clavicle","code_information":[{"code":"23490","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Treat clavicle fracture","code_information":[{"code":"23515","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Treat clavicle dislocation","code_information":[{"code":"23530","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Treat clavicle dislocation","code_information":[{"code":"23532","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Treat clavicle dislocation","code_information":[{"code":"23550","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Treat clavicle dislocation","code_information":[{"code":"23552","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Treat scapula fracture","code_information":[{"code":"23585","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Treat humerus fracture","code_information":[{"code":"23630","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Treat shoulder dislocation","code_information":[{"code":"23660","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Treat dislocation/fracture","code_information":[{"code":"23670","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Fusion of shoulder joint","code_information":[{"code":"23800","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Remove/graft bone lesion","code_information":[{"code":"24115","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Remove/graft bone lesion","code_information":[{"code":"24116","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Remove/graft bone lesion","code_information":[{"code":"24126","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Removal of arm bone lesion","code_information":[{"code":"24134","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Remove elbow bone lesion","code_information":[{"code":"24138","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Partial removal of radius","code_information":[{"code":"24145","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Radical resection of elbow","code_information":[{"code":"24149","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Resect distal humerus tumor","code_information":[{"code":"24150","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Resect radius tumor","code_information":[{"code":"24152","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Muscle/tendon transfer","code_information":[{"code":"24301","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Repair of arm tendon","code_information":[{"code":"24320","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Revision of arm muscles","code_information":[{"code":"24330","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Revision of arm muscles","code_information":[{"code":"24331","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Repair of biceps tendon","code_information":[{"code":"24340","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Repair arm tendon/muscle","code_information":[{"code":"24341","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Repair of ruptured tendon","code_information":[{"code":"24342","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruct elbow lat ligmnt","code_information":[{"code":"24344","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Repr elbw med ligmnt w/tissu","code_information":[{"code":"24345","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruct elbow joint","code_information":[{"code":"24360","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Revision of humerus","code_information":[{"code":"24400","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Revision of humerus","code_information":[{"code":"24420","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Decompression of forearm","code_information":[{"code":"24495","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Treat humerus fracture","code_information":[{"code":"24538","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Treat humerus fracture","code_information":[{"code":"24582","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Treat elbow dislocation","code_information":[{"code":"24615","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Treat elbow fracture","code_information":[{"code":"24635","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Treat radius fracture","code_information":[{"code":"24665","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Treat ulnar fracture","code_information":[{"code":"24685","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Fusion of elbow joint","code_information":[{"code":"24800","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Amputation follow-up surgery","code_information":[{"code":"24930","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Revision of amputation","code_information":[{"code":"24935","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Treat forearm bone lesion","code_information":[{"code":"25035","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Remove & graft wrist lesion","code_information":[{"code":"25135","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Remove & graft wrist lesion","code_information":[{"code":"25136","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Resect radius/ulnar tumor","code_information":[{"code":"25170","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Repair forearm tendon/muscle","code_information":[{"code":"25263","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Revise palsy hand tendon(s)","code_information":[{"code":"25315","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Revise palsy hand tendon(s)","code_information":[{"code":"25316","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Repair/revise wrist joint","code_information":[{"code":"25320","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruct ulna/radioulnar","code_information":[{"code":"25337","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Revision of radius","code_information":[{"code":"25350","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Revision of ulna","code_information":[{"code":"25360","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Shorten radius or ulna","code_information":[{"code":"25390","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Shorten radius & ulna","code_information":[{"code":"25392","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Lengthen radius & ulna","code_information":[{"code":"25393","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Repair radius or ulna","code_information":[{"code":"25400","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Repair/graft radius or ulna","code_information":[{"code":"25405","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Repair radius & ulna","code_information":[{"code":"25415","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Repair/graft radius & ulna","code_information":[{"code":"25420","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Repair/graft radius or ulna","code_information":[{"code":"25425","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Repair nonunion carpal bone","code_information":[{"code":"25431","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Repair/graft wrist bone","code_information":[{"code":"25440","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruct wrist joint","code_information":[{"code":"25443","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruct wrist joint","code_information":[{"code":"25445","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Remove wrist joint implant","code_information":[{"code":"25449","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Reinforce radius","code_information":[{"code":"25490","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Treat fracture of radius","code_information":[{"code":"25515","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Treat fracture of radius","code_information":[{"code":"25525","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Treat fracture of radius","code_information":[{"code":"25526","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Treat fracture of ulna","code_information":[{"code":"25545","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Treat fracture radius & ulna","code_information":[{"code":"25574","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Treat fracture radius/ulna","code_information":[{"code":"25575","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Treat Fx Rad Extra-Articul","code_information":[{"code":"25607","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Treat Fx Rad Intra-Articul","code_information":[{"code":"25608","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Treat Fx Radial 3+ Frag","code_information":[{"code":"25609","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Treat wrist bone fracture","code_information":[{"code":"25628","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Treat fracture ulnar styloid","code_information":[{"code":"25652","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Treat wrist dislocation","code_information":[{"code":"25670","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Treat wrist dislocation","code_information":[{"code":"25676","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Treat wrist fracture","code_information":[{"code":"25685","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Treat wrist dislocation","code_information":[{"code":"25695","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Fusion of wrist joint","code_information":[{"code":"25800","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Fusion/graft of wrist joint","code_information":[{"code":"25805","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Fusion of hand bones","code_information":[{"code":"25820","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Fuse hand bones with graft","code_information":[{"code":"25825","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Fusion radioulnar jnt/ulna","code_information":[{"code":"25830","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Amputation of forearm","code_information":[{"code":"25900","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Amputation of forearm","code_information":[{"code":"25905","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Amputation follow-up surgery","code_information":[{"code":"25909","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Amputation of forearm","code_information":[{"code":"25915","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Remove/graft bone lesion","code_information":[{"code":"26205","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Repair/graft hand tendon","code_information":[{"code":"26352","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Repair/graft hand tendon","code_information":[{"code":"26358","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Repair/graft hand tendon","code_information":[{"code":"26372","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Revise hand/finger tendon","code_information":[{"code":"26390","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Repair/graft hand tendon","code_information":[{"code":"26392","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Hand tendon reconstruction","code_information":[{"code":"26500","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Fusion of knuckle joints","code_information":[{"code":"26518","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Revise knuckle joint","code_information":[{"code":"26530","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Revise knuckle with implant","code_information":[{"code":"26531","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Revise/implant finger joint","code_information":[{"code":"26536","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Repair nonunion hand","code_information":[{"code":"26546","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Great toe-hand transfer","code_information":[{"code":"26551","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Single transfer toe-hand","code_information":[{"code":"26553","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Double transfer toe-hand","code_information":[{"code":"26554","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Positional change of finger","code_information":[{"code":"26555","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Toe joint transfer","code_information":[{"code":"26556","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Lengthen metacarpal/finger","code_information":[{"code":"26568","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Thumb fusion with graft","code_information":[{"code":"26820","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Fusion of thumb","code_information":[{"code":"26841","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Thumb fusion with graft","code_information":[{"code":"26842","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Fusion of hand joint","code_information":[{"code":"26843","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Fusion/graft of hand joint","code_information":[{"code":"26844","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Fusion of knuckle","code_information":[{"code":"26850","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Fusion of knuckle with graft","code_information":[{"code":"26852","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Incision of hip tendon","code_information":[{"code":"27003","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Buttock fasciotomy","code_information":[{"code":"27027","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of hip joint","code_information":[{"code":"27030","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Exploration of hip joint","code_information":[{"code":"27033","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Excision of hip joint/muscle","code_information":[{"code":"27036","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Removal of ischial bursa","code_information":[{"code":"27060","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Remove hip bone les super","code_information":[{"code":"27065","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Remove/graft hip bone lesion","code_information":[{"code":"27067","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Resect hip tumor","code_information":[{"code":"27075","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Resect hip tum incl acetabul","code_information":[{"code":"27076","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Resect hip tum w/innom bone","code_information":[{"code":"27077","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Rsect hip tum incl femur","code_information":[{"code":"27078","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Removal of hip prosthesis","code_information":[{"code":"27090","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Transfer of abdominal muscle","code_information":[{"code":"27100","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Transfer of iliopsoas muscle","code_information":[{"code":"27110","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruction of hip socket","code_information":[{"code":"27122","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Transplant femur ridge","code_information":[{"code":"27140","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Incision of hip bone","code_information":[{"code":"27146","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Revision of hip bone","code_information":[{"code":"27147","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Incision of hip bones","code_information":[{"code":"27151","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Revision of hip bones","code_information":[{"code":"27156","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Revision of pelvis","code_information":[{"code":"27158","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Incision of neck of femur","code_information":[{"code":"27161","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Incision/fixation of femur","code_information":[{"code":"27165","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Repair/graft femur head/neck","code_information":[{"code":"27170","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Revise head/neck of femur","code_information":[{"code":"27179","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Treat slipped epiphysis","code_information":[{"code":"27181","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Reinforce hip bones","code_information":[{"code":"27187","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Treat hip wall fracture","code_information":[{"code":"27226","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Treat hip fracture(s)","code_information":[{"code":"27227","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Treat hip fracture(s)","code_information":[{"code":"27228","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Treat thigh fracture","code_information":[{"code":"27235","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Treat thigh fracture","code_information":[{"code":"27236","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Treat thigh fracture","code_information":[{"code":"27244","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Treat thigh fracture","code_information":[{"code":"27245","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Treat thigh fracture","code_information":[{"code":"27248","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Treat hip dislocation","code_information":[{"code":"27254","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Optx thigh fx","code_information":[{"code":"27269","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Remove knee joint lining","code_information":[{"code":"27335","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Removal of kneecap","code_information":[{"code":"27350","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Remove femur lesion/graft","code_information":[{"code":"27357","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Repair of kneecap tendon","code_information":[{"code":"27380","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Repair/graft kneecap tendon","code_information":[{"code":"27381","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Repair of thigh muscle","code_information":[{"code":"27385","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Repair/graft of thigh muscle","code_information":[{"code":"27386","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Lengthening of thigh tendon","code_information":[{"code":"27393","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Lengthening of thigh tendons","code_information":[{"code":"27394","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Transplant of thigh tendon","code_information":[{"code":"27396","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Transplants of thigh tendons","code_information":[{"code":"27397","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Revise thigh muscles/tendons","code_information":[{"code":"27400","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Repair of knee cartilage","code_information":[{"code":"27403","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Repair of knee ligament","code_information":[{"code":"27405","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Repair of knee ligament","code_information":[{"code":"27407","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Repair of knee ligaments","code_information":[{"code":"27409","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Autochondrocyte implant knee","code_information":[{"code":"27412","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Osteochondral knee autograft","code_information":[{"code":"27416","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Repair degenerated kneecap","code_information":[{"code":"27418","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Revision of unstable kneecap","code_information":[{"code":"27420","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Revision of unstable kneecap","code_information":[{"code":"27422","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Revision/removal of kneecap","code_information":[{"code":"27424","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruction knee","code_information":[{"code":"27427","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Revision of thigh muscles","code_information":[{"code":"27430","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Revise kneecap","code_information":[{"code":"27437","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Incision of thigh","code_information":[{"code":"27448","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Incision of thigh","code_information":[{"code":"27450","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Realignment of thigh bone","code_information":[{"code":"27454","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Realignment of knee","code_information":[{"code":"27455","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Realignment of knee","code_information":[{"code":"27457","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Osteot femur imed lngth dev","code_information":[{"code":"27458","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Shortening of thigh bone","code_information":[{"code":"27465","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Lengthening of thigh bone","code_information":[{"code":"27466","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Repair of thigh","code_information":[{"code":"27470","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Repair/graft of thigh","code_information":[{"code":"27472","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Surgery to stop leg growth","code_information":[{"code":"27475","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Surgery to stop leg growth","code_information":[{"code":"27477","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Surgery to stop leg growth","code_information":[{"code":"27479","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Surgery to stop leg growth","code_information":[{"code":"27485","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Reinforce thigh","code_information":[{"code":"27495","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Decompression of thigh/knee","code_information":[{"code":"27499","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Treatment of thigh fracture","code_information":[{"code":"27506","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Treatment of thigh fracture","code_information":[{"code":"27507","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Treatment of thigh fracture","code_information":[{"code":"27509","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Treat thigh fx growth plate","code_information":[{"code":"27519","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Treat kneecap fracture","code_information":[{"code":"27524","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Treat knee fracture","code_information":[{"code":"27535","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Treat knee fracture","code_information":[{"code":"27536","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Treat knee fracture","code_information":[{"code":"27540","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Treat knee dislocation","code_information":[{"code":"27556","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Treat knee dislocation","code_information":[{"code":"27557","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Treat knee dislocation","code_information":[{"code":"27558","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Treat kneecap dislocation","code_information":[{"code":"27566","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Remove/graft leg bone lesion","code_information":[{"code":"27637","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Remove/graft leg bone lesion","code_information":[{"code":"27638","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Repair achilles tendon","code_information":[{"code":"27650","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Repair/graft achilles tendon","code_information":[{"code":"27652","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Repair of achilles tendon","code_information":[{"code":"27654","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Repair of leg tendon each","code_information":[{"code":"27659","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Repair of leg tendon each","code_information":[{"code":"27664","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Repair of leg tendon each","code_information":[{"code":"27665","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Repair lower leg tendons","code_information":[{"code":"27676","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Revise lower leg tendon","code_information":[{"code":"27690","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Revise lower leg tendon","code_information":[{"code":"27691","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Repair of ankle ligament","code_information":[{"code":"27695","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Repair of ankle ligaments","code_information":[{"code":"27696","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Repair of ankle ligament","code_information":[{"code":"27698","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Revision of ankle joint","code_information":[{"code":"27700","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Incision of tibia","code_information":[{"code":"27705","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Osteot tibia imed lngth dev","code_information":[{"code":"27713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Repair of tibia","code_information":[{"code":"27720","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Repair/graft of tibia","code_information":[{"code":"27722","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Repair/graft of tibia","code_information":[{"code":"27724","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Repair of lower leg","code_information":[{"code":"27725","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Repair fibula nonunion","code_information":[{"code":"27726","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Reinforce tibia","code_information":[{"code":"27745","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Treatment of tibia fracture","code_information":[{"code":"27756","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Optx medial ankle fx","code_information":[{"code":"27766","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Optx post ankle fx","code_information":[{"code":"27769","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Treatment of fibula fracture","code_information":[{"code":"27784","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Treatment of ankle fracture","code_information":[{"code":"27792","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Treatment of ankle fracture","code_information":[{"code":"27814","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Treatment of ankle fracture","code_information":[{"code":"27822","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Treatment of ankle fracture","code_information":[{"code":"27823","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Treat lower leg fracture","code_information":[{"code":"27826","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Treat lower leg joint","code_information":[{"code":"27829","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Treat lower leg dislocation","code_information":[{"code":"27832","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Treat ankle dislocation","code_information":[{"code":"27846","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Treat ankle dislocation","code_information":[{"code":"27848","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Amputation of lower leg","code_information":[{"code":"27880","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Amputation of foot at ankle","code_information":[{"code":"27889","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Decompression of leg","code_information":[{"code":"27893","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Removal of foot joint lining","code_information":[{"code":"28070","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Remove/graft foot lesion","code_information":[{"code":"28102","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Remove/graft foot lesion","code_information":[{"code":"28103","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Remove/graft foot lesion","code_information":[{"code":"28106","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Remove/graft foot lesion","code_information":[{"code":"28107","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Removal of ankle bone","code_information":[{"code":"28130","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Repair/graft of foot tendon","code_information":[{"code":"28202","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Repair/graft of foot tendon","code_information":[{"code":"28210","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Revision of foot tendon","code_information":[{"code":"28238","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Revision of foot and ankle","code_information":[{"code":"28262","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Corrj halux rigdus w/implt","code_information":[{"code":"28291","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Correction hallux valgus","code_information":[{"code":"28298","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Correction hallux valgus","code_information":[{"code":"28299","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Incision of heel bone","code_information":[{"code":"28300","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Incision of ankle bone","code_information":[{"code":"28302","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Incision of midfoot bones","code_information":[{"code":"28304","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Incise/graft midfoot bones","code_information":[{"code":"28305","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Incision of metatarsal","code_information":[{"code":"28306","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Incision of metatarsal","code_information":[{"code":"28307","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Incision of metatarsals","code_information":[{"code":"28309","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Revision of big toe","code_information":[{"code":"28310","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Repair of metatarsals","code_information":[{"code":"28322","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruct cleft foot","code_information":[{"code":"28360","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Treatment of heel fracture","code_information":[{"code":"28406","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Treat heel fracture","code_information":[{"code":"28415","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Treatment of ankle fracture","code_information":[{"code":"28436","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Treat ankle fracture","code_information":[{"code":"28445","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Osteochondral talus autogrft","code_information":[{"code":"28446","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Treat midfoot fracture","code_information":[{"code":"28456","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Treat midfoot fracture each","code_information":[{"code":"28465","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Treat metatarsal fracture","code_information":[{"code":"28485","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Treat sesamoid bone fracture","code_information":[{"code":"28531","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Repair foot dislocation","code_information":[{"code":"28555","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Treat foot dislocation","code_information":[{"code":"28576","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Repair foot dislocation","code_information":[{"code":"28585","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Repair foot dislocation","code_information":[{"code":"28615","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Fusion of foot bones","code_information":[{"code":"28740","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Fusion of big toe joint","code_information":[{"code":"28750","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Fusion of big toe joint","code_information":[{"code":"28755","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Fusion of big toe joint","code_information":[{"code":"28760","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Shoulder arthroscopy/surgery","code_information":[{"code":"29806","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Shoulder arthroscopy/surgery","code_information":[{"code":"29807","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Shoulder arthroscopy/surgery","code_information":[{"code":"29820","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Arthroscop rotator cuff repr","code_information":[{"code":"29827","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Arthroscopy biceps tenodesis","code_information":[{"code":"29828","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Elbow arthroscopy/surgery","code_information":[{"code":"29836","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Wrist arthroscopy/surgery","code_information":[{"code":"29847","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Tibial arthroscopy/surgery","code_information":[{"code":"29855","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Hip arthroscopy dx","code_information":[{"code":"29860","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Hip arthro w/fb removal","code_information":[{"code":"29861","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Hip arthr0 w/debridement","code_information":[{"code":"29862","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Autgrft implnt knee w/scope","code_information":[{"code":"29866","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Meniscal trnspl knee w/scpe","code_information":[{"code":"29868","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Knee arthroscopy/surgery","code_information":[{"code":"29885","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Knee arthroscopy/surgery","code_information":[{"code":"29887","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Knee arthroscopy/surgery","code_information":[{"code":"29888","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Ankle arthroscopy/surgery","code_information":[{"code":"29892","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Ankle arthroscopy/surgery","code_information":[{"code":"29899","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Subtalar arthro w/exc","code_information":[{"code":"29905","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Hip arthro w/femoroplasty","code_information":[{"code":"29914","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Hip arthro acetabuloplasty","code_information":[{"code":"29915","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Hip arthro w/labral repair","code_information":[{"code":"29916","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Dcmprn prq rmv lig flv 1lmbr","code_information":[{"code":"62330","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Implant spinal canal cath","code_information":[{"code":"62351","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Ndsc dcmprn 1 ntrspc lumbar","code_information":[{"code":"62380","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Remove spine lamina 1/2 crvl","code_information":[{"code":"63001","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Remove spine lamina 1/2 thrc","code_information":[{"code":"63003","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Remove spine lamina 1/2 lmbr","code_information":[{"code":"63005","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Remove spine lamina 1/2 scrl","code_information":[{"code":"63011","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Remove lamina/facets lumbar","code_information":[{"code":"63012","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Remove spine lamina >2 crvcl","code_information":[{"code":"63015","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Remove spine lamina >2 thrc","code_information":[{"code":"63016","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Remove spine lamina >2 lmbr","code_information":[{"code":"63017","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Neck spine disk surgery","code_information":[{"code":"63020","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Low back disk surgery","code_information":[{"code":"63030","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Laminotomy single cervical","code_information":[{"code":"63040","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Laminotomy single lumbar","code_information":[{"code":"63042","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Remove spine lamina 1 crvl","code_information":[{"code":"63045","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Remove spine lamina 1 thrc","code_information":[{"code":"63046","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Remove spine lamina 1 lmbr","code_information":[{"code":"63047","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Decompress spinal cord thrc","code_information":[{"code":"63055","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Decompress spinal cord lmbr","code_information":[{"code":"63056","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Decompress spinal cord thrc","code_information":[{"code":"63064","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Neck spine disk surgery","code_information":[{"code":"63075","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Excise intraspinl lesion crv","code_information":[{"code":"63265","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Excise intrspinl lesion thrc","code_information":[{"code":"63266","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Excise intrspinl lesion lmbr","code_information":[{"code":"63267","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Excise intrspinl lesion scrl","code_information":[{"code":"63268","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Temple Bone Implant Revision","code_information":[{"code":"69717","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Pild/placebo control clin tr","code_information":[{"code":"G0276","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Open tx iliac spine uni/bil","code_information":[{"code":"G0412","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Pelvic ring fracture uni/bil","code_information":[{"code":"G0413","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Pelvic ring fx treat int fix","code_information":[{"code":"G0414","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6935.66,"maximum":17318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6935.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7074.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7005.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17318.35,"additional_payer_notes":"APC"}]}]},{"description":"Post vert arthrplst 1 lumbar","code_information":[{"code":"0202T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12271.52,"maximum":30641.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12271.52,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12516.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12394.23,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12639.66,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":30641.98,"additional_payer_notes":"APC"}]}]},{"description":"Plmt post facet implt cerv","code_information":[{"code":"0219T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12271.52,"maximum":30641.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12271.52,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12516.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12394.23,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12639.66,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":30641.98,"additional_payer_notes":"APC"}]}]},{"description":"Plmt post facet implt thor","code_information":[{"code":"0220T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12271.52,"maximum":30641.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12271.52,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12516.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12394.23,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12639.66,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":30641.98,"additional_payer_notes":"APC"}]}]},{"description":"Perq njx algc fluor lmbr 1st","code_information":[{"code":"0627T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12271.52,"maximum":30641.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12271.52,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12516.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12394.23,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12639.66,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":30641.98,"additional_payer_notes":"APC"}]}]},{"description":"Perq njx algc ct lmbr 1st","code_information":[{"code":"0629T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12271.52,"maximum":30641.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12271.52,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12516.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12394.23,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12639.66,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":30641.98,"additional_payer_notes":"APC"}]}]},{"description":"Xenograft impltj artclr surf","code_information":[{"code":"0737T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12271.52,"maximum":30641.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12271.52,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12516.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12394.23,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12639.66,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":30641.98,"additional_payer_notes":"APC"}]}]},{"description":"Arthrp 1st crp/mtcrpl prostc","code_information":[{"code":"1003T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12271.52,"maximum":30641.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12271.52,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12516.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12394.23,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12639.66,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":30641.98,"additional_payer_notes":"APC"}]}]},{"description":"Apply bone fixation device","code_information":[{"code":"20692","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12271.52,"maximum":30641.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12271.52,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12516.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12394.23,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12639.66,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":30641.98,"additional_payer_notes":"APC"}]}]},{"description":"Treat odontoid fx w/o graft","code_information":[{"code":"22318","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12271.52,"maximum":30641.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12271.52,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12516.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12394.23,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12639.66,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":30641.98,"additional_payer_notes":"APC"}]}]},{"description":"Treat odontoid fx w/graft","code_information":[{"code":"22319","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12271.52,"maximum":30641.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12271.52,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12516.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12394.23,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12639.66,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":30641.98,"additional_payer_notes":"APC"}]}]},{"description":"Treat spine fracture","code_information":[{"code":"22325","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12271.52,"maximum":30641.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12271.52,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12516.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12394.23,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12639.66,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":30641.98,"additional_payer_notes":"APC"}]}]},{"description":"Treat neck spine fracture","code_information":[{"code":"22326","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12271.52,"maximum":30641.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12271.52,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12516.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12394.23,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12639.66,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":30641.98,"additional_payer_notes":"APC"}]}]},{"description":"Treat thorax spine fracture","code_information":[{"code":"22327","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12271.52,"maximum":30641.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12271.52,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12516.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12394.23,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12639.66,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":30641.98,"additional_payer_notes":"APC"}]}]},{"description":"Lat thorax spine fusion","code_information":[{"code":"22532","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12271.52,"maximum":30641.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12271.52,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12516.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12394.23,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12639.66,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":30641.98,"additional_payer_notes":"APC"}]}]},{"description":"Neck spine fusion","code_information":[{"code":"22548","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12271.52,"maximum":30641.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12271.52,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12516.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12394.23,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12639.66,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":30641.98,"additional_payer_notes":"APC"}]}]},{"description":"Neck spine fuse&remov bel c2","code_information":[{"code":"22551","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12271.52,"maximum":30641.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12271.52,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12516.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12394.23,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12639.66,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":30641.98,"additional_payer_notes":"APC"}]}]},{"description":"Neck spine fusion","code_information":[{"code":"22554","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12271.52,"maximum":30641.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12271.52,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12516.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12394.23,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12639.66,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":30641.98,"additional_payer_notes":"APC"}]}]},{"description":"Spine & skull spinal fusion","code_information":[{"code":"22590","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12271.52,"maximum":30641.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12271.52,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12516.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12394.23,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12639.66,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":30641.98,"additional_payer_notes":"APC"}]}]},{"description":"Neck spinal fusion","code_information":[{"code":"22595","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12271.52,"maximum":30641.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12271.52,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12516.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12394.23,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12639.66,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":30641.98,"additional_payer_notes":"APC"}]}]},{"description":"Reinsert spinal fixation","code_information":[{"code":"22849","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12271.52,"maximum":30641.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12271.52,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12516.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12394.23,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12639.66,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":30641.98,"additional_payer_notes":"APC"}]}]},{"description":"Insj stablj dev w/o dcmprn","code_information":[{"code":"22869","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12271.52,"maximum":30641.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12271.52,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12516.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12394.23,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12639.66,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":30641.98,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruct shoulder joint","code_information":[{"code":"23470","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12271.52,"maximum":30641.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12271.52,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12516.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12394.23,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12639.66,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":30641.98,"additional_payer_notes":"APC"}]}]},{"description":"Revis reconst shoulder joint","code_information":[{"code":"23473","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12271.52,"maximum":30641.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12271.52,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12516.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12394.23,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12639.66,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":30641.98,"additional_payer_notes":"APC"}]}]},{"description":"Revis reconst shoulder joint","code_information":[{"code":"23474","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12271.52,"maximum":30641.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12271.52,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12516.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12394.23,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12639.66,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":30641.98,"additional_payer_notes":"APC"}]}]},{"description":"Revision of collar bone","code_information":[{"code":"23485","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12271.52,"maximum":30641.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12271.52,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12516.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12394.23,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12639.66,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":30641.98,"additional_payer_notes":"APC"}]}]},{"description":"Reinforce shoulder bones","code_information":[{"code":"23491","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12271.52,"maximum":30641.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12271.52,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12516.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12394.23,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12639.66,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":30641.98,"additional_payer_notes":"APC"}]}]},{"description":"Treat humerus fracture","code_information":[{"code":"23615","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12271.52,"maximum":30641.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12271.52,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12516.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12394.23,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12639.66,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":30641.98,"additional_payer_notes":"APC"}]}]},{"description":"Treat dislocation/fracture","code_information":[{"code":"23680","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12271.52,"maximum":30641.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12271.52,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12516.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12394.23,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12639.66,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":30641.98,"additional_payer_notes":"APC"}]}]},{"description":"Fusion of shoulder joint","code_information":[{"code":"23802","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12271.52,"maximum":30641.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12271.52,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12516.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12394.23,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12639.66,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":30641.98,"additional_payer_notes":"APC"}]}]},{"description":"Amputation of arm & girdle","code_information":[{"code":"23900","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12271.52,"maximum":30641.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12271.52,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12516.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12394.23,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12639.66,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":30641.98,"additional_payer_notes":"APC"}]}]},{"description":"Amputation at shoulder joint","code_information":[{"code":"23920","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12271.52,"maximum":30641.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12271.52,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12516.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12394.23,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12639.66,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":30641.98,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruct elbow med ligmnt","code_information":[{"code":"24346","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12271.52,"maximum":30641.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12271.52,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12516.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12394.23,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12639.66,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":30641.98,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruct elbow joint","code_information":[{"code":"24362","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12271.52,"maximum":30641.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12271.52,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12516.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12394.23,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12639.66,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":30641.98,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruct head of radius","code_information":[{"code":"24365","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12271.52,"maximum":30641.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12271.52,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12516.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12394.23,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12639.66,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":30641.98,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruct head of radius","code_information":[{"code":"24366","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12271.52,"maximum":30641.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12271.52,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12516.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12394.23,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12639.66,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":30641.98,"additional_payer_notes":"APC"}]}]},{"description":"Revise reconst elbow joint","code_information":[{"code":"24370","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12271.52,"maximum":30641.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12271.52,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12516.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12394.23,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12639.66,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":30641.98,"additional_payer_notes":"APC"}]}]},{"description":"Revision of humerus","code_information":[{"code":"24410","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12271.52,"maximum":30641.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12271.52,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12516.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12394.23,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12639.66,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":30641.98,"additional_payer_notes":"APC"}]}]},{"description":"Repair of humerus","code_information":[{"code":"24430","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12271.52,"maximum":30641.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12271.52,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12516.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12394.23,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12639.66,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":30641.98,"additional_payer_notes":"APC"}]}]},{"description":"Repair humerus with graft","code_information":[{"code":"24435","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12271.52,"maximum":30641.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12271.52,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12516.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12394.23,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12639.66,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":30641.98,"additional_payer_notes":"APC"}]}]},{"description":"Reinforce humerus","code_information":[{"code":"24498","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12271.52,"maximum":30641.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12271.52,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12516.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12394.23,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12639.66,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":30641.98,"additional_payer_notes":"APC"}]}]},{"description":"Treat humerus fracture","code_information":[{"code":"24515","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12271.52,"maximum":30641.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12271.52,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12516.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12394.23,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12639.66,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":30641.98,"additional_payer_notes":"APC"}]}]},{"description":"Treat humerus fracture","code_information":[{"code":"24516","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12271.52,"maximum":30641.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12271.52,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12516.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12394.23,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12639.66,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":30641.98,"additional_payer_notes":"APC"}]}]},{"description":"Treat humerus fracture","code_information":[{"code":"24545","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12271.52,"maximum":30641.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12271.52,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12516.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12394.23,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12639.66,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":30641.98,"additional_payer_notes":"APC"}]}]},{"description":"Treat humerus fracture","code_information":[{"code":"24546","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12271.52,"maximum":30641.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12271.52,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12516.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12394.23,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12639.66,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":30641.98,"additional_payer_notes":"APC"}]}]},{"description":"Treat humerus fracture","code_information":[{"code":"24575","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12271.52,"maximum":30641.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12271.52,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12516.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12394.23,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12639.66,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":30641.98,"additional_payer_notes":"APC"}]}]},{"description":"Treat humerus fracture","code_information":[{"code":"24579","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12271.52,"maximum":30641.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12271.52,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12516.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12394.23,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12639.66,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":30641.98,"additional_payer_notes":"APC"}]}]},{"description":"Treat elbow fracture","code_information":[{"code":"24586","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12271.52,"maximum":30641.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12271.52,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12516.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12394.23,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12639.66,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":30641.98,"additional_payer_notes":"APC"}]}]},{"description":"Treat elbow fracture","code_information":[{"code":"24587","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12271.52,"maximum":30641.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12271.52,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12516.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12394.23,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12639.66,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":30641.98,"additional_payer_notes":"APC"}]}]},{"description":"Treat radius fracture","code_information":[{"code":"24666","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12271.52,"maximum":30641.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12271.52,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12516.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12394.23,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12639.66,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":30641.98,"additional_payer_notes":"APC"}]}]},{"description":"Fusion/graft of elbow joint","code_information":[{"code":"24802","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12271.52,"maximum":30641.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12271.52,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12516.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12394.23,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12639.66,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":30641.98,"additional_payer_notes":"APC"}]}]},{"description":"Amputation of upper arm","code_information":[{"code":"24900","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12271.52,"maximum":30641.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12271.52,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12516.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12394.23,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12639.66,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":30641.98,"additional_payer_notes":"APC"}]}]},{"description":"Amputation of upper arm","code_information":[{"code":"24920","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12271.52,"maximum":30641.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12271.52,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12516.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12394.23,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12639.66,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":30641.98,"additional_payer_notes":"APC"}]}]},{"description":"Amputate upper arm & implant","code_information":[{"code":"24931","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12271.52,"maximum":30641.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12271.52,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12516.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12394.23,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12639.66,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":30641.98,"additional_payer_notes":"APC"}]}]},{"description":"Revision of upper arm","code_information":[{"code":"24940","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12271.52,"maximum":30641.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12271.52,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12516.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12394.23,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12639.66,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":30641.98,"additional_payer_notes":"APC"}]}]},{"description":"Revise radius & ulna","code_information":[{"code":"25365","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12271.52,"maximum":30641.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12271.52,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12516.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12394.23,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12639.66,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":30641.98,"additional_payer_notes":"APC"}]}]},{"description":"Lengthen radius or ulna","code_information":[{"code":"25391","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12271.52,"maximum":30641.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12271.52,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12516.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12394.23,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12639.66,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":30641.98,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruct wrist joint","code_information":[{"code":"25441","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12271.52,"maximum":30641.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12271.52,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12516.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12394.23,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12639.66,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":30641.98,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruct wrist joint","code_information":[{"code":"25444","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12271.52,"maximum":30641.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12271.52,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12516.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12394.23,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12639.66,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":30641.98,"additional_payer_notes":"APC"}]}]},{"description":"Reinforce ulna","code_information":[{"code":"25491","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12271.52,"maximum":30641.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12271.52,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12516.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12394.23,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12639.66,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":30641.98,"additional_payer_notes":"APC"}]}]},{"description":"Fusion/graft of wrist joint","code_information":[{"code":"25810","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12271.52,"maximum":30641.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12271.52,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12516.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12394.23,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12639.66,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":30641.98,"additional_payer_notes":"APC"}]}]},{"description":"Removal of hip prosthesis","code_information":[{"code":"27091","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12271.52,"maximum":30641.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12271.52,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12516.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12394.23,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12639.66,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":30641.98,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruction of hip socket","code_information":[{"code":"27120","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12271.52,"maximum":30641.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12271.52,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12516.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12394.23,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12639.66,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":30641.98,"additional_payer_notes":"APC"}]}]},{"description":"Partial hip replacement","code_information":[{"code":"27125","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12271.52,"maximum":30641.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12271.52,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12516.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12394.23,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12639.66,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":30641.98,"additional_payer_notes":"APC"}]}]},{"description":"Total hip arthroplasty","code_information":[{"code":"27130","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12271.52,"maximum":30641.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12271.52,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12516.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12394.23,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12639.66,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":30641.98,"additional_payer_notes":"APC"}]}]},{"description":"Total hip arthroplasty","code_information":[{"code":"27132","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12271.52,"maximum":30641.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12271.52,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12516.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12394.23,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12639.66,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":30641.98,"additional_payer_notes":"APC"}]}]},{"description":"Revise hip joint replacement","code_information":[{"code":"27134","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12271.52,"maximum":30641.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12271.52,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12516.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12394.23,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12639.66,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":30641.98,"additional_payer_notes":"APC"}]}]},{"description":"Revise hip joint replacement","code_information":[{"code":"27137","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12271.52,"maximum":30641.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12271.52,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12516.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12394.23,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12639.66,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":30641.98,"additional_payer_notes":"APC"}]}]},{"description":"Revise hip joint replacement","code_information":[{"code":"27138","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12271.52,"maximum":30641.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12271.52,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12516.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12394.23,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12639.66,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":30641.98,"additional_payer_notes":"APC"}]}]},{"description":"Fusion of hip joint","code_information":[{"code":"27284","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12271.52,"maximum":30641.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12271.52,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12516.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12394.23,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12639.66,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":30641.98,"additional_payer_notes":"APC"}]}]},{"description":"Fusion of hip joint","code_information":[{"code":"27286","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12271.52,"maximum":30641.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12271.52,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12516.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12394.23,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12639.66,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":30641.98,"additional_payer_notes":"APC"}]}]},{"description":"Remove femur lesion/graft","code_information":[{"code":"27356","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12271.52,"maximum":30641.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12271.52,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12516.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12394.23,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12639.66,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":30641.98,"additional_payer_notes":"APC"}]}]},{"description":"Osteochondral knee allograft","code_information":[{"code":"27415","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12271.52,"maximum":30641.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12271.52,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12516.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12394.23,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12639.66,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":30641.98,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruction knee","code_information":[{"code":"27428","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12271.52,"maximum":30641.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12271.52,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12516.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12394.23,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12639.66,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":30641.98,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruction knee","code_information":[{"code":"27429","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12271.52,"maximum":30641.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12271.52,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12516.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12394.23,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12639.66,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":30641.98,"additional_payer_notes":"APC"}]}]},{"description":"Revise kneecap with implant","code_information":[{"code":"27438","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12271.52,"maximum":30641.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12271.52,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12516.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12394.23,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12639.66,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":30641.98,"additional_payer_notes":"APC"}]}]},{"description":"Revision of knee joint","code_information":[{"code":"27440","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12271.52,"maximum":30641.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12271.52,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12516.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12394.23,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12639.66,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":30641.98,"additional_payer_notes":"APC"}]}]},{"description":"Revision of knee joint","code_information":[{"code":"27441","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12271.52,"maximum":30641.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12271.52,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12516.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12394.23,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12639.66,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":30641.98,"additional_payer_notes":"APC"}]}]},{"description":"Revision of knee joint","code_information":[{"code":"27442","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12271.52,"maximum":30641.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12271.52,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12516.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12394.23,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12639.66,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":30641.98,"additional_payer_notes":"APC"}]}]},{"description":"Revision of knee joint","code_information":[{"code":"27443","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12271.52,"maximum":30641.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12271.52,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12516.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12394.23,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12639.66,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":30641.98,"additional_payer_notes":"APC"}]}]},{"description":"Revision of knee joint","code_information":[{"code":"27446","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12271.52,"maximum":30641.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12271.52,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12516.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12394.23,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12639.66,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":30641.98,"additional_payer_notes":"APC"}]}]},{"description":"Total knee arthroplasty","code_information":[{"code":"27447","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12271.52,"maximum":30641.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12271.52,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12516.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12394.23,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12639.66,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":30641.98,"additional_payer_notes":"APC"}]}]},{"description":"Revise/replace knee joint","code_information":[{"code":"27486","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12271.52,"maximum":30641.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12271.52,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12516.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12394.23,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12639.66,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":30641.98,"additional_payer_notes":"APC"}]}]},{"description":"Removal of knee prosthesis","code_information":[{"code":"27488","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12271.52,"maximum":30641.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12271.52,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12516.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12394.23,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12639.66,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":30641.98,"additional_payer_notes":"APC"}]}]},{"description":"Treatment of thigh fracture","code_information":[{"code":"27511","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12271.52,"maximum":30641.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12271.52,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12516.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12394.23,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12639.66,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":30641.98,"additional_payer_notes":"APC"}]}]},{"description":"Treatment of thigh fracture","code_information":[{"code":"27513","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12271.52,"maximum":30641.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12271.52,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12516.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12394.23,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12639.66,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":30641.98,"additional_payer_notes":"APC"}]}]},{"description":"Treatment of thigh fracture","code_information":[{"code":"27514","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12271.52,"maximum":30641.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12271.52,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12516.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12394.23,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12639.66,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":30641.98,"additional_payer_notes":"APC"}]}]},{"description":"Fusion of knee","code_information":[{"code":"27580","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12271.52,"maximum":30641.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12271.52,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12516.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12394.23,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12639.66,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":30641.98,"additional_payer_notes":"APC"}]}]},{"description":"Incision of tibia & fibula","code_information":[{"code":"27709","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12271.52,"maximum":30641.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12271.52,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12516.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12394.23,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12639.66,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":30641.98,"additional_payer_notes":"APC"}]}]},{"description":"Realignment of lower leg","code_information":[{"code":"27712","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12271.52,"maximum":30641.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12271.52,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12516.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12394.23,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12639.66,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":30641.98,"additional_payer_notes":"APC"}]}]},{"description":"Revision of lower leg","code_information":[{"code":"27715","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12271.52,"maximum":30641.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12271.52,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12516.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12394.23,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12639.66,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":30641.98,"additional_payer_notes":"APC"}]}]},{"description":"Treatment of tibia fracture","code_information":[{"code":"27758","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12271.52,"maximum":30641.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12271.52,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12516.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12394.23,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12639.66,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":30641.98,"additional_payer_notes":"APC"}]}]},{"description":"Treatment of tibia fracture","code_information":[{"code":"27759","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12271.52,"maximum":30641.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12271.52,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12516.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12394.23,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12639.66,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":30641.98,"additional_payer_notes":"APC"}]}]},{"description":"Treat lower leg fracture","code_information":[{"code":"27827","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12271.52,"maximum":30641.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12271.52,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12516.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12394.23,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12639.66,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":30641.98,"additional_payer_notes":"APC"}]}]},{"description":"Treat lower leg fracture","code_information":[{"code":"27828","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12271.52,"maximum":30641.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12271.52,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12516.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12394.23,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12639.66,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":30641.98,"additional_payer_notes":"APC"}]}]},{"description":"Fusion of ankle joint open","code_information":[{"code":"27870","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12271.52,"maximum":30641.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12271.52,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12516.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12394.23,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12639.66,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":30641.98,"additional_payer_notes":"APC"}]}]},{"description":"Fusion of tibiofibular joint","code_information":[{"code":"27871","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12271.52,"maximum":30641.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12271.52,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12516.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12394.23,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12639.66,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":30641.98,"additional_payer_notes":"APC"}]}]},{"description":"Correction hallux valgus","code_information":[{"code":"28297","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12271.52,"maximum":30641.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12271.52,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12516.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12394.23,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12639.66,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":30641.98,"additional_payer_notes":"APC"}]}]},{"description":"Repair of foot bones","code_information":[{"code":"28320","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12271.52,"maximum":30641.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12271.52,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12516.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12394.23,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12639.66,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":30641.98,"additional_payer_notes":"APC"}]}]},{"description":"Treat/graft heel fracture","code_information":[{"code":"28420","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12271.52,"maximum":30641.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12271.52,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12516.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12394.23,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12639.66,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":30641.98,"additional_payer_notes":"APC"}]}]},{"description":"Fusion of foot bones","code_information":[{"code":"28715","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12271.52,"maximum":30641.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12271.52,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12516.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12394.23,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12639.66,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":30641.98,"additional_payer_notes":"APC"}]}]},{"description":"Fusion of foot bones","code_information":[{"code":"28725","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12271.52,"maximum":30641.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12271.52,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12516.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12394.23,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12639.66,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":30641.98,"additional_payer_notes":"APC"}]}]},{"description":"Fusion of foot bones","code_information":[{"code":"28730","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12271.52,"maximum":30641.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12271.52,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12516.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12394.23,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12639.66,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":30641.98,"additional_payer_notes":"APC"}]}]},{"description":"Fusion of foot bones","code_information":[{"code":"28735","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12271.52,"maximum":30641.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12271.52,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12516.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12394.23,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12639.66,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":30641.98,"additional_payer_notes":"APC"}]}]},{"description":"Revision of foot bones","code_information":[{"code":"28737","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12271.52,"maximum":30641.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12271.52,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12516.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12394.23,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12639.66,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":30641.98,"additional_payer_notes":"APC"}]}]},{"description":"Tibial arthroscopy/surgery","code_information":[{"code":"29856","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12271.52,"maximum":30641.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12271.52,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12516.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12394.23,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12639.66,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":30641.98,"additional_payer_notes":"APC"}]}]},{"description":"Allgrft implnt knee w/scope","code_information":[{"code":"29867","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12271.52,"maximum":30641.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12271.52,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12516.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12394.23,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12639.66,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":30641.98,"additional_payer_notes":"APC"}]}]},{"description":"Knee arthroscopy/surgery","code_information":[{"code":"29889","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12271.52,"maximum":30641.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12271.52,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12516.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12394.23,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12639.66,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":30641.98,"additional_payer_notes":"APC"}]}]},{"description":"Subtalar arthro w/fusion","code_information":[{"code":"29907","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12271.52,"maximum":30641.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12271.52,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12516.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12394.23,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12639.66,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":30641.98,"additional_payer_notes":"APC"}]}]},{"description":"Trml dstrj ios bvn 1st 2 l/s","code_information":[{"code":"64628","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12271.52,"maximum":30641.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12271.52,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12516.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12394.23,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12639.66,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":30641.98,"additional_payer_notes":"APC"}]}]},{"description":"Implant Temple Bone W/Stimul","code_information":[{"code":"69714","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12271.52,"maximum":30641.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12271.52,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12516.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12394.23,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12639.66,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":30641.98,"additional_payer_notes":"APC"}]}]},{"description":"Impltj oi implt skl tc esp","code_information":[{"code":"69716","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12271.52,"maximum":30641.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12271.52,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12516.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12394.23,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12639.66,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":30641.98,"additional_payer_notes":"APC"}]}]},{"description":"Revj/rplcmt oi implt tc esp","code_information":[{"code":"69719","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12271.52,"maximum":30641.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12271.52,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12516.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12394.23,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12639.66,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":30641.98,"additional_payer_notes":"APC"}]}]},{"description":"Impl oi implt sk tc esp>=100","code_information":[{"code":"69729","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12271.52,"maximum":30641.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12271.52,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12516.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12394.23,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12639.66,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":30641.98,"additional_payer_notes":"APC"}]}]},{"description":"Rplc oi implt sk tc esp>=100","code_information":[{"code":"69730","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12271.52,"maximum":30641.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12271.52,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12516.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12394.23,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12639.66,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":30641.98,"additional_payer_notes":"APC"}]}]},{"description":"U/s trtmt, not leiomyomata","code_information":[{"code":"C9734","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12271.52,"maximum":30641.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12271.52,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12516.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12394.23,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12639.66,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":30641.98,"additional_payer_notes":"APC"}]}]},{"description":"Spine/lumbar disk surgery","code_information":[{"code":"C9757","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12271.52,"maximum":30641.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12271.52,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12516.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12394.23,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12639.66,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":30641.98,"additional_payer_notes":"APC"}]}]},{"description":"Arthro/shoul surg; w/spacer","code_information":[{"code":"C9781","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12271.52,"maximum":30641.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12271.52,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12516.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12394.23,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12639.66,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":30641.98,"additional_payer_notes":"APC"}]}]},{"description":"Vrt bdy tethering ant","code_information":[{"code":"0656T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16759.24,"maximum":41847.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16759.24,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17094.42,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16926.83,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17262.02,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":41847.82,"additional_payer_notes":"APC"}]}]},{"description":"Vrt bdy tethering ant 8+ seg","code_information":[{"code":"0657T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16759.24,"maximum":41847.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16759.24,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17094.42,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16926.83,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17262.02,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":41847.82,"additional_payer_notes":"APC"}]}]},{"description":"Revj rplcmt/rmvl vrt tethrg","code_information":[{"code":"0790T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16759.24,"maximum":41847.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16759.24,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17094.42,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16926.83,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17262.02,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":41847.82,"additional_payer_notes":"APC"}]}]},{"description":"Replantation arm complete","code_information":[{"code":"20802","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16759.24,"maximum":41847.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16759.24,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17094.42,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16926.83,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17262.02,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":41847.82,"additional_payer_notes":"APC"}]}]},{"description":"Replant forearm complete","code_information":[{"code":"20805","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16759.24,"maximum":41847.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16759.24,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17094.42,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16926.83,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17262.02,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":41847.82,"additional_payer_notes":"APC"}]}]},{"description":"Replantation hand complete","code_information":[{"code":"20808","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16759.24,"maximum":41847.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16759.24,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17094.42,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16926.83,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17262.02,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":41847.82,"additional_payer_notes":"APC"}]}]},{"description":"Replantation foot complete","code_information":[{"code":"20838","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16759.24,"maximum":41847.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16759.24,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17094.42,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16926.83,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17262.02,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":41847.82,"additional_payer_notes":"APC"}]}]},{"description":"Ablate bone tumor(s) perq","code_information":[{"code":"20982","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16759.24,"maximum":41847.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16759.24,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17094.42,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16926.83,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17262.02,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":41847.82,"additional_payer_notes":"APC"}]}]},{"description":"Lat lumbar spine fusion","code_information":[{"code":"22533","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16759.24,"maximum":41847.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16759.24,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17094.42,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16926.83,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17262.02,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":41847.82,"additional_payer_notes":"APC"}]}]},{"description":"Thorax spine fusion","code_information":[{"code":"22556","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16759.24,"maximum":41847.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16759.24,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17094.42,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16926.83,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17262.02,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":41847.82,"additional_payer_notes":"APC"}]}]},{"description":"Prescrl fuse w/ instr l5-s1","code_information":[{"code":"22586","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16759.24,"maximum":41847.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16759.24,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17094.42,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16926.83,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17262.02,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":41847.82,"additional_payer_notes":"APC"}]}]},{"description":"Neck spine fusion","code_information":[{"code":"22600","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16759.24,"maximum":41847.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16759.24,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17094.42,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16926.83,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17262.02,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":41847.82,"additional_payer_notes":"APC"}]}]},{"description":"Thorax spine fusion","code_information":[{"code":"22610","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16759.24,"maximum":41847.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16759.24,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17094.42,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16926.83,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17262.02,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":41847.82,"additional_payer_notes":"APC"}]}]},{"description":"Lumbar spine fusion","code_information":[{"code":"22612","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16759.24,"maximum":41847.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16759.24,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17094.42,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16926.83,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17262.02,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":41847.82,"additional_payer_notes":"APC"}]}]},{"description":"Post fusion <=6 vert seg","code_information":[{"code":"22800","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16759.24,"maximum":41847.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16759.24,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17094.42,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16926.83,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17262.02,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":41847.82,"additional_payer_notes":"APC"}]}]},{"description":"Post fusion 7-12 vert seg","code_information":[{"code":"22802","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16759.24,"maximum":41847.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16759.24,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17094.42,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16926.83,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17262.02,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":41847.82,"additional_payer_notes":"APC"}]}]},{"description":"Post fusion 13/> vert seg","code_information":[{"code":"22804","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16759.24,"maximum":41847.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16759.24,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17094.42,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16926.83,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17262.02,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":41847.82,"additional_payer_notes":"APC"}]}]},{"description":"Ant fusion 2-3 vert seg","code_information":[{"code":"22808","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16759.24,"maximum":41847.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16759.24,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17094.42,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16926.83,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17262.02,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":41847.82,"additional_payer_notes":"APC"}]}]},{"description":"Ant fusion 4-7 vert seg","code_information":[{"code":"22810","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16759.24,"maximum":41847.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16759.24,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17094.42,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16926.83,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17262.02,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":41847.82,"additional_payer_notes":"APC"}]}]},{"description":"Ant fusion 8/> vert seg","code_information":[{"code":"22812","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16759.24,"maximum":41847.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16759.24,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17094.42,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16926.83,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17262.02,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":41847.82,"additional_payer_notes":"APC"}]}]},{"description":"Kyphectomy 1-2 segments","code_information":[{"code":"22818","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16759.24,"maximum":41847.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16759.24,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17094.42,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16926.83,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17262.02,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":41847.82,"additional_payer_notes":"APC"}]}]},{"description":"Kyphectomy 3 or more","code_information":[{"code":"22819","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16759.24,"maximum":41847.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16759.24,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17094.42,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16926.83,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17262.02,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":41847.82,"additional_payer_notes":"APC"}]}]},{"description":"Ant thrc vrt body tethrg <7","code_information":[{"code":"22836","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16759.24,"maximum":41847.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16759.24,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17094.42,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16926.83,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17262.02,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":41847.82,"additional_payer_notes":"APC"}]}]},{"description":"Ant thrc vrt body tethrg 8+","code_information":[{"code":"22837","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16759.24,"maximum":41847.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16759.24,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17094.42,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16926.83,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17262.02,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":41847.82,"additional_payer_notes":"APC"}]}]},{"description":"Rev rplc/rmv thrc vrt tethrg","code_information":[{"code":"22838","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16759.24,"maximum":41847.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16759.24,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17094.42,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16926.83,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17262.02,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":41847.82,"additional_payer_notes":"APC"}]}]},{"description":"Cerv artific diskectomy","code_information":[{"code":"22856","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16759.24,"maximum":41847.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16759.24,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17094.42,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16926.83,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17262.02,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":41847.82,"additional_payer_notes":"APC"}]}]},{"description":"Lumbar Artif Diskectomy","code_information":[{"code":"22857","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16759.24,"maximum":41847.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16759.24,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17094.42,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16926.83,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17262.02,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":41847.82,"additional_payer_notes":"APC"}]}]},{"description":"Revise cerv artific disc","code_information":[{"code":"22861","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16759.24,"maximum":41847.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16759.24,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17094.42,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16926.83,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17262.02,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":41847.82,"additional_payer_notes":"APC"}]}]},{"description":"Revise Lumbar Artif Disc","code_information":[{"code":"22862","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16759.24,"maximum":41847.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16759.24,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17094.42,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16926.83,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17262.02,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":41847.82,"additional_payer_notes":"APC"}]}]},{"description":"Insj stablj dev w/dcmprn","code_information":[{"code":"22867","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16759.24,"maximum":41847.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16759.24,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17094.42,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16926.83,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17262.02,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":41847.82,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruct shoulder joint","code_information":[{"code":"23472","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16759.24,"maximum":41847.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16759.24,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17094.42,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16926.83,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17262.02,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":41847.82,"additional_payer_notes":"APC"}]}]},{"description":"Treat humerus fracture","code_information":[{"code":"23616","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16759.24,"maximum":41847.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16759.24,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17094.42,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16926.83,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17262.02,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":41847.82,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruct elbow joint","code_information":[{"code":"24361","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16759.24,"maximum":41847.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16759.24,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17094.42,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16926.83,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17262.02,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":41847.82,"additional_payer_notes":"APC"}]}]},{"description":"Replace elbow joint","code_information":[{"code":"24363","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16759.24,"maximum":41847.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16759.24,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17094.42,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16926.83,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17262.02,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":41847.82,"additional_payer_notes":"APC"}]}]},{"description":"Revise reconst elbow joint","code_information":[{"code":"24371","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16759.24,"maximum":41847.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16759.24,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17094.42,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16926.83,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17262.02,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":41847.82,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruct wrist joint","code_information":[{"code":"25442","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16759.24,"maximum":41847.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16759.24,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17094.42,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16926.83,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17262.02,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":41847.82,"additional_payer_notes":"APC"}]}]},{"description":"Wrist replacement","code_information":[{"code":"25446","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16759.24,"maximum":41847.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16759.24,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17094.42,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16926.83,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17262.02,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":41847.82,"additional_payer_notes":"APC"}]}]},{"description":"Arthrd si jt prq wo tfxj dev","code_information":[{"code":"27278","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16759.24,"maximum":41847.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16759.24,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17094.42,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16926.83,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17262.02,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":41847.82,"additional_payer_notes":"APC"}]}]},{"description":"Arthrodesis sacroiliac joint","code_information":[{"code":"27279","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16759.24,"maximum":41847.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16759.24,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17094.42,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16926.83,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17262.02,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":41847.82,"additional_payer_notes":"APC"}]}]},{"description":"Fusion of sacroiliac joint","code_information":[{"code":"27280","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16759.24,"maximum":41847.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16759.24,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17094.42,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16926.83,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17262.02,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":41847.82,"additional_payer_notes":"APC"}]}]},{"description":"Amputation of leg at hip","code_information":[{"code":"27290","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16759.24,"maximum":41847.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16759.24,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17094.42,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16926.83,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17262.02,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":41847.82,"additional_payer_notes":"APC"}]}]},{"description":"Amputation of leg at hip","code_information":[{"code":"27295","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16759.24,"maximum":41847.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16759.24,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17094.42,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16926.83,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17262.02,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":41847.82,"additional_payer_notes":"APC"}]}]},{"description":"Revise/replace knee joint","code_information":[{"code":"27487","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16759.24,"maximum":41847.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16759.24,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17094.42,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16926.83,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17262.02,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":41847.82,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruction ankle joint","code_information":[{"code":"27703","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16759.24,"maximum":41847.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16759.24,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17094.42,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16926.83,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17262.02,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":41847.82,"additional_payer_notes":"APC"}]}]},{"description":"Fusion of foot bones","code_information":[{"code":"28705","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16759.24,"maximum":41847.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16759.24,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17094.42,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16926.83,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17262.02,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":41847.82,"additional_payer_notes":"APC"}]}]},{"description":"Imp extar knee shck absrb","code_information":[{"code":"C8003","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16759.24,"maximum":41847.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16759.24,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17094.42,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16926.83,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17262.02,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":41847.82,"additional_payer_notes":"APC"}]}]},{"description":"Nasal endoscopy dx","code_information":[{"code":"31231","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":190.79,"maximum":476.40,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":190.79,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":194.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":192.7,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":196.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":476.4,"additional_payer_notes":"APC"}]}]},{"description":"Diagnostic laryngoscopy","code_information":[{"code":"31505","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":190.79,"maximum":476.40,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":190.79,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":194.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":192.7,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":196.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":476.4,"additional_payer_notes":"APC"}]}]},{"description":"Remove foreign body larynx","code_information":[{"code":"31511","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":190.79,"maximum":476.40,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":190.79,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":194.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":192.7,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":196.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":476.4,"additional_payer_notes":"APC"}]}]},{"description":"Diagnostic laryngoscopy","code_information":[{"code":"31575","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":190.79,"maximum":476.40,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":190.79,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":194.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":192.7,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":196.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":476.4,"additional_payer_notes":"APC"}]}]},{"description":"Airways surgical procedure","code_information":[{"code":"31899","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":190.79,"maximum":476.40,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":190.79,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":194.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":192.7,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":196.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":476.4,"additional_payer_notes":"APC"}]}]},{"description":"Nasopharyngoscopy","code_information":[{"code":"92511","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":190.79,"maximum":476.40,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":190.79,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":194.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":192.7,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":196.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":476.4,"additional_payer_notes":"APC"}]}]},{"description":"Nasal/sinus endoscopy dx","code_information":[{"code":"31235","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1701.27,"maximum":4248.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1701.27,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1735.29,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1718.28,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1752.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4248.07,"additional_payer_notes":"APC"}]}]},{"description":"Nasal/sinus endoscopy surg","code_information":[{"code":"31237","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1701.27,"maximum":4248.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1701.27,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1735.29,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1718.28,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1752.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4248.07,"additional_payer_notes":"APC"}]}]},{"description":"Nasal/sinus endoscopy surg","code_information":[{"code":"31238","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1701.27,"maximum":4248.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1701.27,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1735.29,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1718.28,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1752.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4248.07,"additional_payer_notes":"APC"}]}]},{"description":"Nasal/sinus endoscopy surg","code_information":[{"code":"31240","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1701.27,"maximum":4248.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1701.27,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1735.29,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1718.28,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1752.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4248.07,"additional_payer_notes":"APC"}]}]},{"description":"Nsl/sins ndsc w/artery lig","code_information":[{"code":"31241","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1701.27,"maximum":4248.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1701.27,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1735.29,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1718.28,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1752.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4248.07,"additional_payer_notes":"APC"}]}]},{"description":"Dx laryngoscopy excl nb","code_information":[{"code":"31525","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1701.27,"maximum":4248.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1701.27,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1735.29,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1718.28,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1752.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4248.07,"additional_payer_notes":"APC"}]}]},{"description":"Dx laryngoscopy w/oper scope","code_information":[{"code":"31526","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1701.27,"maximum":4248.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1701.27,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1735.29,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1718.28,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1752.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4248.07,"additional_payer_notes":"APC"}]}]},{"description":"Laryngoscopy w/fb removal","code_information":[{"code":"31530","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1701.27,"maximum":4248.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1701.27,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1735.29,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1718.28,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1752.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4248.07,"additional_payer_notes":"APC"}]}]},{"description":"Largsc w/ther injection","code_information":[{"code":"31573","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1701.27,"maximum":4248.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1701.27,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1735.29,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1718.28,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1752.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4248.07,"additional_payer_notes":"APC"}]}]},{"description":"Largsc w/njx augmentation","code_information":[{"code":"31574","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1701.27,"maximum":4248.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1701.27,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1735.29,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1718.28,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1752.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4248.07,"additional_payer_notes":"APC"}]}]},{"description":"Laryngoscopy with biopsy","code_information":[{"code":"31576","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1701.27,"maximum":4248.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1701.27,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1735.29,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1718.28,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1752.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4248.07,"additional_payer_notes":"APC"}]}]},{"description":"Dx bronchoscope/wash","code_information":[{"code":"31622","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1701.27,"maximum":4248.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1701.27,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1735.29,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1718.28,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1752.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4248.07,"additional_payer_notes":"APC"}]}]},{"description":"Dx bronchoscope/brush","code_information":[{"code":"31623","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1701.27,"maximum":4248.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1701.27,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1735.29,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1718.28,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1752.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4248.07,"additional_payer_notes":"APC"}]}]},{"description":"Dx bronchoscope/lavage","code_information":[{"code":"31624","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1701.27,"maximum":4248.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1701.27,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1735.29,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1718.28,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1752.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4248.07,"additional_payer_notes":"APC"}]}]},{"description":"Bronchoscopy w/biopsy(s)","code_information":[{"code":"31625","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1701.27,"maximum":4248.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1701.27,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1735.29,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1718.28,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1752.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4248.07,"additional_payer_notes":"APC"}]}]},{"description":"Bronchoscopy w/fb removal","code_information":[{"code":"31635","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1701.27,"maximum":4248.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1701.27,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1735.29,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1718.28,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1752.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4248.07,"additional_payer_notes":"APC"}]}]},{"description":"Diag bronchoscope/catheter","code_information":[{"code":"31643","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1701.27,"maximum":4248.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1701.27,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1735.29,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1718.28,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1752.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4248.07,"additional_payer_notes":"APC"}]}]},{"description":"Bronchoscopy clear airways","code_information":[{"code":"31645","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1701.27,"maximum":4248.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1701.27,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1735.29,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1718.28,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1752.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4248.07,"additional_payer_notes":"APC"}]}]},{"description":"Bronchial valve remov addl","code_information":[{"code":"31649","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1701.27,"maximum":4248.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1701.27,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1735.29,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1718.28,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1752.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4248.07,"additional_payer_notes":"APC"}]}]},{"description":"Intro windpipe wire/tube","code_information":[{"code":"31730","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1701.27,"maximum":4248.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1701.27,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1735.29,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1718.28,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1752.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4248.07,"additional_payer_notes":"APC"}]}]},{"description":"Dise eval slp do brth flx dx","code_information":[{"code":"42975","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1701.27,"maximum":4248.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1701.27,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1735.29,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1718.28,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1752.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4248.07,"additional_payer_notes":"APC"}]}]},{"description":"Nasal/sinus endoscopy surg","code_information":[{"code":"31239","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3563.64,"maximum":8898.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3563.64,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3634.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3599.28,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3670.55,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8898.41,"additional_payer_notes":"APC"}]}]},{"description":"Exploration maxillary sinus","code_information":[{"code":"31256","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3563.64,"maximum":8898.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3563.64,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3634.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3599.28,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3670.55,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8898.41,"additional_payer_notes":"APC"}]}]},{"description":"Laryngoscopy with biopsy","code_information":[{"code":"31510","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3563.64,"maximum":8898.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3563.64,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3634.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3599.28,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3670.55,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8898.41,"additional_payer_notes":"APC"}]}]},{"description":"Removal of larynx lesion","code_information":[{"code":"31512","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3563.64,"maximum":8898.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3563.64,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3634.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3599.28,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3670.55,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8898.41,"additional_payer_notes":"APC"}]}]},{"description":"Laryngoscopy for treatment","code_information":[{"code":"31527","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3563.64,"maximum":8898.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3563.64,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3634.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3599.28,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3670.55,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8898.41,"additional_payer_notes":"APC"}]}]},{"description":"Laryngoscopy and dilation","code_information":[{"code":"31528","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3563.64,"maximum":8898.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3563.64,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3634.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3599.28,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3670.55,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8898.41,"additional_payer_notes":"APC"}]}]},{"description":"Laryngoscopy and dilation","code_information":[{"code":"31529","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3563.64,"maximum":8898.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3563.64,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3634.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3599.28,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3670.55,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8898.41,"additional_payer_notes":"APC"}]}]},{"description":"Laryngoscopy w/fb & op scope","code_information":[{"code":"31531","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3563.64,"maximum":8898.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3563.64,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3634.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3599.28,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3670.55,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8898.41,"additional_payer_notes":"APC"}]}]},{"description":"Laryngoscopy w/biopsy","code_information":[{"code":"31535","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3563.64,"maximum":8898.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3563.64,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3634.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3599.28,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3670.55,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8898.41,"additional_payer_notes":"APC"}]}]},{"description":"Laryngoscopy w/bx & op scope","code_information":[{"code":"31536","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3563.64,"maximum":8898.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3563.64,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3634.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3599.28,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3670.55,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8898.41,"additional_payer_notes":"APC"}]}]},{"description":"Laryngoscopy w/exc of tumor","code_information":[{"code":"31540","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3563.64,"maximum":8898.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3563.64,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3634.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3599.28,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3670.55,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8898.41,"additional_payer_notes":"APC"}]}]},{"description":"Larynscop w/tumr exc + scope","code_information":[{"code":"31541","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3563.64,"maximum":8898.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3563.64,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3634.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3599.28,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3670.55,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8898.41,"additional_payer_notes":"APC"}]}]},{"description":"Remove vc lesion w/scope","code_information":[{"code":"31545","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3563.64,"maximum":8898.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3563.64,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3634.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3599.28,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3670.55,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8898.41,"additional_payer_notes":"APC"}]}]},{"description":"Laryngoscope w/vc inj","code_information":[{"code":"31570","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3563.64,"maximum":8898.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3563.64,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3634.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3599.28,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3670.55,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8898.41,"additional_payer_notes":"APC"}]}]},{"description":"Laryngoscop w/vc inj + scope","code_information":[{"code":"31571","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3563.64,"maximum":8898.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3563.64,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3634.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3599.28,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3670.55,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8898.41,"additional_payer_notes":"APC"}]}]},{"description":"Largsc w/laser dstrj les","code_information":[{"code":"31572","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3563.64,"maximum":8898.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3563.64,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3634.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3599.28,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3670.55,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8898.41,"additional_payer_notes":"APC"}]}]},{"description":"Largsc w/removal lesion","code_information":[{"code":"31578","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3563.64,"maximum":8898.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3563.64,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3634.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3599.28,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3670.55,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8898.41,"additional_payer_notes":"APC"}]}]},{"description":"Bronchoscopy/lung bx each","code_information":[{"code":"31628","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3563.64,"maximum":8898.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3563.64,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3634.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3599.28,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3670.55,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8898.41,"additional_payer_notes":"APC"}]}]},{"description":"Bronchoscopy/needle bx each","code_information":[{"code":"31629","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3563.64,"maximum":8898.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3563.64,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3634.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3599.28,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3670.55,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8898.41,"additional_payer_notes":"APC"}]}]},{"description":"Bronchoscopy dilate/fx repr","code_information":[{"code":"31630","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3563.64,"maximum":8898.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3563.64,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3634.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3599.28,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3670.55,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8898.41,"additional_payer_notes":"APC"}]}]},{"description":"Bronchoscopy w/tumor excise","code_information":[{"code":"31640","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3563.64,"maximum":8898.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3563.64,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3634.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3599.28,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3670.55,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8898.41,"additional_payer_notes":"APC"}]}]},{"description":"Bronchoscopy treat blockage","code_information":[{"code":"31641","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3563.64,"maximum":8898.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3563.64,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3634.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3599.28,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3670.55,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8898.41,"additional_payer_notes":"APC"}]}]},{"description":"Bronchial valve remov init","code_information":[{"code":"31648","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3563.64,"maximum":8898.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3563.64,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3634.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3599.28,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3670.55,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8898.41,"additional_payer_notes":"APC"}]}]},{"description":"Bronch ebus samplng 1/2 node","code_information":[{"code":"31652","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3563.64,"maximum":8898.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3563.64,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3634.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3599.28,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3670.55,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8898.41,"additional_payer_notes":"APC"}]}]},{"description":"Bronch ebus samplng 3/> node","code_information":[{"code":"31653","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3563.64,"maximum":8898.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3563.64,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3634.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3599.28,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3670.55,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8898.41,"additional_payer_notes":"APC"}]}]},{"description":"Nsl/sins ndsc total","code_information":[{"code":"31253","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6745.69,"maximum":16843.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6745.69,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6880.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6813.14,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6948.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":16843.98,"additional_payer_notes":"APC"}]}]},{"description":"Revision of ethmoid sinus","code_information":[{"code":"31254","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6745.69,"maximum":16843.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6745.69,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6880.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6813.14,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6948.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":16843.98,"additional_payer_notes":"APC"}]}]},{"description":"Removal of ethmoid sinus","code_information":[{"code":"31255","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6745.69,"maximum":16843.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6745.69,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6880.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6813.14,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6948.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":16843.98,"additional_payer_notes":"APC"}]}]},{"description":"Nsl/sins ndsc tot w/sphendt","code_information":[{"code":"31257","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6745.69,"maximum":16843.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6745.69,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6880.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6813.14,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6948.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":16843.98,"additional_payer_notes":"APC"}]}]},{"description":"Nsl/sins ndsc sphn tiss rmvl","code_information":[{"code":"31259","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6745.69,"maximum":16843.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6745.69,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6880.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6813.14,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6948.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":16843.98,"additional_payer_notes":"APC"}]}]},{"description":"Endoscopy maxillary sinus","code_information":[{"code":"31267","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6745.69,"maximum":16843.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6745.69,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6880.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6813.14,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6948.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":16843.98,"additional_payer_notes":"APC"}]}]},{"description":"Sinus endoscopy surgical","code_information":[{"code":"31276","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6745.69,"maximum":16843.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6745.69,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6880.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6813.14,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6948.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":16843.98,"additional_payer_notes":"APC"}]}]},{"description":"Nasal/sinus endoscopy surg","code_information":[{"code":"31287","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6745.69,"maximum":16843.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6745.69,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6880.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6813.14,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6948.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":16843.98,"additional_payer_notes":"APC"}]}]},{"description":"Nasal/sinus endoscopy surg","code_information":[{"code":"31288","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6745.69,"maximum":16843.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6745.69,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6880.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6813.14,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6948.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":16843.98,"additional_payer_notes":"APC"}]}]},{"description":"Nasal/sinus endoscopy surg","code_information":[{"code":"31292","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6745.69,"maximum":16843.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6745.69,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6880.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6813.14,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6948.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":16843.98,"additional_payer_notes":"APC"}]}]},{"description":"Nasal/sinus endoscopy surg","code_information":[{"code":"31293","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6745.69,"maximum":16843.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6745.69,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6880.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6813.14,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6948.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":16843.98,"additional_payer_notes":"APC"}]}]},{"description":"Nasal/sinus endoscopy surg","code_information":[{"code":"31294","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6745.69,"maximum":16843.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6745.69,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6880.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6813.14,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6948.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":16843.98,"additional_payer_notes":"APC"}]}]},{"description":"Sinus endo w/balloon dil","code_information":[{"code":"31295","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6745.69,"maximum":16843.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6745.69,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6880.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6813.14,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6948.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":16843.98,"additional_payer_notes":"APC"}]}]},{"description":"Sinus endo w/balloon dil","code_information":[{"code":"31296","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6745.69,"maximum":16843.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6745.69,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6880.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6813.14,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6948.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":16843.98,"additional_payer_notes":"APC"}]}]},{"description":"Sinus endo w/balloon dil","code_information":[{"code":"31297","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6745.69,"maximum":16843.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6745.69,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6880.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6813.14,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6948.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":16843.98,"additional_payer_notes":"APC"}]}]},{"description":"Nsl/sins ndsc w/sins dilat","code_information":[{"code":"31298","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6745.69,"maximum":16843.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6745.69,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6880.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6813.14,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6948.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":16843.98,"additional_payer_notes":"APC"}]}]},{"description":"Remove vc lesion scope/graft","code_information":[{"code":"31546","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6745.69,"maximum":16843.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6745.69,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6880.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6813.14,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6948.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":16843.98,"additional_payer_notes":"APC"}]}]},{"description":"Laryngoscop w/arytenoidectom","code_information":[{"code":"31560","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6745.69,"maximum":16843.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6745.69,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6880.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6813.14,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6948.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":16843.98,"additional_payer_notes":"APC"}]}]},{"description":"Larynscop remve cart + scop","code_information":[{"code":"31561","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6745.69,"maximum":16843.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6745.69,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6880.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6813.14,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6948.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":16843.98,"additional_payer_notes":"APC"}]}]},{"description":"Bronchoscopy w/markers","code_information":[{"code":"31626","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6745.69,"maximum":16843.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6745.69,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6880.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6813.14,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6948.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":16843.98,"additional_payer_notes":"APC"}]}]},{"description":"Bronchoscopy dilate w/stent","code_information":[{"code":"31631","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6745.69,"maximum":16843.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6745.69,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6880.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6813.14,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6948.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":16843.98,"additional_payer_notes":"APC"}]}]},{"description":"Bronch w/balloon occlusion","code_information":[{"code":"31634","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6745.69,"maximum":16843.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6745.69,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6880.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6813.14,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6948.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":16843.98,"additional_payer_notes":"APC"}]}]},{"description":"Bronchoscopy bronch stents","code_information":[{"code":"31636","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6745.69,"maximum":16843.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6745.69,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6880.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6813.14,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6948.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":16843.98,"additional_payer_notes":"APC"}]}]},{"description":"Bronchoscopy revise stent","code_information":[{"code":"31638","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6745.69,"maximum":16843.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6745.69,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6880.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6813.14,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6948.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":16843.98,"additional_payer_notes":"APC"}]}]},{"description":"Bronchial valve init insert","code_information":[{"code":"31647","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6745.69,"maximum":16843.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6745.69,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6880.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6813.14,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6948.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":16843.98,"additional_payer_notes":"APC"}]}]},{"description":"Bronch thermoplsty 1 lobe","code_information":[{"code":"31660","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6745.69,"maximum":16843.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6745.69,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6880.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6813.14,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6948.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":16843.98,"additional_payer_notes":"APC"}]}]},{"description":"Bronch thermoplsty 2/> lobes","code_information":[{"code":"31661","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6745.69,"maximum":16843.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6745.69,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6880.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6813.14,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6948.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":16843.98,"additional_payer_notes":"APC"}]}]},{"description":"Prepare face/oral prosthesis","code_information":[{"code":"21085","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":226.39,"maximum":565.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":226.39,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":230.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":228.65,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":233.18,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":565.29,"additional_payer_notes":"APC"}]}]},{"description":"Prepare face/oral prosthesis","code_information":[{"code":"21089","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":226.39,"maximum":565.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":226.39,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":230.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":228.65,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":233.18,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":565.29,"additional_payer_notes":"APC"}]}]},{"description":"Cranio/maxillofacial surgery","code_information":[{"code":"21299","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":226.39,"maximum":565.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":226.39,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":230.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":228.65,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":233.18,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":565.29,"additional_payer_notes":"APC"}]}]},{"description":"Head surgery procedure","code_information":[{"code":"21499","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":226.39,"maximum":565.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":226.39,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":230.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":228.65,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":233.18,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":565.29,"additional_payer_notes":"APC"}]}]},{"description":"Neck/chest surgery procedure","code_information":[{"code":"21899","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":226.39,"maximum":565.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":226.39,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":230.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":228.65,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":233.18,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":565.29,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of nose lesion","code_information":[{"code":"30000","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":226.39,"maximum":565.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":226.39,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":230.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":228.65,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":233.18,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":565.29,"additional_payer_notes":"APC"}]}]},{"description":"Repeat control of nosebleed","code_information":[{"code":"30906","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":226.39,"maximum":565.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":226.39,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":230.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":228.65,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":233.18,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":565.29,"additional_payer_notes":"APC"}]}]},{"description":"Nasal surgery procedure","code_information":[{"code":"30999","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":226.39,"maximum":565.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":226.39,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":230.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":228.65,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":233.18,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":565.29,"additional_payer_notes":"APC"}]}]},{"description":"Irrigation maxillary sinus","code_information":[{"code":"31000","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":226.39,"maximum":565.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":226.39,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":230.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":228.65,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":233.18,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":565.29,"additional_payer_notes":"APC"}]}]},{"description":"Sinus surgery procedure","code_information":[{"code":"31299","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":226.39,"maximum":565.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":226.39,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":230.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":228.65,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":233.18,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":565.29,"additional_payer_notes":"APC"}]}]},{"description":"Insert emergency airway","code_information":[{"code":"31500","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":226.39,"maximum":565.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":226.39,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":230.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":228.65,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":233.18,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":565.29,"additional_payer_notes":"APC"}]}]},{"description":"Change of windpipe airway","code_information":[{"code":"31502","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":226.39,"maximum":565.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":226.39,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":230.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":228.65,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":233.18,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":565.29,"additional_payer_notes":"APC"}]}]},{"description":"Larynx surgery procedure","code_information":[{"code":"31599","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":226.39,"maximum":565.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":226.39,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":230.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":228.65,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":233.18,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":565.29,"additional_payer_notes":"APC"}]}]},{"description":"Incision of windpipe","code_information":[{"code":"31605","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":226.39,"maximum":565.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":226.39,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":230.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":228.65,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":233.18,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":565.29,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy of lip","code_information":[{"code":"40490","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":226.39,"maximum":565.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":226.39,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":230.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":228.65,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":233.18,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":565.29,"additional_payer_notes":"APC"}]}]},{"description":"Lip surgery procedure","code_information":[{"code":"40799","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":226.39,"maximum":565.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":226.39,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":230.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":228.65,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":233.18,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":565.29,"additional_payer_notes":"APC"}]}]},{"description":"Repair mouth laceration","code_information":[{"code":"40830","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":226.39,"maximum":565.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":226.39,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":230.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":228.65,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":233.18,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":565.29,"additional_payer_notes":"APC"}]}]},{"description":"Mouth surgery procedure","code_information":[{"code":"40899","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":226.39,"maximum":565.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":226.39,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":230.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":228.65,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":233.18,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":565.29,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of mouth lesion","code_information":[{"code":"41005","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":226.39,"maximum":565.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":226.39,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":230.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":228.65,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":233.18,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":565.29,"additional_payer_notes":"APC"}]}]},{"description":"Repair tongue laceration","code_information":[{"code":"41251","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":226.39,"maximum":565.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":226.39,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":230.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":228.65,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":233.18,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":565.29,"additional_payer_notes":"APC"}]}]},{"description":"Repair tongue laceration","code_information":[{"code":"41252","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":226.39,"maximum":565.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":226.39,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":230.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":228.65,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":233.18,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":565.29,"additional_payer_notes":"APC"}]}]},{"description":"Tongue and mouth surgery","code_information":[{"code":"41599","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":226.39,"maximum":565.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":226.39,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":230.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":228.65,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":233.18,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":565.29,"additional_payer_notes":"APC"}]}]},{"description":"Dental surgery procedure","code_information":[{"code":"41899","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":226.39,"maximum":565.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":226.39,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":230.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":228.65,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":233.18,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":565.29,"additional_payer_notes":"APC"}]}]},{"description":"Drainage mouth roof lesion","code_information":[{"code":"42000","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":226.39,"maximum":565.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":226.39,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":230.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":228.65,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":233.18,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":565.29,"additional_payer_notes":"APC"}]}]},{"description":"Palate/uvula surgery","code_information":[{"code":"42299","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":226.39,"maximum":565.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":226.39,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":230.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":228.65,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":233.18,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":565.29,"additional_payer_notes":"APC"}]}]},{"description":"Salivary surgery procedure","code_information":[{"code":"42699","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":226.39,"maximum":565.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":226.39,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":230.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":228.65,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":233.18,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":565.29,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of tonsil abscess","code_information":[{"code":"42700","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":226.39,"maximum":565.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":226.39,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":230.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":228.65,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":233.18,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":565.29,"additional_payer_notes":"APC"}]}]},{"description":"Control nose/throat bleeding","code_information":[{"code":"42970","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":226.39,"maximum":565.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":226.39,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":230.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":228.65,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":233.18,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":565.29,"additional_payer_notes":"APC"}]}]},{"description":"Throat surgery procedure","code_information":[{"code":"42999","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":226.39,"maximum":565.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":226.39,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":230.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":228.65,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":233.18,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":565.29,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy of external ear","code_information":[{"code":"69100","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":226.39,"maximum":565.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":226.39,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":230.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":228.65,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":233.18,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":565.29,"additional_payer_notes":"APC"}]}]},{"description":"Outer ear surgery procedure","code_information":[{"code":"69399","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":226.39,"maximum":565.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":226.39,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":230.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":228.65,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":233.18,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":565.29,"additional_payer_notes":"APC"}]}]},{"description":"Incision of eardrum","code_information":[{"code":"69420","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":226.39,"maximum":565.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":226.39,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":230.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":228.65,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":233.18,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":565.29,"additional_payer_notes":"APC"}]}]},{"description":"Middle ear surgery procedure","code_information":[{"code":"69799","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":226.39,"maximum":565.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":226.39,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":230.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":228.65,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":233.18,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":565.29,"additional_payer_notes":"APC"}]}]},{"description":"Inner ear surgery procedure","code_information":[{"code":"69949","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":226.39,"maximum":565.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":226.39,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":230.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":228.65,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":233.18,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":565.29,"additional_payer_notes":"APC"}]}]},{"description":"Temporal bone surgery","code_information":[{"code":"69979","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":226.39,"maximum":565.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":226.39,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":230.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":228.65,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":233.18,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":565.29,"additional_payer_notes":"APC"}]}]},{"description":"Unspecified periodontal proc","code_information":[{"code":"D4999","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":226.39,"maximum":565.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":226.39,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":230.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":228.65,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":233.18,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":565.29,"additional_payer_notes":"APC"}]}]},{"description":"Explore wound neck","code_information":[{"code":"20100","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":515.50,"maximum":1287.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":515.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":525.81,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":520.66,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":530.97,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1287.21,"additional_payer_notes":"APC"}]}]},{"description":"Closed tx orbit w/o manipulj","code_information":[{"code":"21400","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":515.50,"maximum":1287.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":515.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":525.81,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":520.66,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":530.97,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1287.21,"additional_payer_notes":"APC"}]}]},{"description":"Treat lower jaw fracture","code_information":[{"code":"21450","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":515.50,"maximum":1287.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":515.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":525.81,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":520.66,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":530.97,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1287.21,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of nose lesion","code_information":[{"code":"30020","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":515.50,"maximum":1287.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":515.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":525.81,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":520.66,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":530.97,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1287.21,"additional_payer_notes":"APC"}]}]},{"description":"Injection treatment of nose","code_information":[{"code":"30200","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":515.50,"maximum":1287.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":515.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":525.81,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":520.66,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":530.97,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1287.21,"additional_payer_notes":"APC"}]}]},{"description":"Release of nasal adhesions","code_information":[{"code":"30560","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":515.50,"maximum":1287.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":515.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":525.81,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":520.66,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":530.97,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1287.21,"additional_payer_notes":"APC"}]}]},{"description":"Visualization of windpipe","code_information":[{"code":"31615","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":515.50,"maximum":1287.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":515.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":525.81,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":520.66,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":530.97,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1287.21,"additional_payer_notes":"APC"}]}]},{"description":"Repair lip","code_information":[{"code":"40650","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":515.50,"maximum":1287.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":515.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":525.81,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":520.66,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":530.97,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1287.21,"additional_payer_notes":"APC"}]}]},{"description":"Repair lip","code_information":[{"code":"40652","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":515.50,"maximum":1287.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":515.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":525.81,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":520.66,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":530.97,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1287.21,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of mouth lesion","code_information":[{"code":"40801","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":515.50,"maximum":1287.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":515.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":525.81,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":520.66,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":530.97,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1287.21,"additional_payer_notes":"APC"}]}]},{"description":"Removal foreign body mouth","code_information":[{"code":"40805","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":515.50,"maximum":1287.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":515.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":525.81,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":520.66,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":530.97,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1287.21,"additional_payer_notes":"APC"}]}]},{"description":"Incision of lip fold","code_information":[{"code":"40806","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":515.50,"maximum":1287.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":515.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":525.81,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":520.66,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":530.97,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1287.21,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy of mouth lesion","code_information":[{"code":"40808","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":515.50,"maximum":1287.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":515.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":525.81,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":520.66,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":530.97,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1287.21,"additional_payer_notes":"APC"}]}]},{"description":"Excise oral mucosa for graft","code_information":[{"code":"40818","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":515.50,"maximum":1287.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":515.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":525.81,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":520.66,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":530.97,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1287.21,"additional_payer_notes":"APC"}]}]},{"description":"Repair mouth laceration","code_information":[{"code":"40831","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":515.50,"maximum":1287.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":515.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":525.81,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":520.66,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":530.97,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1287.21,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of mouth lesion","code_information":[{"code":"41000","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":515.50,"maximum":1287.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":515.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":525.81,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":520.66,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":530.97,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1287.21,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of mouth lesion","code_information":[{"code":"41009","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":515.50,"maximum":1287.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":515.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":525.81,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":520.66,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":530.97,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1287.21,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of mouth lesion","code_information":[{"code":"41015","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":515.50,"maximum":1287.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":515.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":525.81,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":520.66,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":530.97,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1287.21,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy of tongue","code_information":[{"code":"41100","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":515.50,"maximum":1287.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":515.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":525.81,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":520.66,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":530.97,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1287.21,"additional_payer_notes":"APC"}]}]},{"description":"Repair palate","code_information":[{"code":"42180","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":515.50,"maximum":1287.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":515.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":525.81,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":520.66,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":530.97,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1287.21,"additional_payer_notes":"APC"}]}]},{"description":"Preparation palate mold","code_information":[{"code":"42280","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":515.50,"maximum":1287.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":515.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":525.81,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":520.66,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":530.97,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1287.21,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of salivary gland","code_information":[{"code":"42310","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":515.50,"maximum":1287.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":515.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":525.81,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":520.66,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":530.97,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1287.21,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of salivary gland","code_information":[{"code":"42320","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":515.50,"maximum":1287.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":515.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":525.81,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":520.66,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":530.97,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1287.21,"additional_payer_notes":"APC"}]}]},{"description":"Dilation of salivary duct","code_information":[{"code":"42660","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":515.50,"maximum":1287.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":515.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":525.81,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":520.66,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":530.97,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1287.21,"additional_payer_notes":"APC"}]}]},{"description":"Control throat bleeding","code_information":[{"code":"42960","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":515.50,"maximum":1287.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":515.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":525.81,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":520.66,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":530.97,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1287.21,"additional_payer_notes":"APC"}]}]},{"description":"Clean out mastoid cavity","code_information":[{"code":"69222","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":515.50,"maximum":1287.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":515.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":525.81,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":520.66,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":530.97,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1287.21,"additional_payer_notes":"APC"}]}]},{"description":"Create eardrum opening","code_information":[{"code":"69433","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":515.50,"maximum":1287.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":515.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":525.81,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":520.66,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":530.97,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1287.21,"additional_payer_notes":"APC"}]}]},{"description":"Ear and throat examination","code_information":[{"code":"92502","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":515.50,"maximum":1287.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":515.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":525.81,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":520.66,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":530.97,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1287.21,"additional_payer_notes":"APC"}]}]},{"description":"Tmpst auto tube dlvr sys","code_information":[{"code":"0583T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1483.04,"maximum":3703.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1483.04,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1512.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1497.87,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1527.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3703.15,"additional_payer_notes":"APC"}]}]},{"description":"Injection of sinus tract","code_information":[{"code":"20500","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1483.04,"maximum":3703.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1483.04,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1512.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1497.87,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1527.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3703.15,"additional_payer_notes":"APC"}]}]},{"description":"Mnpj of tmj w/anesth","code_information":[{"code":"21073","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1483.04,"maximum":3703.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1483.04,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1512.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1497.87,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1527.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3703.15,"additional_payer_notes":"APC"}]}]},{"description":"Prepare face/oral prosthesis","code_information":[{"code":"21076","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1483.04,"maximum":3703.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1483.04,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1512.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1497.87,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1527.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3703.15,"additional_payer_notes":"APC"}]}]},{"description":"Interdental fixation","code_information":[{"code":"21110","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1483.04,"maximum":3703.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1483.04,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1512.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1497.87,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1527.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3703.15,"additional_payer_notes":"APC"}]}]},{"description":"Revision of jaw muscle/bone","code_information":[{"code":"21295","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1483.04,"maximum":3703.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1483.04,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1512.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1497.87,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1527.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3703.15,"additional_payer_notes":"APC"}]}]},{"description":"Closed tx nose fx w/o stablj","code_information":[{"code":"21315","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1483.04,"maximum":3703.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1483.04,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1512.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1497.87,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1527.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3703.15,"additional_payer_notes":"APC"}]}]},{"description":"Closed tx nose/jaw fx","code_information":[{"code":"21345","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1483.04,"maximum":3703.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1483.04,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1512.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1497.87,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1527.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3703.15,"additional_payer_notes":"APC"}]}]},{"description":"Closed tx orbit w/manipulj","code_information":[{"code":"21401","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1483.04,"maximum":3703.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1483.04,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1512.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1497.87,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1527.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3703.15,"additional_payer_notes":"APC"}]}]},{"description":"Treat lower jaw fracture","code_information":[{"code":"21451","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1483.04,"maximum":3703.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1483.04,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1512.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1497.87,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1527.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3703.15,"additional_payer_notes":"APC"}]}]},{"description":"Reset dislocated jaw","code_information":[{"code":"21485","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1483.04,"maximum":3703.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1483.04,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1512.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1497.87,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1527.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3703.15,"additional_payer_notes":"APC"}]}]},{"description":"Interdental wiring","code_information":[{"code":"21497","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1483.04,"maximum":3703.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1483.04,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1512.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1497.87,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1527.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3703.15,"additional_payer_notes":"APC"}]}]},{"description":"Intranasal biopsy","code_information":[{"code":"30100","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1483.04,"maximum":3703.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1483.04,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1512.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1497.87,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1527.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3703.15,"additional_payer_notes":"APC"}]}]},{"description":"Removal of nose polyp(s)","code_information":[{"code":"30110","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1483.04,"maximum":3703.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1483.04,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1512.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1497.87,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1527.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3703.15,"additional_payer_notes":"APC"}]}]},{"description":"Removal of nose lesion","code_information":[{"code":"30124","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1483.04,"maximum":3703.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1483.04,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1512.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1497.87,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1527.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3703.15,"additional_payer_notes":"APC"}]}]},{"description":"Nasal sinus therapy","code_information":[{"code":"30210","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1483.04,"maximum":3703.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1483.04,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1512.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1497.87,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1527.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3703.15,"additional_payer_notes":"APC"}]}]},{"description":"Insert nasal septal button","code_information":[{"code":"30220","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1483.04,"maximum":3703.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1483.04,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1512.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1497.87,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1527.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3703.15,"additional_payer_notes":"APC"}]}]},{"description":"Remove nasal foreign body","code_information":[{"code":"30320","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1483.04,"maximum":3703.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1483.04,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1512.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1497.87,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1527.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3703.15,"additional_payer_notes":"APC"}]}]},{"description":"Ablate inf turbinate superf","code_information":[{"code":"30801","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1483.04,"maximum":3703.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1483.04,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1512.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1497.87,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1527.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3703.15,"additional_payer_notes":"APC"}]}]},{"description":"Ablate inf turbinate submuc","code_information":[{"code":"30802","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1483.04,"maximum":3703.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1483.04,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1512.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1497.87,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1527.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3703.15,"additional_payer_notes":"APC"}]}]},{"description":"Irrigation sphenoid sinus","code_information":[{"code":"31002","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1483.04,"maximum":3703.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1483.04,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1512.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1497.87,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1527.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3703.15,"additional_payer_notes":"APC"}]}]},{"description":"Removal of ethmoid sinus","code_information":[{"code":"31201","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1483.04,"maximum":3703.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1483.04,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1512.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1497.87,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1527.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3703.15,"additional_payer_notes":"APC"}]}]},{"description":"Incision of windpipe","code_information":[{"code":"31603","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1483.04,"maximum":3703.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1483.04,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1512.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1497.87,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1527.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3703.15,"additional_payer_notes":"APC"}]}]},{"description":"Repair lip","code_information":[{"code":"40654","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1483.04,"maximum":3703.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1483.04,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1512.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1497.87,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1527.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3703.15,"additional_payer_notes":"APC"}]}]},{"description":"Excise/repair mouth lesion","code_information":[{"code":"40812","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1483.04,"maximum":3703.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1483.04,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1512.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1497.87,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1527.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3703.15,"additional_payer_notes":"APC"}]}]},{"description":"Excise lip or cheek fold","code_information":[{"code":"40819","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1483.04,"maximum":3703.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1483.04,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1512.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1497.87,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1527.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3703.15,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of mouth lesion","code_information":[{"code":"41006","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1483.04,"maximum":3703.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1483.04,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1512.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1497.87,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1527.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3703.15,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of mouth lesion","code_information":[{"code":"41007","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1483.04,"maximum":3703.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1483.04,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1512.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1497.87,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1527.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3703.15,"additional_payer_notes":"APC"}]}]},{"description":"Incision of tongue fold","code_information":[{"code":"41010","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1483.04,"maximum":3703.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1483.04,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1512.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1497.87,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1527.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3703.15,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of mouth lesion","code_information":[{"code":"41018","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1483.04,"maximum":3703.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1483.04,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1512.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1497.87,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1527.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3703.15,"additional_payer_notes":"APC"}]}]},{"description":"Excision of tongue fold","code_information":[{"code":"41115","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1483.04,"maximum":3703.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1483.04,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1512.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1497.87,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1527.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3703.15,"additional_payer_notes":"APC"}]}]},{"description":"Removal foreign body gum","code_information":[{"code":"41805","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1483.04,"maximum":3703.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1483.04,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1512.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1497.87,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1527.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3703.15,"additional_payer_notes":"APC"}]}]},{"description":"Removal foreign body jawbone","code_information":[{"code":"41806","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1483.04,"maximum":3703.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1483.04,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1512.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1497.87,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1527.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3703.15,"additional_payer_notes":"APC"}]}]},{"description":"Excision of gum flap","code_information":[{"code":"41821","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1483.04,"maximum":3703.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1483.04,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1512.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1497.87,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1527.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3703.15,"additional_payer_notes":"APC"}]}]},{"description":"Excision of gum lesion","code_information":[{"code":"41822","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1483.04,"maximum":3703.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1483.04,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1512.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1497.87,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1527.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3703.15,"additional_payer_notes":"APC"}]}]},{"description":"Excision of gum lesion","code_information":[{"code":"41828","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1483.04,"maximum":3703.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1483.04,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1512.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1497.87,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1527.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3703.15,"additional_payer_notes":"APC"}]}]},{"description":"Treatment of gum lesion","code_information":[{"code":"41850","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1483.04,"maximum":3703.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1483.04,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1512.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1497.87,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1527.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3703.15,"additional_payer_notes":"APC"}]}]},{"description":"Gum graft","code_information":[{"code":"41870","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1483.04,"maximum":3703.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1483.04,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1512.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1497.87,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1527.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3703.15,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy roof of mouth","code_information":[{"code":"42100","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1483.04,"maximum":3703.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1483.04,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1512.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1497.87,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1527.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3703.15,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of salivary gland","code_information":[{"code":"42300","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1483.04,"maximum":3703.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1483.04,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1512.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1497.87,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1527.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3703.15,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy of salivary gland","code_information":[{"code":"42405","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1483.04,"maximum":3703.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1483.04,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1512.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1497.87,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1527.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3703.15,"additional_payer_notes":"APC"}]}]},{"description":"Dilation of salivary duct","code_information":[{"code":"42650","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1483.04,"maximum":3703.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1483.04,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1512.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1497.87,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1527.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3703.15,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy of throat","code_information":[{"code":"42800","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1483.04,"maximum":3703.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1483.04,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1512.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1497.87,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1527.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3703.15,"additional_payer_notes":"APC"}]}]},{"description":"Repair throat wound","code_information":[{"code":"42900","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1483.04,"maximum":3703.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1483.04,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1512.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1497.87,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1527.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3703.15,"additional_payer_notes":"APC"}]}]},{"description":"Surgical opening of throat","code_information":[{"code":"42955","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1483.04,"maximum":3703.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1483.04,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1512.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1497.87,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1527.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3703.15,"additional_payer_notes":"APC"}]}]},{"description":"Incision of esophagus","code_information":[{"code":"43020","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1483.04,"maximum":3703.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1483.04,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1512.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1497.87,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1527.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3703.15,"additional_payer_notes":"APC"}]}]},{"description":"Drain thyroid/tongue cyst","code_information":[{"code":"60000","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1483.04,"maximum":3703.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1483.04,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1512.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1497.87,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1527.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3703.15,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy of external ear canal","code_information":[{"code":"69105","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1483.04,"maximum":3703.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1483.04,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1512.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1497.87,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1527.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3703.15,"additional_payer_notes":"APC"}]}]},{"description":"Create eardrum opening","code_information":[{"code":"69436","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1483.04,"maximum":3703.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1483.04,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1512.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1497.87,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1527.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3703.15,"additional_payer_notes":"APC"}]}]},{"description":"Remove ear lesion","code_information":[{"code":"69540","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1483.04,"maximum":3703.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1483.04,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1512.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1497.87,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1527.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3703.15,"additional_payer_notes":"APC"}]}]},{"description":"Repair of eardrum","code_information":[{"code":"69610","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1483.04,"maximum":3703.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1483.04,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1512.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1497.87,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1527.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3703.15,"additional_payer_notes":"APC"}]}]},{"description":"Close mastoid fistula","code_information":[{"code":"69700","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1483.04,"maximum":3703.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1483.04,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1512.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1497.87,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1527.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3703.15,"additional_payer_notes":"APC"}]}]},{"description":"Incise inner ear","code_information":[{"code":"69801","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1483.04,"maximum":3703.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1483.04,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1512.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1497.87,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1527.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3703.15,"additional_payer_notes":"APC"}]}]},{"description":"Insert palate implants","code_information":[{"code":"C9727","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1483.04,"maximum":3703.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1483.04,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1512.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1497.87,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1527.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3703.15,"additional_payer_notes":"APC"}]}]},{"description":"Ana crown exp 1-3 per quad","code_information":[{"code":"D4231","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1483.04,"maximum":3703.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1483.04,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1512.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1497.87,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1527.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3703.15,"additional_payer_notes":"APC"}]}]},{"description":"Gngvl flap w rootplan 1-3 th","code_information":[{"code":"D4241","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1483.04,"maximum":3703.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1483.04,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1512.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1497.87,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1527.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3703.15,"additional_payer_notes":"APC"}]}]},{"description":"Apically positioned flap","code_information":[{"code":"D4245","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1483.04,"maximum":3703.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1483.04,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1512.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1497.87,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1527.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3703.15,"additional_payer_notes":"APC"}]}]},{"description":"Guided tiss regen resorble","code_information":[{"code":"D4266","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1483.04,"maximum":3703.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1483.04,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1512.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1497.87,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1527.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3703.15,"additional_payer_notes":"APC"}]}]},{"description":"Guided tiss regen nonresorb","code_information":[{"code":"D4267","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1483.04,"maximum":3703.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1483.04,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1512.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1497.87,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1527.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3703.15,"additional_payer_notes":"APC"}]}]},{"description":"Pedicle soft tissue graft pr","code_information":[{"code":"D4270","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1483.04,"maximum":3703.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1483.04,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1512.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1497.87,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1527.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3703.15,"additional_payer_notes":"APC"}]}]},{"description":"Auto tissue graft 1st tooth","code_information":[{"code":"D4273","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1483.04,"maximum":3703.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1483.04,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1512.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1497.87,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1527.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3703.15,"additional_payer_notes":"APC"}]}]},{"description":"Non-auto graft 1st tooth","code_information":[{"code":"D4275","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1483.04,"maximum":3703.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1483.04,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1512.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1497.87,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1527.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3703.15,"additional_payer_notes":"APC"}]}]},{"description":"Con tissue w dble ped graft","code_information":[{"code":"D4276","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1483.04,"maximum":3703.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1483.04,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1512.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1497.87,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1527.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3703.15,"additional_payer_notes":"APC"}]}]},{"description":"Soft tissue graft firsttooth","code_information":[{"code":"D4277","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1483.04,"maximum":3703.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1483.04,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1512.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1497.87,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1527.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3703.15,"additional_payer_notes":"APC"}]}]},{"description":"Rem imp tooth w mucoper flp","code_information":[{"code":"D7210","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1483.04,"maximum":3703.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1483.04,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1512.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1497.87,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1527.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3703.15,"additional_payer_notes":"APC"}]}]},{"description":"Coronectomy","code_information":[{"code":"D7251","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1483.04,"maximum":3703.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1483.04,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1512.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1497.87,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1527.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3703.15,"additional_payer_notes":"APC"}]}]},{"description":"Alveoplasty w/ extraction","code_information":[{"code":"D7310","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1483.04,"maximum":3703.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1483.04,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1512.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1497.87,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1527.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3703.15,"additional_payer_notes":"APC"}]}]},{"description":"Alveoloplasty w/extract 1-3","code_information":[{"code":"D7311","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1483.04,"maximum":3703.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1483.04,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1512.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1497.87,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1527.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3703.15,"additional_payer_notes":"APC"}]}]},{"description":"Alveoplasty w/o extraction","code_information":[{"code":"D7320","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1483.04,"maximum":3703.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1483.04,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1512.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1497.87,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1527.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3703.15,"additional_payer_notes":"APC"}]}]},{"description":"Alveoloplasty not w/extracts","code_information":[{"code":"D7321","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1483.04,"maximum":3703.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1483.04,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1512.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1497.87,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1527.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3703.15,"additional_payer_notes":"APC"}]}]},{"description":"Rad exc lesion up to 1.25 cm","code_information":[{"code":"D7410","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1483.04,"maximum":3703.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1483.04,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1512.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1497.87,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1527.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3703.15,"additional_payer_notes":"APC"}]}]},{"description":"Excision benign lesion>1.25c","code_information":[{"code":"D7411","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1483.04,"maximum":3703.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1483.04,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1512.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1497.87,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1527.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3703.15,"additional_payer_notes":"APC"}]}]},{"description":"Excision benign lesion compl","code_information":[{"code":"D7412","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1483.04,"maximum":3703.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1483.04,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1512.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1497.87,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1527.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3703.15,"additional_payer_notes":"APC"}]}]},{"description":"Excision malig lesion<=1.25c","code_information":[{"code":"D7413","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1483.04,"maximum":3703.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1483.04,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1512.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1497.87,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1527.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3703.15,"additional_payer_notes":"APC"}]}]},{"description":"Excision malig lesion>1.25cm","code_information":[{"code":"D7414","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1483.04,"maximum":3703.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1483.04,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1512.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1497.87,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1527.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3703.15,"additional_payer_notes":"APC"}]}]},{"description":"Excision malig les complicat","code_information":[{"code":"D7415","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1483.04,"maximum":3703.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1483.04,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1512.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1497.87,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1527.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3703.15,"additional_payer_notes":"APC"}]}]},{"description":"I&cust prep jaw xpnsj 1arch","code_information":[{"code":"0964T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3168.99,"maximum":7912.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3168.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3232.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3200.68,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3264.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7912.98,"additional_payer_notes":"APC"}]}]},{"description":"I&cst prp jw xpn dl arch non","code_information":[{"code":"0965T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3168.99,"maximum":7912.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3168.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3232.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3200.68,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3264.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7912.98,"additional_payer_notes":"APC"}]}]},{"description":"I&cst prp jw xpn dl arch fxd","code_information":[{"code":"0966T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3168.99,"maximum":7912.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3168.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3232.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3200.68,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3264.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7912.98,"additional_payer_notes":"APC"}]}]},{"description":"Incision of jaw joint","code_information":[{"code":"21010","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3168.99,"maximum":7912.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3168.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3232.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3200.68,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3264.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7912.98,"additional_payer_notes":"APC"}]}]},{"description":"Contour of face bone lesion","code_information":[{"code":"21029","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3168.99,"maximum":7912.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3168.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3232.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3200.68,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3264.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7912.98,"additional_payer_notes":"APC"}]}]},{"description":"Remove exostosis mandible","code_information":[{"code":"21031","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3168.99,"maximum":7912.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3168.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3232.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3200.68,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3264.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7912.98,"additional_payer_notes":"APC"}]}]},{"description":"Remove exostosis maxilla","code_information":[{"code":"21032","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3168.99,"maximum":7912.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3168.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3232.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3200.68,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3264.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7912.98,"additional_payer_notes":"APC"}]}]},{"description":"Excise mandible lesion","code_information":[{"code":"21040","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3168.99,"maximum":7912.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3168.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3232.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3200.68,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3264.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7912.98,"additional_payer_notes":"APC"}]}]},{"description":"Prepare face/oral prosthesis","code_information":[{"code":"21079","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3168.99,"maximum":7912.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3168.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3232.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3200.68,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3264.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7912.98,"additional_payer_notes":"APC"}]}]},{"description":"Prepare face/oral prosthesis","code_information":[{"code":"21080","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3168.99,"maximum":7912.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3168.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3232.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3200.68,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3264.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7912.98,"additional_payer_notes":"APC"}]}]},{"description":"Prepare face/oral prosthesis","code_information":[{"code":"21082","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3168.99,"maximum":7912.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3168.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3232.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3200.68,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3264.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7912.98,"additional_payer_notes":"APC"}]}]},{"description":"Prepare face/oral prosthesis","code_information":[{"code":"21083","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3168.99,"maximum":7912.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3168.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3232.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3200.68,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3264.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7912.98,"additional_payer_notes":"APC"}]}]},{"description":"Prepare face/oral prosthesis","code_information":[{"code":"21084","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3168.99,"maximum":7912.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3168.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3232.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3200.68,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3264.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7912.98,"additional_payer_notes":"APC"}]}]},{"description":"Prepare face/oral prosthesis","code_information":[{"code":"21086","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3168.99,"maximum":7912.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3168.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3232.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3200.68,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3264.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7912.98,"additional_payer_notes":"APC"}]}]},{"description":"Prepare face/oral prosthesis","code_information":[{"code":"21088","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3168.99,"maximum":7912.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3168.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3232.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3200.68,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3264.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7912.98,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruction of chin","code_information":[{"code":"21121","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3168.99,"maximum":7912.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3168.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3232.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3200.68,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3264.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7912.98,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruction of chin","code_information":[{"code":"21123","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3168.99,"maximum":7912.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3168.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3232.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3200.68,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3264.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7912.98,"additional_payer_notes":"APC"}]}]},{"description":"Reduction of forehead","code_information":[{"code":"21137","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3168.99,"maximum":7912.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3168.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3232.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3200.68,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3264.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7912.98,"additional_payer_notes":"APC"}]}]},{"description":"Revision of eyelid","code_information":[{"code":"21280","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3168.99,"maximum":7912.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3168.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3232.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3200.68,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3264.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7912.98,"additional_payer_notes":"APC"}]}]},{"description":"Revision of eyelid","code_information":[{"code":"21282","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3168.99,"maximum":7912.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3168.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3232.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3200.68,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3264.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7912.98,"additional_payer_notes":"APC"}]}]},{"description":"Revision of jaw muscle/bone","code_information":[{"code":"21296","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3168.99,"maximum":7912.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3168.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3232.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3200.68,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3264.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7912.98,"additional_payer_notes":"APC"}]}]},{"description":"Closed tx nose fx w/ stablj","code_information":[{"code":"21320","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3168.99,"maximum":7912.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3168.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3232.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3200.68,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3264.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7912.98,"additional_payer_notes":"APC"}]}]},{"description":"Open tx nose fx uncomplicatd","code_information":[{"code":"21325","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3168.99,"maximum":7912.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3168.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3232.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3200.68,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3264.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7912.98,"additional_payer_notes":"APC"}]}]},{"description":"Open tx nose & septal fx","code_information":[{"code":"21335","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3168.99,"maximum":7912.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3168.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3232.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3200.68,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3264.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7912.98,"additional_payer_notes":"APC"}]}]},{"description":"Closed tx septal&nose fx","code_information":[{"code":"21337","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3168.99,"maximum":7912.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3168.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3232.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3200.68,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3264.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7912.98,"additional_payer_notes":"APC"}]}]},{"description":"Perq tx nasoethmoid fx","code_information":[{"code":"21340","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3168.99,"maximum":7912.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3168.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3232.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3200.68,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3264.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7912.98,"additional_payer_notes":"APC"}]}]},{"description":"Perq tx malar fracture","code_information":[{"code":"21355","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3168.99,"maximum":7912.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3168.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3232.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3200.68,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3264.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7912.98,"additional_payer_notes":"APC"}]}]},{"description":"Treat mouth roof fracture","code_information":[{"code":"21421","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3168.99,"maximum":7912.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3168.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3232.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3200.68,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3264.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7912.98,"additional_payer_notes":"APC"}]}]},{"description":"Treat dental ridge fracture","code_information":[{"code":"21440","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3168.99,"maximum":7912.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3168.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3232.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3200.68,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3264.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7912.98,"additional_payer_notes":"APC"}]}]},{"description":"Repair dislocated jaw","code_information":[{"code":"21490","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3168.99,"maximum":7912.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3168.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3232.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3200.68,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3264.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7912.98,"additional_payer_notes":"APC"}]}]},{"description":"Removal of nose polyp(s)","code_information":[{"code":"30115","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3168.99,"maximum":7912.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3168.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3232.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3200.68,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3264.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7912.98,"additional_payer_notes":"APC"}]}]},{"description":"Removal of intranasal lesion","code_information":[{"code":"30117","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3168.99,"maximum":7912.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3168.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3232.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3200.68,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3264.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7912.98,"additional_payer_notes":"APC"}]}]},{"description":"Removal of intranasal lesion","code_information":[{"code":"30118","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3168.99,"maximum":7912.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3168.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3232.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3200.68,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3264.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7912.98,"additional_payer_notes":"APC"}]}]},{"description":"Revision of nose","code_information":[{"code":"30120","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3168.99,"maximum":7912.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3168.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3232.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3200.68,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3264.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7912.98,"additional_payer_notes":"APC"}]}]},{"description":"Excise inferior turbinate","code_information":[{"code":"30130","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3168.99,"maximum":7912.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3168.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3232.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3200.68,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3264.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7912.98,"additional_payer_notes":"APC"}]}]},{"description":"Resect inferior turbinate","code_information":[{"code":"30140","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3168.99,"maximum":7912.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3168.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3232.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3200.68,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3264.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7912.98,"additional_payer_notes":"APC"}]}]},{"description":"Remove nasal foreign body","code_information":[{"code":"30310","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3168.99,"maximum":7912.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3168.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3232.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3200.68,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3264.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7912.98,"additional_payer_notes":"APC"}]}]},{"description":"Repair of nasal septum","code_information":[{"code":"30520","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3168.99,"maximum":7912.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3168.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3232.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3200.68,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3264.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7912.98,"additional_payer_notes":"APC"}]}]},{"description":"Repair nasal septum defect","code_information":[{"code":"30630","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3168.99,"maximum":7912.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3168.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3232.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3200.68,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3264.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7912.98,"additional_payer_notes":"APC"}]}]},{"description":"Ther fx nasal inf turbinate","code_information":[{"code":"30930","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3168.99,"maximum":7912.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3168.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3232.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3200.68,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3264.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7912.98,"additional_payer_notes":"APC"}]}]},{"description":"Exploration maxillary sinus","code_information":[{"code":"31020","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3168.99,"maximum":7912.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3168.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3232.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3200.68,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3264.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7912.98,"additional_payer_notes":"APC"}]}]},{"description":"Removal of ethmoid sinus","code_information":[{"code":"31205","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3168.99,"maximum":7912.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3168.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3232.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3200.68,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3264.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7912.98,"additional_payer_notes":"APC"}]}]},{"description":"Removal of larynx lesion","code_information":[{"code":"31300","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3168.99,"maximum":7912.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3168.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3232.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3200.68,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3264.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7912.98,"additional_payer_notes":"APC"}]}]},{"description":"Incision of windpipe","code_information":[{"code":"31600","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3168.99,"maximum":7912.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3168.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3232.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3200.68,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3264.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7912.98,"additional_payer_notes":"APC"}]}]},{"description":"Surgery/speech prosthesis","code_information":[{"code":"31611","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3168.99,"maximum":7912.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3168.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3232.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3200.68,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3264.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7912.98,"additional_payer_notes":"APC"}]}]},{"description":"Puncture/clear windpipe","code_information":[{"code":"31612","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3168.99,"maximum":7912.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3168.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3232.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3200.68,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3264.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7912.98,"additional_payer_notes":"APC"}]}]},{"description":"Repair windpipe opening","code_information":[{"code":"31613","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3168.99,"maximum":7912.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3168.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3232.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3200.68,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3264.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7912.98,"additional_payer_notes":"APC"}]}]},{"description":"Closure of windpipe lesion","code_information":[{"code":"31820","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3168.99,"maximum":7912.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3168.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3232.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3200.68,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3264.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7912.98,"additional_payer_notes":"APC"}]}]},{"description":"Repair of windpipe defect","code_information":[{"code":"31825","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3168.99,"maximum":7912.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3168.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3232.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3200.68,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3264.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7912.98,"additional_payer_notes":"APC"}]}]},{"description":"Revise windpipe scar","code_information":[{"code":"31830","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3168.99,"maximum":7912.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3168.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3232.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3200.68,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3264.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7912.98,"additional_payer_notes":"APC"}]}]},{"description":"Partial excision of lip","code_information":[{"code":"40500","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3168.99,"maximum":7912.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3168.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3232.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3200.68,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3264.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7912.98,"additional_payer_notes":"APC"}]}]},{"description":"Partial excision of lip","code_information":[{"code":"40510","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3168.99,"maximum":7912.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3168.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3232.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3200.68,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3264.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7912.98,"additional_payer_notes":"APC"}]}]},{"description":"Partial excision of lip","code_information":[{"code":"40520","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3168.99,"maximum":7912.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3168.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3232.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3200.68,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3264.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7912.98,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruct lip with flap","code_information":[{"code":"40525","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3168.99,"maximum":7912.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3168.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3232.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3200.68,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3264.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7912.98,"additional_payer_notes":"APC"}]}]},{"description":"Partial removal of lip","code_information":[{"code":"40530","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3168.99,"maximum":7912.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3168.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3232.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3200.68,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3264.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7912.98,"additional_payer_notes":"APC"}]}]},{"description":"Repair cleft lip/nasal","code_information":[{"code":"40720","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3168.99,"maximum":7912.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3168.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3232.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3200.68,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3264.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7912.98,"additional_payer_notes":"APC"}]}]},{"description":"Excision of mouth lesion","code_information":[{"code":"40810","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3168.99,"maximum":7912.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3168.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3232.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3200.68,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3264.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7912.98,"additional_payer_notes":"APC"}]}]},{"description":"Excise/repair mouth lesion","code_information":[{"code":"40814","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3168.99,"maximum":7912.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3168.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3232.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3200.68,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3264.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7912.98,"additional_payer_notes":"APC"}]}]},{"description":"Excision of mouth lesion","code_information":[{"code":"40816","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3168.99,"maximum":7912.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3168.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3232.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3200.68,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3264.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7912.98,"additional_payer_notes":"APC"}]}]},{"description":"Treatment of mouth lesion","code_information":[{"code":"40820","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3168.99,"maximum":7912.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3168.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3232.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3200.68,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3264.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7912.98,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of mouth lesion","code_information":[{"code":"41008","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3168.99,"maximum":7912.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3168.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3232.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3200.68,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3264.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7912.98,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of mouth lesion","code_information":[{"code":"41017","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3168.99,"maximum":7912.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3168.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3232.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3200.68,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3264.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7912.98,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy of tongue","code_information":[{"code":"41105","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3168.99,"maximum":7912.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3168.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3232.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3200.68,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3264.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7912.98,"additional_payer_notes":"APC"}]}]},{"description":"Excision of tongue lesion","code_information":[{"code":"41110","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3168.99,"maximum":7912.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3168.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3232.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3200.68,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3264.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7912.98,"additional_payer_notes":"APC"}]}]},{"description":"Excision of tongue lesion","code_information":[{"code":"41112","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3168.99,"maximum":7912.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3168.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3232.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3200.68,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3264.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7912.98,"additional_payer_notes":"APC"}]}]},{"description":"Excision of tongue lesion","code_information":[{"code":"41113","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3168.99,"maximum":7912.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3168.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3232.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3200.68,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3264.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7912.98,"additional_payer_notes":"APC"}]}]},{"description":"Excision of tongue lesion","code_information":[{"code":"41114","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3168.99,"maximum":7912.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3168.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3232.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3200.68,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3264.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7912.98,"additional_payer_notes":"APC"}]}]},{"description":"Excision of mouth lesion","code_information":[{"code":"41116","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3168.99,"maximum":7912.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3168.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3232.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3200.68,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3264.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7912.98,"additional_payer_notes":"APC"}]}]},{"description":"Tongue to lip surgery","code_information":[{"code":"41510","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3168.99,"maximum":7912.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3168.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3232.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3200.68,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3264.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7912.98,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruction tongue fold","code_information":[{"code":"41520","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3168.99,"maximum":7912.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3168.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3232.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3200.68,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3264.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7912.98,"additional_payer_notes":"APC"}]}]},{"description":"Tongue base vol reduction","code_information":[{"code":"41530","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3168.99,"maximum":7912.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3168.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3232.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3200.68,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3264.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7912.98,"additional_payer_notes":"APC"}]}]},{"description":"Excision gum each quadrant","code_information":[{"code":"41820","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3168.99,"maximum":7912.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3168.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3232.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3200.68,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3264.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7912.98,"additional_payer_notes":"APC"}]}]},{"description":"Excision of gum lesion","code_information":[{"code":"41825","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3168.99,"maximum":7912.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3168.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3232.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3200.68,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3264.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7912.98,"additional_payer_notes":"APC"}]}]},{"description":"Excision of gum lesion","code_information":[{"code":"41826","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3168.99,"maximum":7912.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3168.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3232.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3200.68,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3264.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7912.98,"additional_payer_notes":"APC"}]}]},{"description":"Removal of gum tissue","code_information":[{"code":"41830","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3168.99,"maximum":7912.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3168.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3232.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3200.68,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3264.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7912.98,"additional_payer_notes":"APC"}]}]},{"description":"Repair gum","code_information":[{"code":"41872","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3168.99,"maximum":7912.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3168.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3232.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3200.68,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3264.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7912.98,"additional_payer_notes":"APC"}]}]},{"description":"Repair tooth socket","code_information":[{"code":"41874","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3168.99,"maximum":7912.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3168.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3232.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3200.68,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3264.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7912.98,"additional_payer_notes":"APC"}]}]},{"description":"Excision lesion mouth roof","code_information":[{"code":"42104","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3168.99,"maximum":7912.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3168.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3232.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3200.68,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3264.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7912.98,"additional_payer_notes":"APC"}]}]},{"description":"Excision lesion mouth roof","code_information":[{"code":"42106","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3168.99,"maximum":7912.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3168.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3232.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3200.68,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3264.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7912.98,"additional_payer_notes":"APC"}]}]},{"description":"Excision of uvula","code_information":[{"code":"42140","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3168.99,"maximum":7912.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3168.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3232.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3200.68,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3264.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7912.98,"additional_payer_notes":"APC"}]}]},{"description":"Treatment mouth roof lesion","code_information":[{"code":"42160","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3168.99,"maximum":7912.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3168.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3232.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3200.68,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3264.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7912.98,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruct cleft palate","code_information":[{"code":"42205","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3168.99,"maximum":7912.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3168.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3232.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3200.68,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3264.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7912.98,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of salivary gland","code_information":[{"code":"42305","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3168.99,"maximum":7912.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3168.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3232.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3200.68,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3264.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7912.98,"additional_payer_notes":"APC"}]}]},{"description":"Removal of salivary stone","code_information":[{"code":"42330","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3168.99,"maximum":7912.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3168.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3232.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3200.68,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3264.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7912.98,"additional_payer_notes":"APC"}]}]},{"description":"Removal of salivary stone","code_information":[{"code":"42335","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3168.99,"maximum":7912.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3168.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3232.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3200.68,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3264.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7912.98,"additional_payer_notes":"APC"}]}]},{"description":"Removal of salivary stone","code_information":[{"code":"42340","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3168.99,"maximum":7912.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3168.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3232.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3200.68,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3264.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7912.98,"additional_payer_notes":"APC"}]}]},{"description":"Excision of salivary cyst","code_information":[{"code":"42408","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3168.99,"maximum":7912.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3168.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3232.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3200.68,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3264.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7912.98,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of salivary cyst","code_information":[{"code":"42409","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3168.99,"maximum":7912.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3168.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3232.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3200.68,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3264.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7912.98,"additional_payer_notes":"APC"}]}]},{"description":"Parotid duct diversion","code_information":[{"code":"42510","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3168.99,"maximum":7912.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3168.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3232.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3200.68,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3264.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7912.98,"additional_payer_notes":"APC"}]}]},{"description":"Closure of salivary fistula","code_information":[{"code":"42600","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3168.99,"maximum":7912.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3168.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3232.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3200.68,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3264.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7912.98,"additional_payer_notes":"APC"}]}]},{"description":"Ligation of salivary duct","code_information":[{"code":"42665","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3168.99,"maximum":7912.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3168.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3232.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3200.68,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3264.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7912.98,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of throat abscess","code_information":[{"code":"42720","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3168.99,"maximum":7912.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3168.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3232.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3200.68,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3264.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7912.98,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy of upper nose/throat","code_information":[{"code":"42804","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3168.99,"maximum":7912.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3168.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3232.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3200.68,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3264.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7912.98,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy of upper nose/throat","code_information":[{"code":"42806","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3168.99,"maximum":7912.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3168.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3232.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3200.68,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3264.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7912.98,"additional_payer_notes":"APC"}]}]},{"description":"Excise pharynx lesion","code_information":[{"code":"42808","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3168.99,"maximum":7912.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3168.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3232.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3200.68,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3264.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7912.98,"additional_payer_notes":"APC"}]}]},{"description":"Excision of neck cyst","code_information":[{"code":"42810","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3168.99,"maximum":7912.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3168.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3232.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3200.68,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3264.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7912.98,"additional_payer_notes":"APC"}]}]},{"description":"Remove tonsils and adenoids","code_information":[{"code":"42821","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3168.99,"maximum":7912.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3168.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3232.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3200.68,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3264.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7912.98,"additional_payer_notes":"APC"}]}]},{"description":"Removal of tonsils","code_information":[{"code":"42826","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3168.99,"maximum":7912.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3168.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3232.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3200.68,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3264.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7912.98,"additional_payer_notes":"APC"}]}]},{"description":"Removal of adenoids","code_information":[{"code":"42830","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3168.99,"maximum":7912.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3168.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3232.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3200.68,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3264.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7912.98,"additional_payer_notes":"APC"}]}]},{"description":"Removal of adenoids","code_information":[{"code":"42831","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3168.99,"maximum":7912.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3168.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3232.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3200.68,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3264.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7912.98,"additional_payer_notes":"APC"}]}]},{"description":"Removal of adenoids","code_information":[{"code":"42835","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3168.99,"maximum":7912.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3168.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3232.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3200.68,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3264.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7912.98,"additional_payer_notes":"APC"}]}]},{"description":"Removal of adenoids","code_information":[{"code":"42836","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3168.99,"maximum":7912.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3168.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3232.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3200.68,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3264.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7912.98,"additional_payer_notes":"APC"}]}]},{"description":"Excision of tonsil tags","code_information":[{"code":"42860","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3168.99,"maximum":7912.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3168.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3232.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3200.68,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3264.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7912.98,"additional_payer_notes":"APC"}]}]},{"description":"Control throat bleeding","code_information":[{"code":"42962","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3168.99,"maximum":7912.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3168.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3232.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3200.68,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3264.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7912.98,"additional_payer_notes":"APC"}]}]},{"description":"Control nose/throat bleeding","code_information":[{"code":"42972","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3168.99,"maximum":7912.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3168.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3232.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3200.68,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3264.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7912.98,"additional_payer_notes":"APC"}]}]},{"description":"Repair esophagus opening","code_information":[{"code":"43420","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3168.99,"maximum":7912.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3168.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3232.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3200.68,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3264.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7912.98,"additional_payer_notes":"APC"}]}]},{"description":"Decompress eye socket","code_information":[{"code":"61330","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3168.99,"maximum":7912.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3168.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3232.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3200.68,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3264.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7912.98,"additional_payer_notes":"APC"}]}]},{"description":"Treat skull fracture","code_information":[{"code":"62000","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3168.99,"maximum":7912.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3168.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3232.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3200.68,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3264.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7912.98,"additional_payer_notes":"APC"}]}]},{"description":"Revise external ear","code_information":[{"code":"69300","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3168.99,"maximum":7912.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3168.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3232.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3200.68,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3264.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7912.98,"additional_payer_notes":"APC"}]}]},{"description":"Incision of eardrum","code_information":[{"code":"69421","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3168.99,"maximum":7912.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3168.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3232.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3200.68,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3264.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7912.98,"additional_payer_notes":"APC"}]}]},{"description":"Remove ventilating tube","code_information":[{"code":"69424","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3168.99,"maximum":7912.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3168.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3232.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3200.68,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3264.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7912.98,"additional_payer_notes":"APC"}]}]},{"description":"Exploration of middle ear","code_information":[{"code":"69440","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3168.99,"maximum":7912.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3168.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3232.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3200.68,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3264.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7912.98,"additional_payer_notes":"APC"}]}]},{"description":"Eardrum revision","code_information":[{"code":"69450","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3168.99,"maximum":7912.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3168.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3232.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3200.68,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3264.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7912.98,"additional_payer_notes":"APC"}]}]},{"description":"Repair of eardrum","code_information":[{"code":"69620","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3168.99,"maximum":7912.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3168.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3232.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3200.68,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3264.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7912.98,"additional_payer_notes":"APC"}]}]},{"description":"Release middle ear bone","code_information":[{"code":"69650","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3168.99,"maximum":7912.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3168.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3232.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3200.68,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3264.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7912.98,"additional_payer_notes":"APC"}]}]},{"description":"Repair middle ear structures","code_information":[{"code":"69666","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3168.99,"maximum":7912.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3168.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3232.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3200.68,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3264.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7912.98,"additional_payer_notes":"APC"}]}]},{"description":"Repair middle ear structures","code_information":[{"code":"69667","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3168.99,"maximum":7912.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3168.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3232.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3200.68,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3264.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7912.98,"additional_payer_notes":"APC"}]}]},{"description":"Remove middle ear nerve","code_information":[{"code":"69676","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3168.99,"maximum":7912.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3168.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3232.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3200.68,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3264.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7912.98,"additional_payer_notes":"APC"}]}]},{"description":"Remove/repair hearing aid","code_information":[{"code":"69711","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3168.99,"maximum":7912.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3168.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3232.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3200.68,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3264.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7912.98,"additional_payer_notes":"APC"}]}]},{"description":"Incise inner ear nerve","code_information":[{"code":"69915","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3168.99,"maximum":7912.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3168.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3232.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3200.68,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3264.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7912.98,"additional_payer_notes":"APC"}]}]},{"description":"Gingivectomy/plasty 4 or mor","code_information":[{"code":"D4210","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3168.99,"maximum":7912.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3168.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3232.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3200.68,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3264.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7912.98,"additional_payer_notes":"APC"}]}]},{"description":"Gingivectomy/plasty 1 to 3","code_information":[{"code":"D4211","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3168.99,"maximum":7912.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3168.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3232.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3200.68,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3264.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7912.98,"additional_payer_notes":"APC"}]}]},{"description":"Gingivectomy/plasty rest","code_information":[{"code":"D4212","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3168.99,"maximum":7912.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3168.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3232.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3200.68,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3264.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7912.98,"additional_payer_notes":"APC"}]}]},{"description":"Ana crown exp 4 or> per quad","code_information":[{"code":"D4230","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3168.99,"maximum":7912.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3168.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3232.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3200.68,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3264.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7912.98,"additional_payer_notes":"APC"}]}]},{"description":"Gingival flap proc w/ planin","code_information":[{"code":"D4240","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3168.99,"maximum":7912.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3168.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3232.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3200.68,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3264.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7912.98,"additional_payer_notes":"APC"}]}]},{"description":"Osseous surg 1 to 3 teeth","code_information":[{"code":"D4261","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3168.99,"maximum":7912.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3168.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3232.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3200.68,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3264.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7912.98,"additional_payer_notes":"APC"}]}]},{"description":"Malig tumor exc to 1.25 cm","code_information":[{"code":"D7440","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3168.99,"maximum":7912.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3168.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3232.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3200.68,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3264.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7912.98,"additional_payer_notes":"APC"}]}]},{"description":"Malig tumor > 1.25 cm","code_information":[{"code":"D7441","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3168.99,"maximum":7912.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3168.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3232.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3200.68,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3264.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7912.98,"additional_payer_notes":"APC"}]}]},{"description":"Rem odontogen cyst to 1.25cm","code_information":[{"code":"D7450","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3168.99,"maximum":7912.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3168.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3232.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3200.68,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3264.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7912.98,"additional_payer_notes":"APC"}]}]},{"description":"Rem odontogen cyst > 1.25 cm","code_information":[{"code":"D7451","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3168.99,"maximum":7912.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3168.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3232.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3200.68,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3264.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7912.98,"additional_payer_notes":"APC"}]}]},{"description":"Rem exostosis any site","code_information":[{"code":"D7471","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3168.99,"maximum":7912.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3168.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3232.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3200.68,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3264.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7912.98,"additional_payer_notes":"APC"}]}]},{"description":"Closd rductn splint alveolus","code_information":[{"code":"D7670","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3168.99,"maximum":7912.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3168.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3232.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3200.68,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3264.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7912.98,"additional_payer_notes":"APC"}]}]},{"description":"Alveolus clsd reduc stblz te","code_information":[{"code":"D7771","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3168.99,"maximum":7912.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3168.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3232.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3200.68,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3264.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7912.98,"additional_payer_notes":"APC"}]}]},{"description":"Facility svs dental rehab","code_information":[{"code":"G0330","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3168.99,"maximum":7912.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3168.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3232.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3200.68,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3264.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7912.98,"additional_payer_notes":"APC"}]}]},{"description":"Excision of bone lower jaw","code_information":[{"code":"21025","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Excision of facial bone(s)","code_information":[{"code":"21026","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Excise max/zygoma b9 tumor","code_information":[{"code":"21030","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Excise max/zygoma mal tumor","code_information":[{"code":"21034","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Removal of jaw bone lesion","code_information":[{"code":"21044","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Extensive jaw surgery","code_information":[{"code":"21045","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Remove mandible cyst complex","code_information":[{"code":"21046","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Excise lwr jaw cyst w/repair","code_information":[{"code":"21047","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Remove maxilla cyst complex","code_information":[{"code":"21048","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Excis uppr jaw cyst w/repair","code_information":[{"code":"21049","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Removal of jaw joint","code_information":[{"code":"21050","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Remove jaw joint cartilage","code_information":[{"code":"21060","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Remove coronoid process","code_information":[{"code":"21070","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Prepare face/oral prosthesis","code_information":[{"code":"21077","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Prepare face/oral prosthesis","code_information":[{"code":"21081","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Prepare face/oral prosthesis","code_information":[{"code":"21087","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Maxillofacial fixation","code_information":[{"code":"21100","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruction of chin","code_information":[{"code":"21120","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruction of chin","code_information":[{"code":"21122","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Augmentation lower jaw bone","code_information":[{"code":"21125","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Augmentation lower jaw bone","code_information":[{"code":"21127","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Reduction of forehead","code_information":[{"code":"21138","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Reduction of forehead","code_information":[{"code":"21139","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Lefort i-1 piece w/o graft","code_information":[{"code":"21141","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Lefort i-2 piece w/o graft","code_information":[{"code":"21142","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Lefort i-3/> piece w/o graft","code_information":[{"code":"21143","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Lefort i-1 piece w/ graft","code_information":[{"code":"21145","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Lefort i-2 piece w/ graft","code_information":[{"code":"21146","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Lefort i-3/> piece w/ graft","code_information":[{"code":"21147","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Lefort ii anterior intrusion","code_information":[{"code":"21150","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Lefort ii w/bone grafts","code_information":[{"code":"21151","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Lefort iii w/o lefort i","code_information":[{"code":"21154","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Lefort iii w/ lefort i","code_information":[{"code":"21155","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Lefort iii w/fhdw/o lefort i","code_information":[{"code":"21159","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Lefort iii w/fhd w/ lefort i","code_information":[{"code":"21160","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruct orbit/forehead","code_information":[{"code":"21172","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruct orbit/forehead","code_information":[{"code":"21175","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruct entire forehead","code_information":[{"code":"21179","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruct entire forehead","code_information":[{"code":"21180","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Contour cranial bone lesion","code_information":[{"code":"21181","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruct cranial bone","code_information":[{"code":"21182","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruct cranial bone","code_information":[{"code":"21183","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruct cranial bone","code_information":[{"code":"21184","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruction of midface","code_information":[{"code":"21188","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Reconst lwr jaw w/o graft","code_information":[{"code":"21193","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Reconst lwr jaw w/graft","code_information":[{"code":"21194","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Reconst lwr jaw w/o fixation","code_information":[{"code":"21195","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Reconst lwr jaw w/fixation","code_information":[{"code":"21196","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Reconstr lwr jaw segment","code_information":[{"code":"21198","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Reconstr Lwr Jaw W/Advance","code_information":[{"code":"21199","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruct upper jaw bone","code_information":[{"code":"21206","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Augmentation of facial bones","code_information":[{"code":"21208","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Reduction of facial bones","code_information":[{"code":"21209","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Face bone graft","code_information":[{"code":"21210","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Lower jaw bone graft","code_information":[{"code":"21215","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Rib cartilage graft","code_information":[{"code":"21230","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Ear cartilage graft","code_information":[{"code":"21235","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruction of jaw joint","code_information":[{"code":"21240","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruction of jaw joint","code_information":[{"code":"21242","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruction of lower jaw","code_information":[{"code":"21244","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruction of jaw","code_information":[{"code":"21245","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruction of jaw","code_information":[{"code":"21246","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruct lower jaw bone","code_information":[{"code":"21247","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruction of jaw","code_information":[{"code":"21248","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruction of jaw","code_information":[{"code":"21249","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruct lower jaw bone","code_information":[{"code":"21255","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruction of orbit","code_information":[{"code":"21256","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Revise eye sockets","code_information":[{"code":"21260","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Revise eye sockets","code_information":[{"code":"21261","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Revise eye sockets","code_information":[{"code":"21263","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Revise eye sockets","code_information":[{"code":"21267","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Revise eye sockets","code_information":[{"code":"21268","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Augmentation cheek bone","code_information":[{"code":"21270","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Revision orbitofacial bones","code_information":[{"code":"21275","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Open tx nose fx w/skele fixj","code_information":[{"code":"21330","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Open nasoethmoid fx w/o fixj","code_information":[{"code":"21338","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Open nasoethmoid fx w/ fixj","code_information":[{"code":"21339","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Open tx dprsd front sinus fx","code_information":[{"code":"21343","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Open tx compl front sinus fx","code_information":[{"code":"21344","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Opn tx nasomax fx w/fixj","code_information":[{"code":"21346","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Opn tx nasomax fx multple","code_information":[{"code":"21347","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Opn tx nasomax fx w/graft","code_information":[{"code":"21348","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Opn tx dprsd zygomatic arch","code_information":[{"code":"21356","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Opn tx dprsd malar fracture","code_information":[{"code":"21360","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Opn tx complx malar fx","code_information":[{"code":"21365","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Opn tx complx malar w/grft","code_information":[{"code":"21366","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Opn tx orbit fx transantral","code_information":[{"code":"21385","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Opn tx orbit fx periorbital","code_information":[{"code":"21386","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Opn tx orbit fx combined","code_information":[{"code":"21387","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Opn tx orbit periorbtl implt","code_information":[{"code":"21390","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Opn tx orbit periorbt w/grft","code_information":[{"code":"21395","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Opn tx orbit fx w/o implant","code_information":[{"code":"21406","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Opn tx orbit fx w/implant","code_information":[{"code":"21407","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Opn tx orbit fx w/bone grft","code_information":[{"code":"21408","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Treat mouth roof fracture","code_information":[{"code":"21422","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Treat mouth roof fracture","code_information":[{"code":"21423","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Treat craniofacial fracture","code_information":[{"code":"21431","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Treat craniofacial fracture","code_information":[{"code":"21432","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Treat craniofacial fracture","code_information":[{"code":"21433","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Treat craniofacial fracture","code_information":[{"code":"21435","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Treat craniofacial fracture","code_information":[{"code":"21436","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Treat dental ridge fracture","code_information":[{"code":"21445","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Treat lower jaw fracture","code_information":[{"code":"21452","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Treat lower jaw fracture","code_information":[{"code":"21453","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Treat lower jaw fracture","code_information":[{"code":"21454","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Treat lower jaw fracture","code_information":[{"code":"21461","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Treat lower jaw fracture","code_information":[{"code":"21462","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Treat lower jaw fracture","code_information":[{"code":"21465","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Treat lower jaw fracture","code_information":[{"code":"21470","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Hyoid myotomy & suspension","code_information":[{"code":"21685","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Removal of nose lesion","code_information":[{"code":"30125","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Partial removal of nose","code_information":[{"code":"30150","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Removal of nose","code_information":[{"code":"30160","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruction of nose","code_information":[{"code":"30400","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruction of nose","code_information":[{"code":"30410","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruction of nose","code_information":[{"code":"30420","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Revision of nose","code_information":[{"code":"30430","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Revision of nose","code_information":[{"code":"30435","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Revision of nose","code_information":[{"code":"30450","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Revision of nose","code_information":[{"code":"30460","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Revision of nose","code_information":[{"code":"30462","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Repair Nasal Stenosis","code_information":[{"code":"30465","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Rpr nsl vlv collapse w/implt","code_information":[{"code":"30468","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Rpr nsl vlv collapse w/rmdlg","code_information":[{"code":"30469","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Repair nasal defect","code_information":[{"code":"30540","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Repair nasal defect","code_information":[{"code":"30545","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Repair upper jaw fistula","code_information":[{"code":"30580","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Repair mouth/nose fistula","code_information":[{"code":"30600","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Intranasal reconstruction","code_information":[{"code":"30620","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Exploration maxillary sinus","code_information":[{"code":"31030","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Explore sinus remove polyps","code_information":[{"code":"31032","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Exploration behind upper jaw","code_information":[{"code":"31040","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Exploration sphenoid sinus","code_information":[{"code":"31050","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Sphenoid sinus surgery","code_information":[{"code":"31051","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Exploration of frontal sinus","code_information":[{"code":"31070","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Exploration of frontal sinus","code_information":[{"code":"31075","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Removal of frontal sinus","code_information":[{"code":"31080","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Removal of frontal sinus","code_information":[{"code":"31081","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Removal of frontal sinus","code_information":[{"code":"31084","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Removal of frontal sinus","code_information":[{"code":"31085","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Removal of frontal sinus","code_information":[{"code":"31086","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Removal of frontal sinus","code_information":[{"code":"31087","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Exploration of sinuses","code_information":[{"code":"31090","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Removal of ethmoid sinus","code_information":[{"code":"31200","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Nsl/sinus ndsc rf abltj pnn","code_information":[{"code":"31242","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Nsl/sinus ndsc cryoabltj pnn","code_information":[{"code":"31243","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Revision of larynx","code_information":[{"code":"31400","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Removal of epiglottis","code_information":[{"code":"31420","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Laryngoplasty laryngeal sten","code_information":[{"code":"31551","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Laryngoplasty laryngeal sten","code_information":[{"code":"31552","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Laryngoplasty laryngeal sten","code_information":[{"code":"31553","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Laryngoplasty laryngeal sten","code_information":[{"code":"31554","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Laryngoplasty laryngeal web","code_information":[{"code":"31580","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Laryngoplasty fx rdctj fixj","code_information":[{"code":"31584","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Laryngoplasty cricoid split","code_information":[{"code":"31587","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Reinnervate larynx","code_information":[{"code":"31590","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Laryngoplasty medialization","code_information":[{"code":"31591","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Cricotracheal resection","code_information":[{"code":"31592","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Incision of windpipe","code_information":[{"code":"31601","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Incision of windpipe","code_information":[{"code":"31610","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Repair windpipe opening","code_information":[{"code":"31614","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Repair of windpipe","code_information":[{"code":"31750","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Repair of windpipe","code_information":[{"code":"31755","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Remove windpipe lesion","code_information":[{"code":"31785","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruct lip with flap","code_information":[{"code":"40527","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Repair cleft lip/nasal","code_information":[{"code":"40700","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Repair cleft lip/nasal","code_information":[{"code":"40701","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Repair cleft lip/nasal","code_information":[{"code":"40702","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Repair cleft lip/nasal","code_information":[{"code":"40761","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruction of mouth","code_information":[{"code":"40840","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruction of mouth","code_information":[{"code":"40842","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruction of mouth","code_information":[{"code":"40843","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruction of mouth","code_information":[{"code":"40844","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruction of mouth","code_information":[{"code":"40845","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of mouth lesion","code_information":[{"code":"41016","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Place needles h&n for rt","code_information":[{"code":"41019","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Partial removal of tongue","code_information":[{"code":"41120","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Tongue suspension","code_information":[{"code":"41512","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Excision of gum lesion","code_information":[{"code":"41823","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Excision of gum lesion","code_information":[{"code":"41827","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Excision lesion mouth roof","code_information":[{"code":"42107","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Remove palate/lesion","code_information":[{"code":"42120","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Repair palate pharynx/uvula","code_information":[{"code":"42145","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Repair palate","code_information":[{"code":"42182","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruct cleft palate","code_information":[{"code":"42200","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruct cleft palate","code_information":[{"code":"42210","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruct cleft palate","code_information":[{"code":"42215","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruct cleft palate","code_information":[{"code":"42220","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruct cleft palate","code_information":[{"code":"42225","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Lengthening of palate","code_information":[{"code":"42226","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Lengthening of palate","code_information":[{"code":"42227","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Repair palate","code_information":[{"code":"42235","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Repair nose to lip fistula","code_information":[{"code":"42260","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Insertion palate prosthesis","code_information":[{"code":"42281","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Excise parotid gland/lesion","code_information":[{"code":"42410","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Excise parotid gland/lesion","code_information":[{"code":"42415","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Excise parotid gland/lesion","code_information":[{"code":"42420","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Excise parotid gland/lesion","code_information":[{"code":"42425","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Excise submaxillary gland","code_information":[{"code":"42440","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Excise sublingual gland","code_information":[{"code":"42450","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Repair salivary duct","code_information":[{"code":"42500","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Repair salivary duct","code_information":[{"code":"42505","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Parotid duct diversion","code_information":[{"code":"42507","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Parotid duct diversion","code_information":[{"code":"42509","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of throat abscess","code_information":[{"code":"42725","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Excision of neck cyst","code_information":[{"code":"42815","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Remove tonsils and adenoids","code_information":[{"code":"42820","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Removal of tonsils","code_information":[{"code":"42825","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Extensive surgery of throat","code_information":[{"code":"42842","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Extensive surgery of throat","code_information":[{"code":"42844","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Excision of lingual tonsil","code_information":[{"code":"42870","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Partial removal of pharynx","code_information":[{"code":"42890","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Revision of pharyngeal walls","code_information":[{"code":"42892","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruction of throat","code_information":[{"code":"42950","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Throat muscle surgery","code_information":[{"code":"43030","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Removal of esophagus pouch","code_information":[{"code":"43130","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Esophagoscopy rigid trnso","code_information":[{"code":"43180","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Removal of thyroid","code_information":[{"code":"60252","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Repeat thyroid surgery","code_information":[{"code":"60260","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Removal of thyroid","code_information":[{"code":"60271","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Explore parathyroid glands","code_information":[{"code":"60500","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Re-explore parathyroids","code_information":[{"code":"60502","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Removal of thymus gland","code_information":[{"code":"60520","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Removal of external ear","code_information":[{"code":"69120","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Remove ear canal lesion(s)","code_information":[{"code":"69140","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Extensive ear canal surgery","code_information":[{"code":"69150","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Rebuild outer ear canal","code_information":[{"code":"69310","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Rebuild outer ear canal","code_information":[{"code":"69320","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Mastoidectomy","code_information":[{"code":"69501","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Mastoidectomy","code_information":[{"code":"69502","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Remove mastoid structures","code_information":[{"code":"69505","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Extensive mastoid surgery","code_information":[{"code":"69511","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Extensive mastoid surgery","code_information":[{"code":"69530","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Remove ear lesion","code_information":[{"code":"69550","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Remove ear lesion","code_information":[{"code":"69552","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Mastoid surgery revision","code_information":[{"code":"69601","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Mastoid surgery revision","code_information":[{"code":"69602","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Mastoid surgery revision","code_information":[{"code":"69603","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Mastoid surgery revision","code_information":[{"code":"69604","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Repair eardrum structures","code_information":[{"code":"69631","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Rebuild eardrum structures","code_information":[{"code":"69632","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Rebuild eardrum structures","code_information":[{"code":"69633","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Repair eardrum structures","code_information":[{"code":"69635","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Rebuild eardrum structures","code_information":[{"code":"69636","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Rebuild eardrum structures","code_information":[{"code":"69637","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Revise middle ear & mastoid","code_information":[{"code":"69641","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Revise middle ear & mastoid","code_information":[{"code":"69642","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Revise middle ear & mastoid","code_information":[{"code":"69643","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Revise middle ear & mastoid","code_information":[{"code":"69644","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Revise middle ear & mastoid","code_information":[{"code":"69645","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Revise middle ear & mastoid","code_information":[{"code":"69646","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Revise middle ear bone","code_information":[{"code":"69660","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Revise middle ear bone","code_information":[{"code":"69661","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Revise middle ear bone","code_information":[{"code":"69662","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Remove mastoid air cells","code_information":[{"code":"69670","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Nps surg dilat eust tube uni","code_information":[{"code":"69705","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Nps surg dilat eust tube bi","code_information":[{"code":"69706","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Release facial nerve","code_information":[{"code":"69720","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Release facial nerve","code_information":[{"code":"69725","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Repair facial nerve","code_information":[{"code":"69740","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Repair facial nerve","code_information":[{"code":"69745","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Explore inner ear","code_information":[{"code":"69805","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Explore inner ear","code_information":[{"code":"69806","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Remove inner ear","code_information":[{"code":"69905","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Remove inner ear & mastoid","code_information":[{"code":"69910","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Release facial nerve","code_information":[{"code":"69955","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Release inner ear canal","code_information":[{"code":"69960","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Remove inner ear lesion","code_information":[{"code":"69970","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Osseous surgery 4 or more","code_information":[{"code":"D4260","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Vestibuloplasty ridge extens","code_information":[{"code":"D7340","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Vestibuloplasty exten graft","code_information":[{"code":"D7350","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Surg reduct osseoustuberosit","code_information":[{"code":"D7485","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Alveolus open reduction","code_information":[{"code":"D7671","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Open reduc compd alveolus fx","code_information":[{"code":"D7770","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Mandible graft","code_information":[{"code":"D7950","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5658.31,"maximum":14128.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5658.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5771.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5714.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5828.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14128.81,"additional_payer_notes":"APC"}]}]},{"description":"Repos car modulj tranvns elt","code_information":[{"code":"0415T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":599.59,"maximum":1497.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":599.59,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":611.58,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":605.59,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":617.58,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1497.18,"additional_payer_notes":"APC"}]}]},{"description":"Rpos prv ccm-d trnsvns eltrd","code_information":[{"code":"0924T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":599.59,"maximum":1497.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":599.59,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":611.58,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":605.59,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":617.58,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1497.18,"additional_payer_notes":"APC"}]}]},{"description":"Active thrc irrigation spx","code_information":[{"code":"1021T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":599.59,"maximum":1497.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":599.59,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":611.58,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":605.59,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":617.58,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1497.18,"additional_payer_notes":"APC"}]}]},{"description":"Remove lung catheter","code_information":[{"code":"32552","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":599.59,"maximum":1497.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":599.59,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":611.58,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":605.59,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":617.58,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1497.18,"additional_payer_notes":"APC"}]}]},{"description":"Aspirate pleura w/o imaging","code_information":[{"code":"32554","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":599.59,"maximum":1497.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":599.59,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":611.58,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":605.59,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":617.58,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1497.18,"additional_payer_notes":"APC"}]}]},{"description":"Aspirate pleura w/ imaging","code_information":[{"code":"32555","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":599.59,"maximum":1497.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":599.59,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":611.58,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":605.59,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":617.58,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1497.18,"additional_payer_notes":"APC"}]}]},{"description":"Treat pleurodesis w/agent","code_information":[{"code":"32560","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":599.59,"maximum":1497.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":599.59,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":611.58,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":605.59,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":617.58,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1497.18,"additional_payer_notes":"APC"}]}]},{"description":"Lyse chest fibrin init day","code_information":[{"code":"32561","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":599.59,"maximum":1497.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":599.59,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":611.58,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":605.59,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":617.58,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1497.18,"additional_payer_notes":"APC"}]}]},{"description":"Lyse chest fibrin subq day","code_information":[{"code":"32562","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":599.59,"maximum":1497.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":599.59,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":611.58,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":605.59,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":617.58,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1497.18,"additional_payer_notes":"APC"}]}]},{"description":"Therapeutic pneumothorax","code_information":[{"code":"32960","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":599.59,"maximum":1497.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":599.59,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":611.58,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":605.59,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":617.58,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1497.18,"additional_payer_notes":"APC"}]}]},{"description":"Chest surgery procedure","code_information":[{"code":"32999","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":599.59,"maximum":1497.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":599.59,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":611.58,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":605.59,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":617.58,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1497.18,"additional_payer_notes":"APC"}]}]},{"description":"Cardiac surgery procedure","code_information":[{"code":"33999","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":599.59,"maximum":1497.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":599.59,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":611.58,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":605.59,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":617.58,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1497.18,"additional_payer_notes":"APC"}]}]},{"description":"Removal of vein clot","code_information":[{"code":"34471","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":599.59,"maximum":1497.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":599.59,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":611.58,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":605.59,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":617.58,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1497.18,"additional_payer_notes":"APC"}]}]},{"description":"Pseudoaneurysm injection trt","code_information":[{"code":"36002","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":599.59,"maximum":1497.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":599.59,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":611.58,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":605.59,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":617.58,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1497.18,"additional_payer_notes":"APC"}]}]},{"description":"Insj picc rs&i <5 yr","code_information":[{"code":"36572","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":599.59,"maximum":1497.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":599.59,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":611.58,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":605.59,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":617.58,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1497.18,"additional_payer_notes":"APC"}]}]},{"description":"Repair tunneled cv cath","code_information":[{"code":"36575","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":599.59,"maximum":1497.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":599.59,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":611.58,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":605.59,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":617.58,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1497.18,"additional_payer_notes":"APC"}]}]},{"description":"Removal tunneled cv cath","code_information":[{"code":"36589","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":599.59,"maximum":1497.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":599.59,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":611.58,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":605.59,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":617.58,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1497.18,"additional_payer_notes":"APC"}]}]},{"description":"Vascular endoscopy procedure","code_information":[{"code":"37501","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":599.59,"maximum":1497.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":599.59,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":611.58,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":605.59,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":617.58,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1497.18,"additional_payer_notes":"APC"}]}]},{"description":"Vascular surgery procedure","code_information":[{"code":"37799","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":599.59,"maximum":1497.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":599.59,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":611.58,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":605.59,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":617.58,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1497.18,"additional_payer_notes":"APC"}]}]},{"description":"Lymph vessel x-ray arm/leg","code_information":[{"code":"75801","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":599.59,"maximum":1497.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":599.59,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":611.58,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":605.59,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":617.58,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1497.18,"additional_payer_notes":"APC"}]}]},{"description":"Vein x-ray skull epidural","code_information":[{"code":"75872","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":599.59,"maximum":1497.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":599.59,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":611.58,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":605.59,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":617.58,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1497.18,"additional_payer_notes":"APC"}]}]},{"description":"Vein x-ray eye socket","code_information":[{"code":"75880","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":599.59,"maximum":1497.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":599.59,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":611.58,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":605.59,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":617.58,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1497.18,"additional_payer_notes":"APC"}]}]},{"description":"Insertion of chest tube","code_information":[{"code":"32551","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1504.61,"maximum":3757.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1504.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1534.71,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1519.66,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1549.75,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3757.02,"additional_payer_notes":"APC"}]}]},{"description":"Insert cath pleura w/ image","code_information":[{"code":"32557","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1504.61,"maximum":3757.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1504.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1534.71,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1519.66,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1549.75,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3757.02,"additional_payer_notes":"APC"}]}]},{"description":"Pericardiocentesis w/imaging","code_information":[{"code":"33016","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1504.61,"maximum":3757.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1504.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1534.71,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1519.66,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1549.75,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3757.02,"additional_payer_notes":"APC"}]}]},{"description":"Repair blood vessel lesion","code_information":[{"code":"35180","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1504.61,"maximum":3757.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1504.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1534.71,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1519.66,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1549.75,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3757.02,"additional_payer_notes":"APC"}]}]},{"description":"Insert picc cath","code_information":[{"code":"36568","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1504.61,"maximum":3757.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1504.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1534.71,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1519.66,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1549.75,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3757.02,"additional_payer_notes":"APC"}]}]},{"description":"Insert picc cath","code_information":[{"code":"36569","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1504.61,"maximum":3757.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1504.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1534.71,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1519.66,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1549.75,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3757.02,"additional_payer_notes":"APC"}]}]},{"description":"Insj picc rs&i 5 yr+","code_information":[{"code":"36573","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1504.61,"maximum":3757.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1504.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1534.71,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1519.66,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1549.75,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3757.02,"additional_payer_notes":"APC"}]}]},{"description":"Repair tunneled cv cath","code_information":[{"code":"36576","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1504.61,"maximum":3757.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1504.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1534.71,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1519.66,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1549.75,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3757.02,"additional_payer_notes":"APC"}]}]},{"description":"Replace cvad cath","code_information":[{"code":"36580","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1504.61,"maximum":3757.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1504.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1534.71,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1519.66,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1549.75,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3757.02,"additional_payer_notes":"APC"}]}]},{"description":"Replace picc cath","code_information":[{"code":"36584","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1504.61,"maximum":3757.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1504.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1534.71,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1519.66,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1549.75,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3757.02,"additional_payer_notes":"APC"}]}]},{"description":"Removal tunneled cv cath","code_information":[{"code":"36590","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1504.61,"maximum":3757.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1504.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1534.71,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1519.66,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1549.75,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3757.02,"additional_payer_notes":"APC"}]}]},{"description":"Mech remov tunneled cv cath","code_information":[{"code":"36596","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1504.61,"maximum":3757.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1504.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1534.71,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1519.66,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1549.75,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3757.02,"additional_payer_notes":"APC"}]}]},{"description":"Reposition venous catheter","code_information":[{"code":"36597","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1504.61,"maximum":3757.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1504.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1534.71,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1519.66,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1549.75,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3757.02,"additional_payer_notes":"APC"}]}]},{"description":"External cannula declotting","code_information":[{"code":"36860","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1504.61,"maximum":3757.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1504.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1534.71,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1519.66,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1549.75,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3757.02,"additional_payer_notes":"APC"}]}]},{"description":"Intro cath dialysis circuit","code_information":[{"code":"36901","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1504.61,"maximum":3757.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1504.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1534.71,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1519.66,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1549.75,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3757.02,"additional_payer_notes":"APC"}]}]},{"description":"Lymph vessel x-ray arms/legs","code_information":[{"code":"75803","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1504.61,"maximum":3757.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1504.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1534.71,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1519.66,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1549.75,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3757.02,"additional_payer_notes":"APC"}]}]},{"description":"Vein x-ray arm/leg","code_information":[{"code":"75820","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1504.61,"maximum":3757.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1504.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1534.71,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1519.66,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1549.75,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3757.02,"additional_payer_notes":"APC"}]}]},{"description":"Vein x-ray arms/legs","code_information":[{"code":"75822","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1504.61,"maximum":3757.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1504.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1534.71,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1519.66,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1549.75,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3757.02,"additional_payer_notes":"APC"}]}]},{"description":"Vein x-ray chest","code_information":[{"code":"75827","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1504.61,"maximum":3757.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1504.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1534.71,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1519.66,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1549.75,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3757.02,"additional_payer_notes":"APC"}]}]},{"description":"Insert/place heart catheter","code_information":[{"code":"93503","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1504.61,"maximum":3757.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1504.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1534.71,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1519.66,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1549.75,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3757.02,"additional_payer_notes":"APC"}]}]},{"description":"Ev cath dir chem abltj w/img","code_information":[{"code":"0524T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3017.99,"maximum":7535.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3017.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3078.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3048.17,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3108.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7535.93,"additional_payer_notes":"APC"}]}]},{"description":"Tcat rmv 2chmbr ldls pm cmpl","code_information":[{"code":"0798T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3017.99,"maximum":7535.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3017.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3078.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3048.17,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3108.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7535.93,"additional_payer_notes":"APC"}]}]},{"description":"Tcat rmvl 2chmbr ldls pm ra","code_information":[{"code":"0799T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3017.99,"maximum":7535.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3017.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3078.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3048.17,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3108.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7535.93,"additional_payer_notes":"APC"}]}]},{"description":"Tcat rmvl 2chmbr ldls pm rv","code_information":[{"code":"0800T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3017.99,"maximum":7535.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3017.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3078.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3048.17,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3108.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7535.93,"additional_payer_notes":"APC"}]}]},{"description":"Tcat rmv 1chmbr ldls pm ra","code_information":[{"code":"0824T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3017.99,"maximum":7535.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3017.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3078.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3048.17,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3108.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7535.93,"additional_payer_notes":"APC"}]}]},{"description":"Ligation nasal sinus artery","code_information":[{"code":"30915","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3017.99,"maximum":7535.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3017.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3078.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3048.17,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3108.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7535.93,"additional_payer_notes":"APC"}]}]},{"description":"Ligation upper jaw artery","code_information":[{"code":"30920","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3017.99,"maximum":7535.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3017.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3078.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3048.17,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3108.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7535.93,"additional_payer_notes":"APC"}]}]},{"description":"Reposition pacing-defib lead","code_information":[{"code":"33215","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3017.99,"maximum":7535.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3017.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3078.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3048.17,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3108.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7535.93,"additional_payer_notes":"APC"}]}]},{"description":"Reposition l ventric lead","code_information":[{"code":"33226","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3017.99,"maximum":7535.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3017.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3078.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3048.17,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3108.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7535.93,"additional_payer_notes":"APC"}]}]},{"description":"Tcat rmvl perm ldls pm","code_information":[{"code":"33275","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3017.99,"maximum":7535.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3017.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3078.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3048.17,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3108.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7535.93,"additional_payer_notes":"APC"}]}]},{"description":"Removal of vein clot","code_information":[{"code":"34421","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3017.99,"maximum":7535.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3017.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3078.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3048.17,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3108.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7535.93,"additional_payer_notes":"APC"}]}]},{"description":"Removal of vein clot","code_information":[{"code":"34490","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3017.99,"maximum":7535.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3017.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3078.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3048.17,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3108.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7535.93,"additional_payer_notes":"APC"}]}]},{"description":"Leg vein fusion","code_information":[{"code":"34530","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3017.99,"maximum":7535.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3017.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3078.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3048.17,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3108.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7535.93,"additional_payer_notes":"APC"}]}]},{"description":"Repair blood vessel lesion","code_information":[{"code":"35184","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3017.99,"maximum":7535.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3017.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3078.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3048.17,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3108.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7535.93,"additional_payer_notes":"APC"}]}]},{"description":"Repair blood vessel lesion","code_information":[{"code":"35206","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3017.99,"maximum":7535.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3017.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3078.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3048.17,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3108.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7535.93,"additional_payer_notes":"APC"}]}]},{"description":"Repair blood vessel lesion","code_information":[{"code":"35207","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3017.99,"maximum":7535.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3017.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3078.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3048.17,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3108.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7535.93,"additional_payer_notes":"APC"}]}]},{"description":"Repair blood vessel lesion","code_information":[{"code":"35231","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3017.99,"maximum":7535.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3017.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3078.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3048.17,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3108.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7535.93,"additional_payer_notes":"APC"}]}]},{"description":"Repair blood vessel lesion","code_information":[{"code":"35261","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3017.99,"maximum":7535.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3017.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3078.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3048.17,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3108.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7535.93,"additional_payer_notes":"APC"}]}]},{"description":"Explore limb vessels","code_information":[{"code":"35860","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3017.99,"maximum":7535.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3017.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3078.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3048.17,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3108.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7535.93,"additional_payer_notes":"APC"}]}]},{"description":"Excision graft extremity","code_information":[{"code":"35903","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3017.99,"maximum":7535.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3017.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3078.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3048.17,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3108.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7535.93,"additional_payer_notes":"APC"}]}]},{"description":"Place cath thoracic aorta","code_information":[{"code":"36221","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3017.99,"maximum":7535.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3017.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3078.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3048.17,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3108.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7535.93,"additional_payer_notes":"APC"}]}]},{"description":"Place cath carotid/inom art","code_information":[{"code":"36222","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3017.99,"maximum":7535.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3017.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3078.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3048.17,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3108.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7535.93,"additional_payer_notes":"APC"}]}]},{"description":"Place cath subclavian art","code_information":[{"code":"36225","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3017.99,"maximum":7535.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3017.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3078.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3048.17,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3108.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7535.93,"additional_payer_notes":"APC"}]}]},{"description":"Ins cath ren art 1st unilat","code_information":[{"code":"36251","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3017.99,"maximum":7535.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3017.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3078.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3048.17,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3108.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7535.93,"additional_payer_notes":"APC"}]}]},{"description":"Ins cath ren art 1st bilat","code_information":[{"code":"36252","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3017.99,"maximum":7535.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3017.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3078.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3048.17,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3108.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7535.93,"additional_payer_notes":"APC"}]}]},{"description":"Ins cath ren art 2nd+ bilat","code_information":[{"code":"36254","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3017.99,"maximum":7535.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3017.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3078.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3048.17,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3108.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7535.93,"additional_payer_notes":"APC"}]}]},{"description":"Endovenous mchnchem 1st vein","code_information":[{"code":"36473","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3017.99,"maximum":7535.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3017.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3078.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3048.17,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3108.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7535.93,"additional_payer_notes":"APC"}]}]},{"description":"Endovenous rf 1st vein","code_information":[{"code":"36475","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3017.99,"maximum":7535.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3017.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3078.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3048.17,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3108.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7535.93,"additional_payer_notes":"APC"}]}]},{"description":"Endovenous laser 1st vein","code_information":[{"code":"36478","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3017.99,"maximum":7535.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3017.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3078.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3048.17,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3108.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7535.93,"additional_payer_notes":"APC"}]}]},{"description":"Insert non-tunnel cv cath","code_information":[{"code":"36555","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3017.99,"maximum":7535.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3017.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3078.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3048.17,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3108.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7535.93,"additional_payer_notes":"APC"}]}]},{"description":"Insert non-tunnel cv cath","code_information":[{"code":"36556","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3017.99,"maximum":7535.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3017.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3078.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3048.17,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3108.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7535.93,"additional_payer_notes":"APC"}]}]},{"description":"Insert tunneled cv cath","code_information":[{"code":"36558","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3017.99,"maximum":7535.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3017.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3078.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3048.17,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3108.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7535.93,"additional_payer_notes":"APC"}]}]},{"description":"Insert tunneled cv cath","code_information":[{"code":"36560","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3017.99,"maximum":7535.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3017.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3078.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3048.17,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3108.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7535.93,"additional_payer_notes":"APC"}]}]},{"description":"Insert tunneled cv cath","code_information":[{"code":"36561","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3017.99,"maximum":7535.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3017.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3078.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3048.17,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3108.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7535.93,"additional_payer_notes":"APC"}]}]},{"description":"Insert tunneled cv cath","code_information":[{"code":"36565","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3017.99,"maximum":7535.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3017.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3078.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3048.17,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3108.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7535.93,"additional_payer_notes":"APC"}]}]},{"description":"Insert picvad cath","code_information":[{"code":"36570","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3017.99,"maximum":7535.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3017.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3078.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3048.17,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3108.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7535.93,"additional_payer_notes":"APC"}]}]},{"description":"Insert picvad cath","code_information":[{"code":"36571","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3017.99,"maximum":7535.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3017.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3078.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3048.17,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3108.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7535.93,"additional_payer_notes":"APC"}]}]},{"description":"Replace tunneled cv cath","code_information":[{"code":"36578","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3017.99,"maximum":7535.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3017.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3078.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3048.17,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3108.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7535.93,"additional_payer_notes":"APC"}]}]},{"description":"Replace tunneled cv cath","code_information":[{"code":"36581","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3017.99,"maximum":7535.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3017.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3078.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3048.17,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3108.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7535.93,"additional_payer_notes":"APC"}]}]},{"description":"Replace tunneled cv cath","code_information":[{"code":"36582","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3017.99,"maximum":7535.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3017.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3078.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3048.17,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3108.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7535.93,"additional_payer_notes":"APC"}]}]},{"description":"Replace picvad cath","code_information":[{"code":"36585","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3017.99,"maximum":7535.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3017.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3078.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3048.17,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3108.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7535.93,"additional_payer_notes":"APC"}]}]},{"description":"Mech remov tunneled cv cath","code_information":[{"code":"36595","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3017.99,"maximum":7535.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3017.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3078.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3048.17,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3108.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7535.93,"additional_payer_notes":"APC"}]}]},{"description":"Insertion catheter artery","code_information":[{"code":"36640","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3017.99,"maximum":7535.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3017.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3078.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3048.17,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3108.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7535.93,"additional_payer_notes":"APC"}]}]},{"description":"Insertion of cannula","code_information":[{"code":"36810","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3017.99,"maximum":7535.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3017.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3078.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3048.17,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3108.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7535.93,"additional_payer_notes":"APC"}]}]},{"description":"Av fusion direct any site","code_information":[{"code":"36821","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3017.99,"maximum":7535.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3017.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3078.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3048.17,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3108.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7535.93,"additional_payer_notes":"APC"}]}]},{"description":"Artery to vein shunt","code_information":[{"code":"36835","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3017.99,"maximum":7535.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3017.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3078.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3048.17,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3108.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7535.93,"additional_payer_notes":"APC"}]}]},{"description":"Venous m-thrombectomy add-on","code_information":[{"code":"37188","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3017.99,"maximum":7535.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3017.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3078.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3048.17,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3108.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7535.93,"additional_payer_notes":"APC"}]}]},{"description":"Redo endovas vena cava filtr","code_information":[{"code":"37192","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3017.99,"maximum":7535.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3017.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3078.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3048.17,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3108.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7535.93,"additional_payer_notes":"APC"}]}]},{"description":"Rem endovas vena cava filter","code_information":[{"code":"37193","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3017.99,"maximum":7535.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3017.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3078.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3048.17,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3108.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7535.93,"additional_payer_notes":"APC"}]}]},{"description":"Remove intrvas foreign body","code_information":[{"code":"37197","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3017.99,"maximum":7535.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3017.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3078.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3048.17,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3108.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7535.93,"additional_payer_notes":"APC"}]}]},{"description":"Thrombolytic venous therapy","code_information":[{"code":"37212","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3017.99,"maximum":7535.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3017.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3078.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3048.17,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3108.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7535.93,"additional_payer_notes":"APC"}]}]},{"description":"Thromblytic art/ven therapy","code_information":[{"code":"37213","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3017.99,"maximum":7535.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3017.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3078.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3048.17,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3108.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7535.93,"additional_payer_notes":"APC"}]}]},{"description":"Cessj therapy cath removal","code_information":[{"code":"37214","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3017.99,"maximum":7535.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3017.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3078.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3048.17,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3108.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7535.93,"additional_payer_notes":"APC"}]}]},{"description":"Ligation of neck vein","code_information":[{"code":"37565","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3017.99,"maximum":7535.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3017.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3078.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3048.17,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3108.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7535.93,"additional_payer_notes":"APC"}]}]},{"description":"Ligation of neck artery","code_information":[{"code":"37600","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3017.99,"maximum":7535.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3017.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3078.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3048.17,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3108.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7535.93,"additional_payer_notes":"APC"}]}]},{"description":"Ligation of neck artery","code_information":[{"code":"37605","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3017.99,"maximum":7535.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3017.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3078.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3048.17,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3108.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7535.93,"additional_payer_notes":"APC"}]}]},{"description":"Ligation of neck artery","code_information":[{"code":"37606","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3017.99,"maximum":7535.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3017.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3078.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3048.17,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3108.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7535.93,"additional_payer_notes":"APC"}]}]},{"description":"Ligation of a-v fistula","code_information":[{"code":"37607","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3017.99,"maximum":7535.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3017.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3078.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3048.17,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3108.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7535.93,"additional_payer_notes":"APC"}]}]},{"description":"Ligation of neck artery","code_information":[{"code":"37615","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3017.99,"maximum":7535.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3017.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3078.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3048.17,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3108.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7535.93,"additional_payer_notes":"APC"}]}]},{"description":"Revision of major vein","code_information":[{"code":"37650","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3017.99,"maximum":7535.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3017.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3078.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3048.17,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3108.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7535.93,"additional_payer_notes":"APC"}]}]},{"description":"Revise leg vein","code_information":[{"code":"37700","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3017.99,"maximum":7535.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3017.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3078.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3048.17,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3108.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7535.93,"additional_payer_notes":"APC"}]}]},{"description":"Ligate/strip short leg vein","code_information":[{"code":"37718","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3017.99,"maximum":7535.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3017.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3078.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3048.17,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3108.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7535.93,"additional_payer_notes":"APC"}]}]},{"description":"Ligate/strip long leg vein","code_information":[{"code":"37722","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3017.99,"maximum":7535.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3017.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3078.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3048.17,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3108.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7535.93,"additional_payer_notes":"APC"}]}]},{"description":"Removal of leg veins/lesion","code_information":[{"code":"37735","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3017.99,"maximum":7535.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3017.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3078.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3048.17,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3108.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7535.93,"additional_payer_notes":"APC"}]}]},{"description":"Ligate leg veins radical","code_information":[{"code":"37760","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3017.99,"maximum":7535.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3017.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3078.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3048.17,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3108.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7535.93,"additional_payer_notes":"APC"}]}]},{"description":"Ligate leg veins open","code_information":[{"code":"37761","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3017.99,"maximum":7535.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3017.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3078.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3048.17,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3108.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7535.93,"additional_payer_notes":"APC"}]}]},{"description":"Stab phleb veins xtr 10-20","code_information":[{"code":"37765","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3017.99,"maximum":7535.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3017.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3078.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3048.17,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3108.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7535.93,"additional_payer_notes":"APC"}]}]},{"description":"Phleb veins - extrem 20+","code_information":[{"code":"37766","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3017.99,"maximum":7535.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3017.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3078.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3048.17,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3108.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7535.93,"additional_payer_notes":"APC"}]}]},{"description":"Revision of leg vein","code_information":[{"code":"37780","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3017.99,"maximum":7535.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3017.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3078.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3048.17,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3108.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7535.93,"additional_payer_notes":"APC"}]}]},{"description":"Ligate/divide/excise vein","code_information":[{"code":"37785","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3017.99,"maximum":7535.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3017.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3078.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3048.17,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3108.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7535.93,"additional_payer_notes":"APC"}]}]},{"description":"Remove tunneled ip cath","code_information":[{"code":"49422","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3017.99,"maximum":7535.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3017.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3078.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3048.17,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3108.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7535.93,"additional_payer_notes":"APC"}]}]},{"description":"Removal of shunt","code_information":[{"code":"49429","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3017.99,"maximum":7535.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3017.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3078.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3048.17,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3108.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7535.93,"additional_payer_notes":"APC"}]}]},{"description":"Contrast exam thoracic aorta","code_information":[{"code":"75600","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3017.99,"maximum":7535.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3017.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3078.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3048.17,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3108.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7535.93,"additional_payer_notes":"APC"}]}]},{"description":"Contrast exam abdominl aorta","code_information":[{"code":"75625","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3017.99,"maximum":7535.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3017.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3078.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3048.17,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3108.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7535.93,"additional_payer_notes":"APC"}]}]},{"description":"X-ray aorta leg arteries","code_information":[{"code":"75630","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3017.99,"maximum":7535.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3017.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3078.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3048.17,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3108.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7535.93,"additional_payer_notes":"APC"}]}]},{"description":"Artery x-rays arm/leg","code_information":[{"code":"75710","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3017.99,"maximum":7535.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3017.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3078.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3048.17,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3108.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7535.93,"additional_payer_notes":"APC"}]}]},{"description":"Artery x-rays arms/legs","code_information":[{"code":"75716","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3017.99,"maximum":7535.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3017.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3078.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3048.17,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3108.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7535.93,"additional_payer_notes":"APC"}]}]},{"description":"Artery x-rays adrenal gland","code_information":[{"code":"75731","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3017.99,"maximum":7535.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3017.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3078.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3048.17,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3108.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7535.93,"additional_payer_notes":"APC"}]}]},{"description":"Artery x-rays adrenals","code_information":[{"code":"75733","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3017.99,"maximum":7535.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3017.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3078.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3048.17,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3108.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7535.93,"additional_payer_notes":"APC"}]}]},{"description":"Artery x-rays lung","code_information":[{"code":"75741","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3017.99,"maximum":7535.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3017.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3078.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3048.17,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3108.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7535.93,"additional_payer_notes":"APC"}]}]},{"description":"Artery x-rays lungs","code_information":[{"code":"75743","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3017.99,"maximum":7535.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3017.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3078.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3048.17,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3108.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7535.93,"additional_payer_notes":"APC"}]}]},{"description":"Artery x-rays lung","code_information":[{"code":"75746","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3017.99,"maximum":7535.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3017.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3078.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3048.17,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3108.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7535.93,"additional_payer_notes":"APC"}]}]},{"description":"Artery x-rays chest","code_information":[{"code":"75756","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3017.99,"maximum":7535.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3017.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3078.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3048.17,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3108.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7535.93,"additional_payer_notes":"APC"}]}]},{"description":"Lymph vessel x-ray trunk","code_information":[{"code":"75805","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3017.99,"maximum":7535.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3017.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3078.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3048.17,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3108.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7535.93,"additional_payer_notes":"APC"}]}]},{"description":"Lymph vessel x-ray trunk","code_information":[{"code":"75807","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3017.99,"maximum":7535.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3017.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3078.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3048.17,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3108.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7535.93,"additional_payer_notes":"APC"}]}]},{"description":"Vein x-ray spleen/liver","code_information":[{"code":"75810","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3017.99,"maximum":7535.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3017.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3078.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3048.17,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3108.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7535.93,"additional_payer_notes":"APC"}]}]},{"description":"Vein x-ray trunk","code_information":[{"code":"75825","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3017.99,"maximum":7535.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3017.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3078.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3048.17,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3108.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7535.93,"additional_payer_notes":"APC"}]}]},{"description":"Vein x-ray kidney","code_information":[{"code":"75831","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3017.99,"maximum":7535.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3017.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3078.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3048.17,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3108.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7535.93,"additional_payer_notes":"APC"}]}]},{"description":"Vein x-ray kidneys","code_information":[{"code":"75833","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3017.99,"maximum":7535.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3017.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3078.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3048.17,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3108.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7535.93,"additional_payer_notes":"APC"}]}]},{"description":"Vein x-ray adrenal gland","code_information":[{"code":"75840","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3017.99,"maximum":7535.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3017.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3078.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3048.17,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3108.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7535.93,"additional_payer_notes":"APC"}]}]},{"description":"Vein x-ray neck","code_information":[{"code":"75860","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3017.99,"maximum":7535.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3017.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3078.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3048.17,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3108.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7535.93,"additional_payer_notes":"APC"}]}]},{"description":"Vein x-ray skull","code_information":[{"code":"75870","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3017.99,"maximum":7535.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3017.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3078.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3048.17,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3108.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7535.93,"additional_payer_notes":"APC"}]}]},{"description":"Vein x-ray liver w/hemodynam","code_information":[{"code":"75885","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3017.99,"maximum":7535.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3017.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3078.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3048.17,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3108.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7535.93,"additional_payer_notes":"APC"}]}]},{"description":"Vein x-ray liver w/o hemodyn","code_information":[{"code":"75887","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3017.99,"maximum":7535.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3017.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3078.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3048.17,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3108.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7535.93,"additional_payer_notes":"APC"}]}]},{"description":"Vein x-ray liver w/hemodynam","code_information":[{"code":"75889","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3017.99,"maximum":7535.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3017.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3078.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3048.17,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3108.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7535.93,"additional_payer_notes":"APC"}]}]},{"description":"Vein x-ray liver","code_information":[{"code":"75891","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3017.99,"maximum":7535.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3017.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3078.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3048.17,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3108.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7535.93,"additional_payer_notes":"APC"}]}]},{"description":"Follow-up angiography","code_information":[{"code":"75898","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3017.99,"maximum":7535.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3017.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3078.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3048.17,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3108.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7535.93,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy of heart lining","code_information":[{"code":"93505","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3017.99,"maximum":7535.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3017.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3078.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3048.17,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3108.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7535.93,"additional_payer_notes":"APC"}]}]},{"description":"Insj/rplc car modulj atr elt","code_information":[{"code":"0410T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7909.81,"maximum":19750.80,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7909.81,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8068.01,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7988.91,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8147.11,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":19750.8,"additional_payer_notes":"APC"}]}]},{"description":"Insj/rplc car modulj vnt elt","code_information":[{"code":"0411T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7909.81,"maximum":19750.80,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7909.81,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8068.01,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7988.91,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8147.11,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":19750.8,"additional_payer_notes":"APC"}]}]},{"description":"Insj/rplcmt iims eltrd only","code_information":[{"code":"0526T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7909.81,"maximum":19750.80,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7909.81,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8068.01,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7988.91,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8147.11,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":19750.8,"additional_payer_notes":"APC"}]}]},{"description":"Insj/rplcmt iims implt mntr","code_information":[{"code":"0527T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7909.81,"maximum":19750.80,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7909.81,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8068.01,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7988.91,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8147.11,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":19750.8,"additional_payer_notes":"APC"}]}]},{"description":"Insertion ss dfb electrode","code_information":[{"code":"0572T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7909.81,"maximum":19750.80,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7909.81,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8068.01,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7988.91,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8147.11,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":19750.8,"additional_payer_notes":"APC"}]}]},{"description":"Insj perm ccm-d sys 1 lead","code_information":[{"code":"0917T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7909.81,"maximum":19750.80,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7909.81,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8068.01,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7988.91,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8147.11,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":19750.8,"additional_payer_notes":"APC"}]}]},{"description":"Insj perm ccm-d sys dual ld","code_information":[{"code":"0918T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7909.81,"maximum":19750.80,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7909.81,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8068.01,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7988.91,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8147.11,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":19750.8,"additional_payer_notes":"APC"}]}]},{"description":"Insert electrd/pm cath sngl","code_information":[{"code":"33210","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7909.81,"maximum":19750.80,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7909.81,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8068.01,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7988.91,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8147.11,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":19750.8,"additional_payer_notes":"APC"}]}]},{"description":"Insert card electrodes dual","code_information":[{"code":"33211","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7909.81,"maximum":19750.80,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7909.81,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8068.01,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7988.91,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8147.11,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":19750.8,"additional_payer_notes":"APC"}]}]},{"description":"Insert pulse gen sngl lead","code_information":[{"code":"33212","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7909.81,"maximum":19750.80,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7909.81,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8068.01,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7988.91,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8147.11,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":19750.8,"additional_payer_notes":"APC"}]}]},{"description":"Insert 1 electrode pm-defib","code_information":[{"code":"33216","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7909.81,"maximum":19750.80,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7909.81,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8068.01,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7988.91,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8147.11,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":19750.8,"additional_payer_notes":"APC"}]}]},{"description":"Insert 2 electrode pm-defib","code_information":[{"code":"33217","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7909.81,"maximum":19750.80,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7909.81,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8068.01,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7988.91,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8147.11,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":19750.8,"additional_payer_notes":"APC"}]}]},{"description":"Remove&replace pm gen singl","code_information":[{"code":"33227","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7909.81,"maximum":19750.80,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7909.81,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8068.01,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7988.91,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8147.11,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":19750.8,"additional_payer_notes":"APC"}]}]},{"description":"Removal of pm generator","code_information":[{"code":"33233","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7909.81,"maximum":19750.80,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7909.81,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8068.01,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7988.91,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8147.11,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":19750.8,"additional_payer_notes":"APC"}]}]},{"description":"Insj subq impltbl dfb elctrd","code_information":[{"code":"33271","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7909.81,"maximum":19750.80,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7909.81,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8068.01,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7988.91,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8147.11,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":19750.8,"additional_payer_notes":"APC"}]}]},{"description":"Insj subq car rhythm mntr","code_information":[{"code":"33285","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7909.81,"maximum":19750.80,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7909.81,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8068.01,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7988.91,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8147.11,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":19750.8,"additional_payer_notes":"APC"}]}]},{"description":"Blood transfusion service","code_information":[{"code":"36430","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":421.68,"maximum":1052.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":421.68,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":430.12,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":425.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":434.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1052.95,"additional_payer_notes":"APC"}]}]},{"description":"Bl push transfuse 2 yr/<","code_information":[{"code":"36440","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":421.68,"maximum":1052.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":421.68,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":430.12,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":425.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":434.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1052.95,"additional_payer_notes":"APC"}]}]},{"description":"Bl exchange/transfuse nb","code_information":[{"code":"36450","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":421.68,"maximum":1052.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":421.68,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":430.12,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":425.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":434.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1052.95,"additional_payer_notes":"APC"}]}]},{"description":"Bl exchange/transfuse non-nb","code_information":[{"code":"36455","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":421.68,"maximum":1052.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":421.68,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":430.12,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":425.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":434.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1052.95,"additional_payer_notes":"APC"}]}]},{"description":"Prtl exchange transfuse nb","code_information":[{"code":"36456","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":421.68,"maximum":1052.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":421.68,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":430.12,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":425.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":434.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1052.95,"additional_payer_notes":"APC"}]}]},{"description":"Transfusion service fetal","code_information":[{"code":"36460","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":421.68,"maximum":1052.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":421.68,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":430.12,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":425.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":434.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1052.95,"additional_payer_notes":"APC"}]}]},{"description":"Apheresis platelets","code_information":[{"code":"36513","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":421.68,"maximum":1052.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":421.68,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":430.12,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":425.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":434.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1052.95,"additional_payer_notes":"APC"}]}]},{"description":"Cryopreserve stem cells","code_information":[{"code":"38207","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":421.68,"maximum":1052.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":421.68,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":430.12,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":425.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":434.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1052.95,"additional_payer_notes":"APC"}]}]},{"description":"Thaw preserved stem cells","code_information":[{"code":"38208","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":421.68,"maximum":1052.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":421.68,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":430.12,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":425.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":434.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1052.95,"additional_payer_notes":"APC"}]}]},{"description":"Wash harvest stem cells","code_information":[{"code":"38209","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":421.68,"maximum":1052.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":421.68,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":430.12,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":425.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":434.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1052.95,"additional_payer_notes":"APC"}]}]},{"description":"T-cell depletion of harvest","code_information":[{"code":"38210","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":421.68,"maximum":1052.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":421.68,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":430.12,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":425.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":434.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1052.95,"additional_payer_notes":"APC"}]}]},{"description":"Tumor cell deplete of harvst","code_information":[{"code":"38211","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":421.68,"maximum":1052.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":421.68,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":430.12,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":425.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":434.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1052.95,"additional_payer_notes":"APC"}]}]},{"description":"Rbc depletion of harvest","code_information":[{"code":"38212","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":421.68,"maximum":1052.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":421.68,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":430.12,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":425.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":434.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1052.95,"additional_payer_notes":"APC"}]}]},{"description":"Platelet deplete of harvest","code_information":[{"code":"38213","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":421.68,"maximum":1052.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":421.68,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":430.12,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":425.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":434.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1052.95,"additional_payer_notes":"APC"}]}]},{"description":"Volume deplete of harvest","code_information":[{"code":"38214","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":421.68,"maximum":1052.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":421.68,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":430.12,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":425.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":434.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1052.95,"additional_payer_notes":"APC"}]}]},{"description":"Harvest stem cell concentrte","code_information":[{"code":"38215","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":421.68,"maximum":1052.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":421.68,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":430.12,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":425.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":434.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1052.95,"additional_payer_notes":"APC"}]}]},{"description":"Blood/lymph system procedure","code_information":[{"code":"38999","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":421.68,"maximum":1052.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":421.68,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":430.12,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":425.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":434.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1052.95,"additional_payer_notes":"APC"}]}]},{"description":"Mag ctrld capsule endoscopy","code_information":[{"code":"0651T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":866.92,"maximum":2164.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":866.92,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":884.26,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":875.59,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":892.93,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2164.69,"additional_payer_notes":"APC"}]}]},{"description":"Egd vol adjmt bariatric balo","code_information":[{"code":"0813T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":866.92,"maximum":2164.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":866.92,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":884.26,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":875.59,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":892.93,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2164.69,"additional_payer_notes":"APC"}]}]},{"description":"Upr gi bld detcj snr capsule","code_information":[{"code":"0977T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":866.92,"maximum":2164.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":866.92,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":884.26,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":875.59,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":892.93,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2164.69,"additional_payer_notes":"APC"}]}]},{"description":"Removal foreign body mouth","code_information":[{"code":"40804","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":866.92,"maximum":2164.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":866.92,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":884.26,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":875.59,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":892.93,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2164.69,"additional_payer_notes":"APC"}]}]},{"description":"Esophagoscopy flex dx brush","code_information":[{"code":"43197","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":866.92,"maximum":2164.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":866.92,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":884.26,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":875.59,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":892.93,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2164.69,"additional_payer_notes":"APC"}]}]},{"description":"Esophagosc flex trnsn biopsy","code_information":[{"code":"43198","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":866.92,"maximum":2164.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":866.92,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":884.26,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":875.59,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":892.93,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2164.69,"additional_payer_notes":"APC"}]}]},{"description":"Esophagoscopy flexible brush","code_information":[{"code":"43200","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":866.92,"maximum":2164.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":866.92,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":884.26,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":875.59,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":892.93,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2164.69,"additional_payer_notes":"APC"}]}]},{"description":"Egd diagnostic brush wash","code_information":[{"code":"43235","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":866.92,"maximum":2164.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":866.92,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":884.26,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":875.59,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":892.93,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2164.69,"additional_payer_notes":"APC"}]}]},{"description":"Uppr gi scope w/submuc inj","code_information":[{"code":"43236","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":866.92,"maximum":2164.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":866.92,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":884.26,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":875.59,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":892.93,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2164.69,"additional_payer_notes":"APC"}]}]},{"description":"Egd biopsy single/multiple","code_information":[{"code":"43239","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":866.92,"maximum":2164.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":866.92,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":884.26,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":875.59,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":892.93,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2164.69,"additional_payer_notes":"APC"}]}]},{"description":"Egd remove foreign body","code_information":[{"code":"43247","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":866.92,"maximum":2164.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":866.92,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":884.26,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":875.59,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":892.93,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2164.69,"additional_payer_notes":"APC"}]}]},{"description":"Egd guide wire insertion","code_information":[{"code":"43248","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":866.92,"maximum":2164.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":866.92,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":884.26,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":875.59,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":892.93,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2164.69,"additional_payer_notes":"APC"}]}]},{"description":"Egd flx trnsorl rmvl balo","code_information":[{"code":"43291","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":866.92,"maximum":2164.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":866.92,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":884.26,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":875.59,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":892.93,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2164.69,"additional_payer_notes":"APC"}]}]},{"description":"Dilate esophagus 1/mult pass","code_information":[{"code":"43450","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":866.92,"maximum":2164.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":866.92,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":884.26,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":875.59,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":892.93,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2164.69,"additional_payer_notes":"APC"}]}]},{"description":"Esophagus surgery procedure","code_information":[{"code":"43499","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":866.92,"maximum":2164.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":866.92,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":884.26,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":875.59,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":892.93,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2164.69,"additional_payer_notes":"APC"}]}]},{"description":"Surgical opening of stomach","code_information":[{"code":"43510","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":866.92,"maximum":2164.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":866.92,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":884.26,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":875.59,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":892.93,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2164.69,"additional_payer_notes":"APC"}]}]},{"description":"Dx duod intub w/asp spec","code_information":[{"code":"43756","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":866.92,"maximum":2164.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":866.92,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":884.26,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":875.59,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":892.93,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2164.69,"additional_payer_notes":"APC"}]}]},{"description":"Dx duod intub w/asp specs","code_information":[{"code":"43757","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":866.92,"maximum":2164.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":866.92,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":884.26,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":875.59,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":892.93,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2164.69,"additional_payer_notes":"APC"}]}]},{"description":"Place gastrostomy tube","code_information":[{"code":"43831","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":866.92,"maximum":2164.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":866.92,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":884.26,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":875.59,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":892.93,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2164.69,"additional_payer_notes":"APC"}]}]},{"description":"Stomach surgery procedure","code_information":[{"code":"43999","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":866.92,"maximum":2164.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":866.92,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":884.26,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":875.59,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":892.93,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2164.69,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy of bowel","code_information":[{"code":"44100","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":866.92,"maximum":2164.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":866.92,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":884.26,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":875.59,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":892.93,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2164.69,"additional_payer_notes":"APC"}]}]},{"description":"Small bowel endoscopy br/wa","code_information":[{"code":"44380","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":866.92,"maximum":2164.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":866.92,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":884.26,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":875.59,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":892.93,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2164.69,"additional_payer_notes":"APC"}]}]},{"description":"Small bowel endoscopy","code_information":[{"code":"44382","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":866.92,"maximum":2164.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":866.92,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":884.26,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":875.59,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":892.93,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2164.69,"additional_payer_notes":"APC"}]}]},{"description":"Intro gastrointestinal tube","code_information":[{"code":"44500","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":866.92,"maximum":2164.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":866.92,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":884.26,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":875.59,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":892.93,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2164.69,"additional_payer_notes":"APC"}]}]},{"description":"Unlisted px small intestine","code_information":[{"code":"44799","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":866.92,"maximum":2164.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":866.92,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":884.26,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":875.59,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":892.93,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2164.69,"additional_payer_notes":"APC"}]}]},{"description":"Removal biliary drg cath","code_information":[{"code":"47537","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":866.92,"maximum":2164.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":866.92,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":884.26,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":875.59,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":892.93,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2164.69,"additional_payer_notes":"APC"}]}]},{"description":"Bile tract surgery procedure","code_information":[{"code":"47999","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":866.92,"maximum":2164.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":866.92,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":884.26,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":875.59,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":892.93,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2164.69,"additional_payer_notes":"APC"}]}]},{"description":"Abd paracentesis","code_information":[{"code":"49082","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":866.92,"maximum":2164.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":866.92,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":884.26,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":875.59,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":892.93,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2164.69,"additional_payer_notes":"APC"}]}]},{"description":"Abd paracentesis w/imaging","code_information":[{"code":"49083","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":866.92,"maximum":2164.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":866.92,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":884.26,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":875.59,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":892.93,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2164.69,"additional_payer_notes":"APC"}]}]},{"description":"Peritoneal lavage","code_information":[{"code":"49084","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":866.92,"maximum":2164.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":866.92,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":884.26,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":875.59,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":892.93,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2164.69,"additional_payer_notes":"APC"}]}]},{"description":"Replace g/c tube perc","code_information":[{"code":"49450","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":866.92,"maximum":2164.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":866.92,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":884.26,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":875.59,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":892.93,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2164.69,"additional_payer_notes":"APC"}]}]},{"description":"Replace duod/jej tube perc","code_information":[{"code":"49451","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":866.92,"maximum":2164.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":866.92,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":884.26,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":875.59,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":892.93,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2164.69,"additional_payer_notes":"APC"}]}]},{"description":"Replace g-j tube perc","code_information":[{"code":"49452","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":866.92,"maximum":2164.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":866.92,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":884.26,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":875.59,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":892.93,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2164.69,"additional_payer_notes":"APC"}]}]},{"description":"Fix g/colon tube w/device","code_information":[{"code":"49460","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":866.92,"maximum":2164.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":866.92,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":884.26,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":875.59,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":892.93,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2164.69,"additional_payer_notes":"APC"}]}]},{"description":"Abdomen surgery procedure","code_information":[{"code":"49999","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":866.92,"maximum":2164.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":866.92,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":884.26,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":875.59,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":892.93,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2164.69,"additional_payer_notes":"APC"}]}]},{"description":"Perq elec nrv field stimj cn","code_information":[{"code":"64567","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":866.92,"maximum":2164.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":866.92,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":884.26,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":875.59,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":892.93,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2164.69,"additional_payer_notes":"APC"}]}]},{"description":"Gi tract capsule endoscopy","code_information":[{"code":"91110","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":866.92,"maximum":2164.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":866.92,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":884.26,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":875.59,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":892.93,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2164.69,"additional_payer_notes":"APC"}]}]},{"description":"Esophageal Capsule Endoscopy","code_information":[{"code":"91111","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":866.92,"maximum":2164.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":866.92,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":884.26,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":875.59,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":892.93,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2164.69,"additional_payer_notes":"APC"}]}]},{"description":"Gi wireless capsule measure","code_information":[{"code":"91112","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":866.92,"maximum":2164.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":866.92,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":884.26,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":875.59,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":892.93,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2164.69,"additional_payer_notes":"APC"}]}]},{"description":"Insj gtube perq mag gastrpxy","code_information":[{"code":"0647T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1834.14,"maximum":4579.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1834.14,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1870.82,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1852.48,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1889.16,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4579.84,"additional_payer_notes":"APC"}]}]},{"description":"Egd flx transnasal dx br/wa","code_information":[{"code":"0652T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1834.14,"maximum":4579.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1834.14,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1870.82,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1852.48,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1889.16,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4579.84,"additional_payer_notes":"APC"}]}]},{"description":"Egd flx transnasal bx 1/ml","code_information":[{"code":"0653T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1834.14,"maximum":4579.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1834.14,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1870.82,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1852.48,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1889.16,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4579.84,"additional_payer_notes":"APC"}]}]},{"description":"Insert cath pleura w/o image","code_information":[{"code":"32556","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1834.14,"maximum":4579.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1834.14,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1870.82,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1852.48,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1889.16,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4579.84,"additional_payer_notes":"APC"}]}]},{"description":"Esophagoscopy rigid trnso dx","code_information":[{"code":"43191","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1834.14,"maximum":4579.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1834.14,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1870.82,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1852.48,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1889.16,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4579.84,"additional_payer_notes":"APC"}]}]},{"description":"Esophagoscp rig trnso inject","code_information":[{"code":"43192","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1834.14,"maximum":4579.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1834.14,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1870.82,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1852.48,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1889.16,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4579.84,"additional_payer_notes":"APC"}]}]},{"description":"Esophagoscp rig trnso biopsy","code_information":[{"code":"43193","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1834.14,"maximum":4579.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1834.14,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1870.82,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1852.48,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1889.16,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4579.84,"additional_payer_notes":"APC"}]}]},{"description":"Esophagoscp rig trnso rem fb","code_information":[{"code":"43194","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1834.14,"maximum":4579.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1834.14,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1870.82,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1852.48,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1889.16,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4579.84,"additional_payer_notes":"APC"}]}]},{"description":"Esophagoscp guide wire dilat","code_information":[{"code":"43196","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1834.14,"maximum":4579.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1834.14,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1870.82,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1852.48,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1889.16,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4579.84,"additional_payer_notes":"APC"}]}]},{"description":"Esoph scope w/submucous inj","code_information":[{"code":"43201","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1834.14,"maximum":4579.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1834.14,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1870.82,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1852.48,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1889.16,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4579.84,"additional_payer_notes":"APC"}]}]},{"description":"Esophagoscopy flex biopsy","code_information":[{"code":"43202","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1834.14,"maximum":4579.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1834.14,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1870.82,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1852.48,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1889.16,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4579.84,"additional_payer_notes":"APC"}]}]},{"description":"Esoph scope w/sclerosis inj","code_information":[{"code":"43204","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1834.14,"maximum":4579.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1834.14,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1870.82,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1852.48,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1889.16,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4579.84,"additional_payer_notes":"APC"}]}]},{"description":"Esophagus endoscopy/ligation","code_information":[{"code":"43205","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1834.14,"maximum":4579.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1834.14,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1870.82,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1852.48,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1889.16,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4579.84,"additional_payer_notes":"APC"}]}]},{"description":"Esoph optical endomicroscopy","code_information":[{"code":"43206","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1834.14,"maximum":4579.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1834.14,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1870.82,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1852.48,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1889.16,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4579.84,"additional_payer_notes":"APC"}]}]},{"description":"Esophagoscop mucosal resect","code_information":[{"code":"43211","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1834.14,"maximum":4579.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1834.14,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1870.82,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1852.48,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1889.16,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4579.84,"additional_payer_notes":"APC"}]}]},{"description":"Esophagoscopy retro balloon","code_information":[{"code":"43213","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1834.14,"maximum":4579.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1834.14,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1870.82,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1852.48,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1889.16,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4579.84,"additional_payer_notes":"APC"}]}]},{"description":"Esophagosc dilate balloon 30","code_information":[{"code":"43214","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1834.14,"maximum":4579.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1834.14,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1870.82,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1852.48,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1889.16,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4579.84,"additional_payer_notes":"APC"}]}]},{"description":"Esophagoscopy flex remove fb","code_information":[{"code":"43215","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1834.14,"maximum":4579.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1834.14,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1870.82,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1852.48,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1889.16,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4579.84,"additional_payer_notes":"APC"}]}]},{"description":"Esophagoscopy lesion removal","code_information":[{"code":"43216","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1834.14,"maximum":4579.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1834.14,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1870.82,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1852.48,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1889.16,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4579.84,"additional_payer_notes":"APC"}]}]},{"description":"Esophagoscopy snare les remv","code_information":[{"code":"43217","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1834.14,"maximum":4579.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1834.14,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1870.82,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1852.48,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1889.16,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4579.84,"additional_payer_notes":"APC"}]}]},{"description":"Esophagoscopy balloon <30mm","code_information":[{"code":"43220","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1834.14,"maximum":4579.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1834.14,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1870.82,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1852.48,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1889.16,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4579.84,"additional_payer_notes":"APC"}]}]},{"description":"Esoph endoscopy dilation","code_information":[{"code":"43226","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1834.14,"maximum":4579.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1834.14,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1870.82,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1852.48,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1889.16,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4579.84,"additional_payer_notes":"APC"}]}]},{"description":"Esophagoscopy control bleed","code_information":[{"code":"43227","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1834.14,"maximum":4579.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1834.14,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1870.82,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1852.48,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1889.16,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4579.84,"additional_payer_notes":"APC"}]}]},{"description":"Esophagoscop ultrasound exam","code_information":[{"code":"43231","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1834.14,"maximum":4579.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1834.14,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1870.82,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1852.48,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1889.16,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4579.84,"additional_payer_notes":"APC"}]}]},{"description":"Esophagoscopy w/us needle bx","code_information":[{"code":"43232","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1834.14,"maximum":4579.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1834.14,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1870.82,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1852.48,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1889.16,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4579.84,"additional_payer_notes":"APC"}]}]},{"description":"Egd balloon dil esoph30 mm/>","code_information":[{"code":"43233","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1834.14,"maximum":4579.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1834.14,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1870.82,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1852.48,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1889.16,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4579.84,"additional_payer_notes":"APC"}]}]},{"description":"Endoscopic us exam esoph","code_information":[{"code":"43237","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1834.14,"maximum":4579.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1834.14,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1870.82,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1852.48,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1889.16,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4579.84,"additional_payer_notes":"APC"}]}]},{"description":"Egd us fine needle bx/aspir","code_information":[{"code":"43238","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1834.14,"maximum":4579.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1834.14,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1870.82,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1852.48,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1889.16,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4579.84,"additional_payer_notes":"APC"}]}]},{"description":"Egd tube/cath insertion","code_information":[{"code":"43241","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1834.14,"maximum":4579.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1834.14,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1870.82,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1852.48,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1889.16,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4579.84,"additional_payer_notes":"APC"}]}]},{"description":"Egd us fine needle bx/aspir","code_information":[{"code":"43242","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1834.14,"maximum":4579.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1834.14,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1870.82,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1852.48,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1889.16,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4579.84,"additional_payer_notes":"APC"}]}]},{"description":"Egd injection varices","code_information":[{"code":"43243","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1834.14,"maximum":4579.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1834.14,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1870.82,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1852.48,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1889.16,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4579.84,"additional_payer_notes":"APC"}]}]},{"description":"Egd varices ligation","code_information":[{"code":"43244","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1834.14,"maximum":4579.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1834.14,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1870.82,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1852.48,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1889.16,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4579.84,"additional_payer_notes":"APC"}]}]},{"description":"Egd dilate stricture","code_information":[{"code":"43245","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1834.14,"maximum":4579.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1834.14,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1870.82,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1852.48,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1889.16,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4579.84,"additional_payer_notes":"APC"}]}]},{"description":"Egd place gastrostomy tube","code_information":[{"code":"43246","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1834.14,"maximum":4579.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1834.14,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1870.82,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1852.48,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1889.16,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4579.84,"additional_payer_notes":"APC"}]}]},{"description":"Esoph egd dilation <30 mm","code_information":[{"code":"43249","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1834.14,"maximum":4579.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1834.14,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1870.82,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1852.48,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1889.16,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4579.84,"additional_payer_notes":"APC"}]}]},{"description":"Egd cautery tumor polyp","code_information":[{"code":"43250","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1834.14,"maximum":4579.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1834.14,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1870.82,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1852.48,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1889.16,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4579.84,"additional_payer_notes":"APC"}]}]},{"description":"Egd remove lesion snare","code_information":[{"code":"43251","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1834.14,"maximum":4579.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1834.14,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1870.82,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1852.48,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1889.16,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4579.84,"additional_payer_notes":"APC"}]}]},{"description":"Egd optical endomicroscopy","code_information":[{"code":"43252","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1834.14,"maximum":4579.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1834.14,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1870.82,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1852.48,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1889.16,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4579.84,"additional_payer_notes":"APC"}]}]},{"description":"Egd us transmural injxn/mark","code_information":[{"code":"43253","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1834.14,"maximum":4579.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1834.14,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1870.82,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1852.48,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1889.16,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4579.84,"additional_payer_notes":"APC"}]}]},{"description":"Egd endo mucosal resection","code_information":[{"code":"43254","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1834.14,"maximum":4579.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1834.14,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1870.82,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1852.48,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1889.16,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4579.84,"additional_payer_notes":"APC"}]}]},{"description":"Egd control bleeding any","code_information":[{"code":"43255","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1834.14,"maximum":4579.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1834.14,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1870.82,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1852.48,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1889.16,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4579.84,"additional_payer_notes":"APC"}]}]},{"description":"Egd us exam duodenum/jejunum","code_information":[{"code":"43259","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1834.14,"maximum":4579.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1834.14,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1870.82,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1852.48,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1889.16,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4579.84,"additional_payer_notes":"APC"}]}]},{"description":"Ercp sphincter pressure meas","code_information":[{"code":"43263","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1834.14,"maximum":4579.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1834.14,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1870.82,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1852.48,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1889.16,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4579.84,"additional_payer_notes":"APC"}]}]},{"description":"Egd lesion ablation","code_information":[{"code":"43270","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1834.14,"maximum":4579.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1834.14,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1870.82,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1852.48,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1889.16,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4579.84,"additional_payer_notes":"APC"}]}]},{"description":"Ercp remove forgn body duct","code_information":[{"code":"43275","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1834.14,"maximum":4579.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1834.14,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1870.82,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1852.48,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1889.16,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4579.84,"additional_payer_notes":"APC"}]}]},{"description":"Egd flx trnsorl dplmnt balo","code_information":[{"code":"43290","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1834.14,"maximum":4579.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1834.14,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1870.82,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1852.48,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1889.16,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4579.84,"additional_payer_notes":"APC"}]}]},{"description":"Dilate esophagus","code_information":[{"code":"43453","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1834.14,"maximum":4579.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1834.14,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1870.82,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1852.48,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1889.16,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4579.84,"additional_payer_notes":"APC"}]}]},{"description":"Place gastrostomy tube","code_information":[{"code":"43830","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1834.14,"maximum":4579.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1834.14,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1870.82,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1852.48,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1889.16,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4579.84,"additional_payer_notes":"APC"}]}]},{"description":"Open bowel to skin","code_information":[{"code":"44300","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1834.14,"maximum":4579.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1834.14,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1870.82,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1852.48,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1889.16,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4579.84,"additional_payer_notes":"APC"}]}]},{"description":"Small bowel endoscopy","code_information":[{"code":"44360","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1834.14,"maximum":4579.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1834.14,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1870.82,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1852.48,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1889.16,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4579.84,"additional_payer_notes":"APC"}]}]},{"description":"Small bowel endoscopy/biopsy","code_information":[{"code":"44361","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1834.14,"maximum":4579.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1834.14,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1870.82,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1852.48,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1889.16,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4579.84,"additional_payer_notes":"APC"}]}]},{"description":"Small bowel endoscopy","code_information":[{"code":"44363","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1834.14,"maximum":4579.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1834.14,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1870.82,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1852.48,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1889.16,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4579.84,"additional_payer_notes":"APC"}]}]},{"description":"Small bowel endoscopy","code_information":[{"code":"44364","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1834.14,"maximum":4579.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1834.14,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1870.82,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1852.48,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1889.16,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4579.84,"additional_payer_notes":"APC"}]}]},{"description":"Small bowel endoscopy","code_information":[{"code":"44365","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1834.14,"maximum":4579.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1834.14,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1870.82,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1852.48,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1889.16,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4579.84,"additional_payer_notes":"APC"}]}]},{"description":"Small bowel endoscopy","code_information":[{"code":"44366","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1834.14,"maximum":4579.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1834.14,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1870.82,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1852.48,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1889.16,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4579.84,"additional_payer_notes":"APC"}]}]},{"description":"Small bowel endoscopy","code_information":[{"code":"44369","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1834.14,"maximum":4579.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1834.14,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1870.82,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1852.48,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1889.16,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4579.84,"additional_payer_notes":"APC"}]}]},{"description":"Small bowel endoscopy","code_information":[{"code":"44372","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1834.14,"maximum":4579.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1834.14,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1870.82,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1852.48,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1889.16,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4579.84,"additional_payer_notes":"APC"}]}]},{"description":"Small bowel endoscopy","code_information":[{"code":"44373","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1834.14,"maximum":4579.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1834.14,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1870.82,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1852.48,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1889.16,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4579.84,"additional_payer_notes":"APC"}]}]},{"description":"Small bowel endoscopy","code_information":[{"code":"44376","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1834.14,"maximum":4579.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1834.14,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1870.82,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1852.48,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1889.16,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4579.84,"additional_payer_notes":"APC"}]}]},{"description":"Small bowel endoscopy/biopsy","code_information":[{"code":"44377","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1834.14,"maximum":4579.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1834.14,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1870.82,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1852.48,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1889.16,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4579.84,"additional_payer_notes":"APC"}]}]},{"description":"Small bowel endoscopy","code_information":[{"code":"44378","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1834.14,"maximum":4579.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1834.14,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1870.82,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1852.48,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1889.16,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4579.84,"additional_payer_notes":"APC"}]}]},{"description":"Small bowel endoscopy br/wa","code_information":[{"code":"44381","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1834.14,"maximum":4579.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1834.14,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1870.82,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1852.48,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1889.16,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4579.84,"additional_payer_notes":"APC"}]}]},{"description":"Small bowel endoscopy","code_information":[{"code":"44384","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1834.14,"maximum":4579.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1834.14,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1870.82,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1852.48,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1889.16,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4579.84,"additional_payer_notes":"APC"}]}]},{"description":"Exchange drainage catheter","code_information":[{"code":"49423","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1834.14,"maximum":4579.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1834.14,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1870.82,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1852.48,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1889.16,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4579.84,"additional_payer_notes":"APC"}]}]},{"description":"Embedded IP Cath Exit-Site","code_information":[{"code":"49436","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1834.14,"maximum":4579.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1834.14,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1870.82,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1852.48,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1889.16,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4579.84,"additional_payer_notes":"APC"}]}]},{"description":"Place gastrostomy tube perc","code_information":[{"code":"49440","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1834.14,"maximum":4579.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1834.14,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1870.82,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1852.48,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1889.16,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4579.84,"additional_payer_notes":"APC"}]}]},{"description":"Place duod/jej tube perc","code_information":[{"code":"49441","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1834.14,"maximum":4579.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1834.14,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1870.82,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1852.48,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1889.16,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4579.84,"additional_payer_notes":"APC"}]}]},{"description":"Change g-tube to g-j perc","code_information":[{"code":"49446","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1834.14,"maximum":4579.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1834.14,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1870.82,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1852.48,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1889.16,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4579.84,"additional_payer_notes":"APC"}]}]},{"description":"Egd flx transnasal tube/cath","code_information":[{"code":"0654T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3685.15,"maximum":9201.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3685.15,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3758.86,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3722.0,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3795.71,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":9201.82,"additional_payer_notes":"APC"}]}]},{"description":"Esophagoscopy rigid balloon","code_information":[{"code":"43195","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3685.15,"maximum":9201.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3685.15,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3758.86,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3722.0,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3795.71,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":9201.82,"additional_payer_notes":"APC"}]}]},{"description":"Esophagoscopy lesion ablate","code_information":[{"code":"43229","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3685.15,"maximum":9201.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3685.15,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3758.86,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3722.0,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3795.71,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":9201.82,"additional_payer_notes":"APC"}]}]},{"description":"Egd w/thrml txmnt gerd","code_information":[{"code":"43257","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3685.15,"maximum":9201.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3685.15,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3758.86,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3722.0,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3795.71,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":9201.82,"additional_payer_notes":"APC"}]}]},{"description":"Ercp w/specimen collection","code_information":[{"code":"43260","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3685.15,"maximum":9201.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3685.15,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3758.86,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3722.0,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3795.71,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":9201.82,"additional_payer_notes":"APC"}]}]},{"description":"Endo cholangiopancreatograph","code_information":[{"code":"43261","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3685.15,"maximum":9201.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3685.15,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3758.86,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3722.0,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3795.71,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":9201.82,"additional_payer_notes":"APC"}]}]},{"description":"Endo cholangiopancreatograph","code_information":[{"code":"43262","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3685.15,"maximum":9201.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3685.15,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3758.86,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3722.0,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3795.71,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":9201.82,"additional_payer_notes":"APC"}]}]},{"description":"Ercp remove duct calculi","code_information":[{"code":"43264","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3685.15,"maximum":9201.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3685.15,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3758.86,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3722.0,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3795.71,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":9201.82,"additional_payer_notes":"APC"}]}]},{"description":"Ercp ea duct/ampulla dilate","code_information":[{"code":"43277","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3685.15,"maximum":9201.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3685.15,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3758.86,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3722.0,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3795.71,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":9201.82,"additional_payer_notes":"APC"}]}]},{"description":"Ercp lesion ablate w/dilate","code_information":[{"code":"43278","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3685.15,"maximum":9201.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3685.15,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3758.86,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3722.0,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3795.71,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":9201.82,"additional_payer_notes":"APC"}]}]},{"description":"Lap rmvl gastr adj device","code_information":[{"code":"43772","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3685.15,"maximum":9201.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3685.15,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3758.86,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3722.0,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3795.71,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":9201.82,"additional_payer_notes":"APC"}]}]},{"description":"Lap rmvl gastr adj all parts","code_information":[{"code":"43774","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3685.15,"maximum":9201.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3685.15,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3758.86,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3722.0,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3795.71,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":9201.82,"additional_payer_notes":"APC"}]}]},{"description":"Repair of stomach lesion","code_information":[{"code":"43840","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3685.15,"maximum":9201.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3685.15,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3758.86,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3722.0,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3795.71,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":9201.82,"additional_payer_notes":"APC"}]}]},{"description":"Repair stomach opening","code_information":[{"code":"43870","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3685.15,"maximum":9201.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3685.15,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3758.86,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3722.0,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3795.71,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":9201.82,"additional_payer_notes":"APC"}]}]},{"description":"Suture small intestine","code_information":[{"code":"44602","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3685.15,"maximum":9201.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3685.15,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3758.86,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3722.0,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3795.71,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":9201.82,"additional_payer_notes":"APC"}]}]},{"description":"Esophag mucosal integ add-on","code_information":[{"code":"C9777","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3685.15,"maximum":9201.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3685.15,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3758.86,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3722.0,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3795.71,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":9201.82,"additional_payer_notes":"APC"}]}]},{"description":"ESD endoscopy or colonoscopy","code_information":[{"code":"C9779","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3685.15,"maximum":9201.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3685.15,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3758.86,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3722.0,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3795.71,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":9201.82,"additional_payer_notes":"APC"}]}]},{"description":"Endoscopy of bowel pouch","code_information":[{"code":"44385","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":888.88,"maximum":2219.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":888.88,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":906.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":897.76,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":915.54,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2219.52,"additional_payer_notes":"APC"}]}]},{"description":"Endoscopy bowel pouch/biop","code_information":[{"code":"44386","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":888.88,"maximum":2219.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":888.88,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":906.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":897.76,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":915.54,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2219.52,"additional_payer_notes":"APC"}]}]},{"description":"Colonoscopy thru stoma spx","code_information":[{"code":"44388","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":888.88,"maximum":2219.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":888.88,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":906.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":897.76,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":915.54,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2219.52,"additional_payer_notes":"APC"}]}]},{"description":"Colonoscopy for foreign body","code_information":[{"code":"44390","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":888.88,"maximum":2219.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":888.88,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":906.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":897.76,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":915.54,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2219.52,"additional_payer_notes":"APC"}]}]},{"description":"Colonoscopy w/decompression","code_information":[{"code":"44408","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":888.88,"maximum":2219.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":888.88,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":906.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":897.76,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":915.54,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2219.52,"additional_payer_notes":"APC"}]}]},{"description":"Proctosigmoidoscopy dx","code_information":[{"code":"45300","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":888.88,"maximum":2219.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":888.88,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":906.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":897.76,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":915.54,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2219.52,"additional_payer_notes":"APC"}]}]},{"description":"Diagnostic sigmoidoscopy","code_information":[{"code":"45330","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":888.88,"maximum":2219.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":888.88,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":906.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":897.76,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":915.54,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2219.52,"additional_payer_notes":"APC"}]}]},{"description":"Sigmoidoscopy and biopsy","code_information":[{"code":"45331","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":888.88,"maximum":2219.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":888.88,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":906.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":897.76,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":915.54,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2219.52,"additional_payer_notes":"APC"}]}]},{"description":"Sigmoidoscopy & polypectomy","code_information":[{"code":"45333","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":888.88,"maximum":2219.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":888.88,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":906.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":897.76,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":915.54,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2219.52,"additional_payer_notes":"APC"}]}]},{"description":"Sigmoidoscopy w/submuc inj","code_information":[{"code":"45335","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":888.88,"maximum":2219.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":888.88,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":906.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":897.76,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":915.54,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2219.52,"additional_payer_notes":"APC"}]}]},{"description":"Sigmoidoscopy & decompress","code_information":[{"code":"45337","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":888.88,"maximum":2219.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":888.88,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":906.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":897.76,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":915.54,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2219.52,"additional_payer_notes":"APC"}]}]},{"description":"Sigmoidoscopy W/Ultrasound","code_information":[{"code":"45341","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":888.88,"maximum":2219.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":888.88,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":906.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":897.76,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":915.54,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2219.52,"additional_payer_notes":"APC"}]}]},{"description":"Diagnostic colonoscopy","code_information":[{"code":"45378","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":888.88,"maximum":2219.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":888.88,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":906.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":897.76,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":915.54,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2219.52,"additional_payer_notes":"APC"}]}]},{"description":"Unlisted procedure colon","code_information":[{"code":"45399","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":888.88,"maximum":2219.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":888.88,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":906.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":897.76,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":915.54,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2219.52,"additional_payer_notes":"APC"}]}]},{"description":"Treatment of rectal prolapse","code_information":[{"code":"45520","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":888.88,"maximum":2219.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":888.88,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":906.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":897.76,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":915.54,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2219.52,"additional_payer_notes":"APC"}]}]},{"description":"Reduction of rectal prolapse","code_information":[{"code":"45900","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":888.88,"maximum":2219.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":888.88,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":906.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":897.76,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":915.54,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2219.52,"additional_payer_notes":"APC"}]}]},{"description":"Rectum surgery procedure","code_information":[{"code":"45999","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":888.88,"maximum":2219.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":888.88,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":906.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":897.76,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":915.54,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2219.52,"additional_payer_notes":"APC"}]}]},{"description":"Incision of anal abscess","code_information":[{"code":"46050","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":888.88,"maximum":2219.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":888.88,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":906.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":897.76,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":915.54,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2219.52,"additional_payer_notes":"APC"}]}]},{"description":"Ligation of hemorrhoid(s)","code_information":[{"code":"46221","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":888.88,"maximum":2219.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":888.88,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":906.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":897.76,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":915.54,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2219.52,"additional_payer_notes":"APC"}]}]},{"description":"Injection into hemorrhoid(s)","code_information":[{"code":"46500","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":888.88,"maximum":2219.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":888.88,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":906.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":897.76,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":915.54,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2219.52,"additional_payer_notes":"APC"}]}]},{"description":"Anoscopy remove for body","code_information":[{"code":"46608","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":888.88,"maximum":2219.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":888.88,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":906.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":897.76,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":915.54,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2219.52,"additional_payer_notes":"APC"}]}]},{"description":"Anoscopy","code_information":[{"code":"46611","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":888.88,"maximum":2219.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":888.88,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":906.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":897.76,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":915.54,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2219.52,"additional_payer_notes":"APC"}]}]},{"description":"Treatment of anal fissure","code_information":[{"code":"46942","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":888.88,"maximum":2219.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":888.88,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":906.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":897.76,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":915.54,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2219.52,"additional_payer_notes":"APC"}]}]},{"description":"Anus surgery procedure","code_information":[{"code":"46999","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":888.88,"maximum":2219.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":888.88,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":906.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":897.76,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":915.54,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2219.52,"additional_payer_notes":"APC"}]}]},{"description":"Gi trc img intral colon i&r","code_information":[{"code":"91113","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":888.88,"maximum":2219.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":888.88,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":906.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":897.76,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":915.54,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2219.52,"additional_payer_notes":"APC"}]}]},{"description":"Place endorectal app","code_information":[{"code":"C9725","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":888.88,"maximum":2219.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":888.88,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":906.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":897.76,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":915.54,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2219.52,"additional_payer_notes":"APC"}]}]},{"description":"CA screen;flexi sigmoidscope","code_information":[{"code":"G0104","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":888.88,"maximum":2219.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":888.88,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":906.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":897.76,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":915.54,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2219.52,"additional_payer_notes":"APC"}]}]},{"description":"Colorectal scrn; hi risk ind","code_information":[{"code":"G0105","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":888.88,"maximum":2219.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":888.88,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":906.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":897.76,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":915.54,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2219.52,"additional_payer_notes":"APC"}]}]},{"description":"Colon ca scrn not hi rsk ind","code_information":[{"code":"G0121","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":888.88,"maximum":2219.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":888.88,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":906.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":897.76,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":915.54,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2219.52,"additional_payer_notes":"APC"}]}]},{"description":"Fecal microbiota prep instil","code_information":[{"code":"G0455","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":888.88,"maximum":2219.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":888.88,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":906.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":897.76,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":915.54,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2219.52,"additional_payer_notes":"APC"}]}]},{"description":"Anosc sbmcsl njx bulking agt","code_information":[{"code":"0963T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1143.78,"maximum":2856.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1143.78,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1166.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1155.22,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1178.09,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2856.01,"additional_payer_notes":"APC"}]}]},{"description":"Tranal ins tmp clrc anst dev","code_information":[{"code":"0967T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1143.78,"maximum":2856.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1143.78,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1166.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1155.22,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1178.09,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2856.01,"additional_payer_notes":"APC"}]}]},{"description":"Colonoscopy with biopsy","code_information":[{"code":"44389","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1143.78,"maximum":2856.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1143.78,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1166.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1155.22,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1178.09,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2856.01,"additional_payer_notes":"APC"}]}]},{"description":"Colonoscopy for bleeding","code_information":[{"code":"44391","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1143.78,"maximum":2856.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1143.78,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1166.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1155.22,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1178.09,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2856.01,"additional_payer_notes":"APC"}]}]},{"description":"Colonoscopy & polypectomy","code_information":[{"code":"44392","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1143.78,"maximum":2856.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1143.78,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1166.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1155.22,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1178.09,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2856.01,"additional_payer_notes":"APC"}]}]},{"description":"Colonoscopy w/snare","code_information":[{"code":"44394","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1143.78,"maximum":2856.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1143.78,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1166.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1155.22,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1178.09,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2856.01,"additional_payer_notes":"APC"}]}]},{"description":"Colonoscopy with ablation","code_information":[{"code":"44401","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1143.78,"maximum":2856.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1143.78,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1166.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1155.22,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1178.09,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2856.01,"additional_payer_notes":"APC"}]}]},{"description":"Colonoscopy w/resection","code_information":[{"code":"44403","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1143.78,"maximum":2856.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1143.78,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1166.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1155.22,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1178.09,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2856.01,"additional_payer_notes":"APC"}]}]},{"description":"Colonoscopy w/injection","code_information":[{"code":"44404","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1143.78,"maximum":2856.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1143.78,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1166.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1155.22,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1178.09,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2856.01,"additional_payer_notes":"APC"}]}]},{"description":"Colonoscopy w/dilation","code_information":[{"code":"44405","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1143.78,"maximum":2856.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1143.78,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1166.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1155.22,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1178.09,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2856.01,"additional_payer_notes":"APC"}]}]},{"description":"Colonoscopy w/ultrasound","code_information":[{"code":"44406","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1143.78,"maximum":2856.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1143.78,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1166.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1155.22,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1178.09,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2856.01,"additional_payer_notes":"APC"}]}]},{"description":"Colonoscopy w/ndl aspir/bx","code_information":[{"code":"44407","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1143.78,"maximum":2856.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1143.78,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1166.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1155.22,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1178.09,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2856.01,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of pelvic abscess","code_information":[{"code":"45000","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1143.78,"maximum":2856.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1143.78,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1166.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1155.22,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1178.09,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2856.01,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of rectal abscess","code_information":[{"code":"45005","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1143.78,"maximum":2856.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1143.78,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1166.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1155.22,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1178.09,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2856.01,"additional_payer_notes":"APC"}]}]},{"description":"Excision of rectal stricture","code_information":[{"code":"45150","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1143.78,"maximum":2856.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1143.78,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1166.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1155.22,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1178.09,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2856.01,"additional_payer_notes":"APC"}]}]},{"description":"Proctosigmoidoscopy dilate","code_information":[{"code":"45303","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1143.78,"maximum":2856.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1143.78,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1166.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1155.22,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1178.09,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2856.01,"additional_payer_notes":"APC"}]}]},{"description":"Proctosigmoidoscopy w/bx","code_information":[{"code":"45305","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1143.78,"maximum":2856.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1143.78,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1166.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1155.22,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1178.09,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2856.01,"additional_payer_notes":"APC"}]}]},{"description":"Proctosigmoidoscopy removal","code_information":[{"code":"45309","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1143.78,"maximum":2856.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1143.78,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1166.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1155.22,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1178.09,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2856.01,"additional_payer_notes":"APC"}]}]},{"description":"Proctosigmoidoscopy removal","code_information":[{"code":"45315","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1143.78,"maximum":2856.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1143.78,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1166.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1155.22,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1178.09,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2856.01,"additional_payer_notes":"APC"}]}]},{"description":"Proctosigmoidoscopy bleed","code_information":[{"code":"45317","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1143.78,"maximum":2856.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1143.78,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1166.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1155.22,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1178.09,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2856.01,"additional_payer_notes":"APC"}]}]},{"description":"Sigmoidoscopy w/fb removal","code_information":[{"code":"45332","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1143.78,"maximum":2856.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1143.78,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1166.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1155.22,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1178.09,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2856.01,"additional_payer_notes":"APC"}]}]},{"description":"Sigmoidoscopy for bleeding","code_information":[{"code":"45334","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1143.78,"maximum":2856.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1143.78,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1166.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1155.22,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1178.09,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2856.01,"additional_payer_notes":"APC"}]}]},{"description":"Sigmoidoscopy w/tumr remove","code_information":[{"code":"45338","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1143.78,"maximum":2856.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1143.78,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1166.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1155.22,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1178.09,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2856.01,"additional_payer_notes":"APC"}]}]},{"description":"Sig w/tndsc balloon dilation","code_information":[{"code":"45340","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1143.78,"maximum":2856.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1143.78,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1166.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1155.22,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1178.09,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2856.01,"additional_payer_notes":"APC"}]}]},{"description":"Sigmoidoscopy W/Us Guide Bx","code_information":[{"code":"45342","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1143.78,"maximum":2856.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1143.78,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1166.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1155.22,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1178.09,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2856.01,"additional_payer_notes":"APC"}]}]},{"description":"Sigmoidoscopy w/ablation","code_information":[{"code":"45346","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1143.78,"maximum":2856.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1143.78,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1166.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1155.22,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1178.09,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2856.01,"additional_payer_notes":"APC"}]}]},{"description":"Sgmdsc w/band ligation","code_information":[{"code":"45350","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1143.78,"maximum":2856.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1143.78,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1166.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1155.22,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1178.09,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2856.01,"additional_payer_notes":"APC"}]}]},{"description":"Colonoscopy w/fb removal","code_information":[{"code":"45379","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1143.78,"maximum":2856.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1143.78,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1166.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1155.22,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1178.09,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2856.01,"additional_payer_notes":"APC"}]}]},{"description":"Colonoscopy and biopsy","code_information":[{"code":"45380","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1143.78,"maximum":2856.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1143.78,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1166.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1155.22,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1178.09,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2856.01,"additional_payer_notes":"APC"}]}]},{"description":"Colonoscopy submucous njx","code_information":[{"code":"45381","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1143.78,"maximum":2856.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1143.78,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1166.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1155.22,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1178.09,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2856.01,"additional_payer_notes":"APC"}]}]},{"description":"Colonoscopy w/control bleed","code_information":[{"code":"45382","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1143.78,"maximum":2856.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1143.78,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1166.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1155.22,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1178.09,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2856.01,"additional_payer_notes":"APC"}]}]},{"description":"Colonoscopy w/lesion removal","code_information":[{"code":"45384","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1143.78,"maximum":2856.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1143.78,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1166.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1155.22,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1178.09,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2856.01,"additional_payer_notes":"APC"}]}]},{"description":"Colonoscopy w/lesion removal","code_information":[{"code":"45385","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1143.78,"maximum":2856.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1143.78,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1166.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1155.22,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1178.09,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2856.01,"additional_payer_notes":"APC"}]}]},{"description":"Colonoscopy w/balloon dilat","code_information":[{"code":"45386","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1143.78,"maximum":2856.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1143.78,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1166.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1155.22,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1178.09,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2856.01,"additional_payer_notes":"APC"}]}]},{"description":"Colonoscopy w/ablation","code_information":[{"code":"45388","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1143.78,"maximum":2856.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1143.78,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1166.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1155.22,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1178.09,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2856.01,"additional_payer_notes":"APC"}]}]},{"description":"Colonoscopy w/endoscope us","code_information":[{"code":"45391","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1143.78,"maximum":2856.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1143.78,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1166.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1155.22,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1178.09,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2856.01,"additional_payer_notes":"APC"}]}]},{"description":"Colonoscopy w/endoscopic fnb","code_information":[{"code":"45392","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1143.78,"maximum":2856.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1143.78,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1166.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1155.22,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1178.09,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2856.01,"additional_payer_notes":"APC"}]}]},{"description":"Colonoscopy w/decompression","code_information":[{"code":"45393","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1143.78,"maximum":2856.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1143.78,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1166.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1155.22,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1178.09,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2856.01,"additional_payer_notes":"APC"}]}]},{"description":"Colonoscopy w/band ligation","code_information":[{"code":"45398","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1143.78,"maximum":2856.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1143.78,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1166.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1155.22,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1178.09,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2856.01,"additional_payer_notes":"APC"}]}]},{"description":"Dilation of anal sphincter","code_information":[{"code":"45905","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1143.78,"maximum":2856.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1143.78,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1166.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1155.22,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1178.09,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2856.01,"additional_payer_notes":"APC"}]}]},{"description":"Dilation of rectal narrowing","code_information":[{"code":"45910","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1143.78,"maximum":2856.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1143.78,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1166.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1155.22,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1178.09,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2856.01,"additional_payer_notes":"APC"}]}]},{"description":"Remove rectal obstruction","code_information":[{"code":"45915","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1143.78,"maximum":2856.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1143.78,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1166.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1155.22,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1178.09,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2856.01,"additional_payer_notes":"APC"}]}]},{"description":"Removal of rectal marker","code_information":[{"code":"46030","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1143.78,"maximum":2856.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1143.78,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1166.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1155.22,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1178.09,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2856.01,"additional_payer_notes":"APC"}]}]},{"description":"Incision of rectal abscess","code_information":[{"code":"46040","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1143.78,"maximum":2856.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1143.78,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1166.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1155.22,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1178.09,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2856.01,"additional_payer_notes":"APC"}]}]},{"description":"Excise anal ext tag/papilla","code_information":[{"code":"46220","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1143.78,"maximum":2856.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1143.78,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1166.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1155.22,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1178.09,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2856.01,"additional_payer_notes":"APC"}]}]},{"description":"Removal of hemorrhoid clot","code_information":[{"code":"46320","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1143.78,"maximum":2856.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1143.78,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1166.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1155.22,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1178.09,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2856.01,"additional_payer_notes":"APC"}]}]},{"description":"Chemodenervation anal musc","code_information":[{"code":"46505","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1143.78,"maximum":2856.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1143.78,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1166.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1155.22,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1178.09,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2856.01,"additional_payer_notes":"APC"}]}]},{"description":"Anoscopy and dilation","code_information":[{"code":"46604","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1143.78,"maximum":2856.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1143.78,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1166.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1155.22,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1178.09,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2856.01,"additional_payer_notes":"APC"}]}]},{"description":"Anoscopy and biopsy","code_information":[{"code":"46606","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1143.78,"maximum":2856.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1143.78,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1166.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1155.22,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1178.09,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2856.01,"additional_payer_notes":"APC"}]}]},{"description":"Diagnostic anoscopy & biopsy","code_information":[{"code":"46607","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1143.78,"maximum":2856.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1143.78,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1166.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1155.22,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1178.09,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2856.01,"additional_payer_notes":"APC"}]}]},{"description":"Anoscopy control bleeding","code_information":[{"code":"46614","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1143.78,"maximum":2856.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1143.78,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1166.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1155.22,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1178.09,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2856.01,"additional_payer_notes":"APC"}]}]},{"description":"Destroy internal hemorrhoids","code_information":[{"code":"46930","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1143.78,"maximum":2856.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1143.78,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1166.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1155.22,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1178.09,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2856.01,"additional_payer_notes":"APC"}]}]},{"description":"Place cecostomy tube perc","code_information":[{"code":"49442","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1143.78,"maximum":2856.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1143.78,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1166.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1155.22,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1178.09,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2856.01,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of rectal abscess","code_information":[{"code":"45020","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2653.04,"maximum":6624.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2653.04,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2706.1,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2679.57,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2732.63,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":6624.65,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy of rectum","code_information":[{"code":"45100","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2653.04,"maximum":6624.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2653.04,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2706.1,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2679.57,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2732.63,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":6624.65,"additional_payer_notes":"APC"}]}]},{"description":"Removal of anorectal lesion","code_information":[{"code":"45108","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2653.04,"maximum":6624.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2653.04,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2706.1,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2679.57,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2732.63,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":6624.65,"additional_payer_notes":"APC"}]}]},{"description":"Excision of rectal lesion","code_information":[{"code":"45160","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2653.04,"maximum":6624.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2653.04,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2706.1,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2679.57,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2732.63,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":6624.65,"additional_payer_notes":"APC"}]}]},{"description":"Exc rect tum transanal part","code_information":[{"code":"45171","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2653.04,"maximum":6624.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2653.04,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2706.1,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2679.57,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2732.63,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":6624.65,"additional_payer_notes":"APC"}]}]},{"description":"Exc rect tum transanal full","code_information":[{"code":"45172","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2653.04,"maximum":6624.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2653.04,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2706.1,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2679.57,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2732.63,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":6624.65,"additional_payer_notes":"APC"}]}]},{"description":"Destruction rectal tumor","code_information":[{"code":"45190","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2653.04,"maximum":6624.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2653.04,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2706.1,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2679.57,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2732.63,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":6624.65,"additional_payer_notes":"APC"}]}]},{"description":"Proctosigmoidoscopy fb","code_information":[{"code":"45307","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2653.04,"maximum":6624.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2653.04,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2706.1,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2679.57,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2732.63,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":6624.65,"additional_payer_notes":"APC"}]}]},{"description":"Proctosigmoidoscopy removal","code_information":[{"code":"45308","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2653.04,"maximum":6624.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2653.04,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2706.1,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2679.57,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2732.63,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":6624.65,"additional_payer_notes":"APC"}]}]},{"description":"Proctosigmoidoscopy ablate","code_information":[{"code":"45320","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2653.04,"maximum":6624.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2653.04,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2706.1,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2679.57,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2732.63,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":6624.65,"additional_payer_notes":"APC"}]}]},{"description":"Proctosigmoidoscopy volvul","code_information":[{"code":"45321","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2653.04,"maximum":6624.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2653.04,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2706.1,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2679.57,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2732.63,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":6624.65,"additional_payer_notes":"APC"}]}]},{"description":"Sigmoidoscopy w/resection","code_information":[{"code":"45349","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2653.04,"maximum":6624.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2653.04,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2706.1,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2679.57,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2732.63,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":6624.65,"additional_payer_notes":"APC"}]}]},{"description":"Colonoscopy w/resection","code_information":[{"code":"45390","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2653.04,"maximum":6624.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2653.04,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2706.1,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2679.57,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2732.63,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":6624.65,"additional_payer_notes":"APC"}]}]},{"description":"Repair of rectum","code_information":[{"code":"45500","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2653.04,"maximum":6624.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2653.04,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2706.1,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2679.57,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2732.63,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":6624.65,"additional_payer_notes":"APC"}]}]},{"description":"Repair of rectum","code_information":[{"code":"45505","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2653.04,"maximum":6624.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2653.04,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2706.1,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2679.57,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2732.63,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":6624.65,"additional_payer_notes":"APC"}]}]},{"description":"Correct rectal prolapse","code_information":[{"code":"45541","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2653.04,"maximum":6624.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2653.04,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2706.1,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2679.57,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2732.63,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":6624.65,"additional_payer_notes":"APC"}]}]},{"description":"Repair of rectocele","code_information":[{"code":"45560","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2653.04,"maximum":6624.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2653.04,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2706.1,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2679.57,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2732.63,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":6624.65,"additional_payer_notes":"APC"}]}]},{"description":"Surg dx exam anorectal","code_information":[{"code":"45990","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2653.04,"maximum":6624.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2653.04,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2706.1,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2679.57,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2732.63,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":6624.65,"additional_payer_notes":"APC"}]}]},{"description":"Placement of seton","code_information":[{"code":"46020","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2653.04,"maximum":6624.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2653.04,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2706.1,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2679.57,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2732.63,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":6624.65,"additional_payer_notes":"APC"}]}]},{"description":"Incision of rectal abscess","code_information":[{"code":"46045","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2653.04,"maximum":6624.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2653.04,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2706.1,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2679.57,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2732.63,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":6624.65,"additional_payer_notes":"APC"}]}]},{"description":"Incision of rectal abscess","code_information":[{"code":"46060","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2653.04,"maximum":6624.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2653.04,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2706.1,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2679.57,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2732.63,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":6624.65,"additional_payer_notes":"APC"}]}]},{"description":"Incision of anal septum","code_information":[{"code":"46070","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2653.04,"maximum":6624.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2653.04,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2706.1,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2679.57,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2732.63,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":6624.65,"additional_payer_notes":"APC"}]}]},{"description":"Incision of anal sphincter","code_information":[{"code":"46080","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2653.04,"maximum":6624.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2653.04,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2706.1,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2679.57,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2732.63,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":6624.65,"additional_payer_notes":"APC"}]}]},{"description":"Removal of anal fissure","code_information":[{"code":"46200","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2653.04,"maximum":6624.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2653.04,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2706.1,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2679.57,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2732.63,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":6624.65,"additional_payer_notes":"APC"}]}]},{"description":"Removal of anal tags","code_information":[{"code":"46230","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2653.04,"maximum":6624.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2653.04,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2706.1,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2679.57,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2732.63,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":6624.65,"additional_payer_notes":"APC"}]}]},{"description":"Remove ext hem groups 2+","code_information":[{"code":"46250","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2653.04,"maximum":6624.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2653.04,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2706.1,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2679.57,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2732.63,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":6624.65,"additional_payer_notes":"APC"}]}]},{"description":"Remove int/ext hem 1 group","code_information":[{"code":"46255","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2653.04,"maximum":6624.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2653.04,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2706.1,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2679.57,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2732.63,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":6624.65,"additional_payer_notes":"APC"}]}]},{"description":"Remove in/ex hem grp & fiss","code_information":[{"code":"46257","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2653.04,"maximum":6624.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2653.04,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2706.1,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2679.57,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2732.63,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":6624.65,"additional_payer_notes":"APC"}]}]},{"description":"Remove in/ex hem grp w/fistu","code_information":[{"code":"46258","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2653.04,"maximum":6624.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2653.04,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2706.1,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2679.57,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2732.63,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":6624.65,"additional_payer_notes":"APC"}]}]},{"description":"Remove in/ex hem groups 2+","code_information":[{"code":"46260","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2653.04,"maximum":6624.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2653.04,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2706.1,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2679.57,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2732.63,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":6624.65,"additional_payer_notes":"APC"}]}]},{"description":"Remove in/ex hem grps & fiss","code_information":[{"code":"46261","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2653.04,"maximum":6624.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2653.04,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2706.1,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2679.57,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2732.63,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":6624.65,"additional_payer_notes":"APC"}]}]},{"description":"Remove in/ex hem grps w/fist","code_information":[{"code":"46262","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2653.04,"maximum":6624.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2653.04,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2706.1,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2679.57,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2732.63,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":6624.65,"additional_payer_notes":"APC"}]}]},{"description":"Remove anal fist subq","code_information":[{"code":"46270","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2653.04,"maximum":6624.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2653.04,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2706.1,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2679.57,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2732.63,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":6624.65,"additional_payer_notes":"APC"}]}]},{"description":"Remove anal fist inter","code_information":[{"code":"46275","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2653.04,"maximum":6624.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2653.04,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2706.1,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2679.57,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2732.63,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":6624.65,"additional_payer_notes":"APC"}]}]},{"description":"Remove anal fist complex","code_information":[{"code":"46280","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2653.04,"maximum":6624.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2653.04,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2706.1,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2679.57,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2732.63,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":6624.65,"additional_payer_notes":"APC"}]}]},{"description":"Remove anal fist 2 stage","code_information":[{"code":"46285","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2653.04,"maximum":6624.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2653.04,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2706.1,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2679.57,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2732.63,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":6624.65,"additional_payer_notes":"APC"}]}]},{"description":"Repair anal fistula","code_information":[{"code":"46288","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2653.04,"maximum":6624.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2653.04,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2706.1,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2679.57,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2732.63,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":6624.65,"additional_payer_notes":"APC"}]}]},{"description":"Anoscopy remove lesion","code_information":[{"code":"46610","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2653.04,"maximum":6624.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2653.04,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2706.1,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2679.57,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2732.63,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":6624.65,"additional_payer_notes":"APC"}]}]},{"description":"Anoscopy remove lesions","code_information":[{"code":"46612","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2653.04,"maximum":6624.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2653.04,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2706.1,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2679.57,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2732.63,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":6624.65,"additional_payer_notes":"APC"}]}]},{"description":"Anoscopy","code_information":[{"code":"46615","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2653.04,"maximum":6624.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2653.04,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2706.1,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2679.57,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2732.63,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":6624.65,"additional_payer_notes":"APC"}]}]},{"description":"Repair of anal stricture","code_information":[{"code":"46700","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2653.04,"maximum":6624.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2653.04,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2706.1,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2679.57,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2732.63,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":6624.65,"additional_payer_notes":"APC"}]}]},{"description":"Repr of anal fistula w/glue","code_information":[{"code":"46706","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2653.04,"maximum":6624.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2653.04,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2706.1,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2679.57,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2732.63,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":6624.65,"additional_payer_notes":"APC"}]}]},{"description":"Repair anorectal fist w/plug","code_information":[{"code":"46707","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2653.04,"maximum":6624.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2653.04,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2706.1,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2679.57,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2732.63,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":6624.65,"additional_payer_notes":"APC"}]}]},{"description":"Repair of anal sphincter","code_information":[{"code":"46750","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2653.04,"maximum":6624.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2653.04,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2706.1,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2679.57,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2732.63,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":6624.65,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruction of anus","code_information":[{"code":"46753","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2653.04,"maximum":6624.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2653.04,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2706.1,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2679.57,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2732.63,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":6624.65,"additional_payer_notes":"APC"}]}]},{"description":"Removal of suture from anus","code_information":[{"code":"46754","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2653.04,"maximum":6624.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2653.04,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2706.1,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2679.57,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2732.63,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":6624.65,"additional_payer_notes":"APC"}]}]},{"description":"Repair of anal sphincter","code_information":[{"code":"46760","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2653.04,"maximum":6624.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2653.04,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2706.1,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2679.57,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2732.63,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":6624.65,"additional_payer_notes":"APC"}]}]},{"description":"Repair of anal sphincter","code_information":[{"code":"46761","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2653.04,"maximum":6624.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2653.04,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2706.1,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2679.57,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2732.63,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":6624.65,"additional_payer_notes":"APC"}]}]},{"description":"Laser surgery anal lesions","code_information":[{"code":"46917","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2653.04,"maximum":6624.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2653.04,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2706.1,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2679.57,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2732.63,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":6624.65,"additional_payer_notes":"APC"}]}]},{"description":"Excision of anal lesion(s)","code_information":[{"code":"46922","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2653.04,"maximum":6624.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2653.04,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2706.1,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2679.57,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2732.63,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":6624.65,"additional_payer_notes":"APC"}]}]},{"description":"Destruction anal lesion(s)","code_information":[{"code":"46924","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2653.04,"maximum":6624.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2653.04,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2706.1,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2679.57,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2732.63,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":6624.65,"additional_payer_notes":"APC"}]}]},{"description":"Treatment of anal fissure","code_information":[{"code":"46940","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2653.04,"maximum":6624.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2653.04,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2706.1,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2679.57,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2732.63,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":6624.65,"additional_payer_notes":"APC"}]}]},{"description":"Remove by ligat int hem grp","code_information":[{"code":"46945","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2653.04,"maximum":6624.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2653.04,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2706.1,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2679.57,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2732.63,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":6624.65,"additional_payer_notes":"APC"}]}]},{"description":"Remove by ligat int hem grps","code_information":[{"code":"46946","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2653.04,"maximum":6624.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2653.04,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2706.1,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2679.57,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2732.63,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":6624.65,"additional_payer_notes":"APC"}]}]},{"description":"Hemorrhoidopexy by stapling","code_information":[{"code":"46947","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2653.04,"maximum":6624.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2653.04,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2706.1,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2679.57,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2732.63,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":6624.65,"additional_payer_notes":"APC"}]}]},{"description":"Int hrhc tranal dartlzj 2+","code_information":[{"code":"46948","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2653.04,"maximum":6624.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2653.04,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2706.1,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2679.57,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2732.63,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":6624.65,"additional_payer_notes":"APC"}]}]},{"description":"Rpr intst excl anrect fist","code_information":[{"code":"C9796","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2653.04,"maximum":6624.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2653.04,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2706.1,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2679.57,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2732.63,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":6624.65,"additional_payer_notes":"APC"}]}]},{"description":"Insert pleural cath","code_information":[{"code":"32550","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3422.23,"maximum":8545.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3422.23,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3490.68,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3456.45,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3524.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8545.31,"additional_payer_notes":"APC"}]}]},{"description":"Incision of gallbladder","code_information":[{"code":"47490","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3422.23,"maximum":8545.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3422.23,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3490.68,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3456.45,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3524.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8545.31,"additional_payer_notes":"APC"}]}]},{"description":"Injection for cholangiogram","code_information":[{"code":"47531","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3422.23,"maximum":8545.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3422.23,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3490.68,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3456.45,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3524.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8545.31,"additional_payer_notes":"APC"}]}]},{"description":"Injection for cholangiogram","code_information":[{"code":"47532","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3422.23,"maximum":8545.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3422.23,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3490.68,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3456.45,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3524.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8545.31,"additional_payer_notes":"APC"}]}]},{"description":"Plmt biliary drainage cath","code_information":[{"code":"47533","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3422.23,"maximum":8545.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3422.23,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3490.68,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3456.45,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3524.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8545.31,"additional_payer_notes":"APC"}]}]},{"description":"Plmt biliary drainage cath","code_information":[{"code":"47534","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3422.23,"maximum":8545.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3422.23,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3490.68,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3456.45,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3524.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8545.31,"additional_payer_notes":"APC"}]}]},{"description":"Conversion ext bil drg cath","code_information":[{"code":"47535","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3422.23,"maximum":8545.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3422.23,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3490.68,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3456.45,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3524.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8545.31,"additional_payer_notes":"APC"}]}]},{"description":"Exchange biliary drg cath","code_information":[{"code":"47536","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3422.23,"maximum":8545.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3422.23,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3490.68,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3456.45,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3524.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8545.31,"additional_payer_notes":"APC"}]}]},{"description":"Excision of umbilicus","code_information":[{"code":"49250","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3422.23,"maximum":8545.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3422.23,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3490.68,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3456.45,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3524.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8545.31,"additional_payer_notes":"APC"}]}]},{"description":"Remove foreign body adbomen","code_information":[{"code":"49402","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3422.23,"maximum":8545.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3422.23,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3490.68,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3456.45,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3524.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8545.31,"additional_payer_notes":"APC"}]}]},{"description":"Insert tun ip cath perc","code_information":[{"code":"49418","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3422.23,"maximum":8545.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3422.23,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3490.68,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3456.45,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3524.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8545.31,"additional_payer_notes":"APC"}]}]},{"description":"Ins tun ip cath for dial opn","code_information":[{"code":"49421","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3422.23,"maximum":8545.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3422.23,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3490.68,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3456.45,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3524.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8545.31,"additional_payer_notes":"APC"}]}]},{"description":"Revise abdomen-venous shunt","code_information":[{"code":"49426","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3422.23,"maximum":8545.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3422.23,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3490.68,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3456.45,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3524.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8545.31,"additional_payer_notes":"APC"}]}]},{"description":"Rpr ing hern premie blocked","code_information":[{"code":"49492","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3422.23,"maximum":8545.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3422.23,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3490.68,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3456.45,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3524.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8545.31,"additional_payer_notes":"APC"}]}]},{"description":"Rpr ing hernia baby reduc","code_information":[{"code":"49495","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3422.23,"maximum":8545.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3422.23,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3490.68,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3456.45,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3524.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8545.31,"additional_payer_notes":"APC"}]}]},{"description":"Rpr ing hernia baby blocked","code_information":[{"code":"49496","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3422.23,"maximum":8545.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3422.23,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3490.68,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3456.45,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3524.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8545.31,"additional_payer_notes":"APC"}]}]},{"description":"Rpr ing hernia init blocked","code_information":[{"code":"49501","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3422.23,"maximum":8545.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3422.23,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3490.68,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3456.45,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3524.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8545.31,"additional_payer_notes":"APC"}]}]},{"description":"Prp i/hern init reduc >5 yr","code_information":[{"code":"49505","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3422.23,"maximum":8545.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3422.23,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3490.68,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3456.45,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3524.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8545.31,"additional_payer_notes":"APC"}]}]},{"description":"Prp i/hern init block >5 yr","code_information":[{"code":"49507","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3422.23,"maximum":8545.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3422.23,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3490.68,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3456.45,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3524.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8545.31,"additional_payer_notes":"APC"}]}]},{"description":"Rerepair ing hernia reduce","code_information":[{"code":"49520","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3422.23,"maximum":8545.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3422.23,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3490.68,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3456.45,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3524.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8545.31,"additional_payer_notes":"APC"}]}]},{"description":"Repair ing hernia sliding","code_information":[{"code":"49525","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3422.23,"maximum":8545.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3422.23,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3490.68,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3456.45,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3524.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8545.31,"additional_payer_notes":"APC"}]}]},{"description":"Rpr rem hernia init reduce","code_information":[{"code":"49550","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3422.23,"maximum":8545.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3422.23,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3490.68,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3456.45,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3524.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8545.31,"additional_payer_notes":"APC"}]}]},{"description":"Rpr fem hernia init blocked","code_information":[{"code":"49553","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3422.23,"maximum":8545.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3422.23,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3490.68,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3456.45,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3524.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8545.31,"additional_payer_notes":"APC"}]}]},{"description":"Rerepair fem hernia reduce","code_information":[{"code":"49555","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3422.23,"maximum":8545.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3422.23,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3490.68,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3456.45,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3524.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8545.31,"additional_payer_notes":"APC"}]}]},{"description":"Rerepair fem hernia blocked","code_information":[{"code":"49557","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3422.23,"maximum":8545.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3422.23,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3490.68,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3456.45,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3524.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8545.31,"additional_payer_notes":"APC"}]}]},{"description":"Rpr aa hrn 1st < 3 cm rdc","code_information":[{"code":"49591","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3422.23,"maximum":8545.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3422.23,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3490.68,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3456.45,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3524.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8545.31,"additional_payer_notes":"APC"}]}]},{"description":"Repair umbilical lesion","code_information":[{"code":"49600","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3422.23,"maximum":8545.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3422.23,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3490.68,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3456.45,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3524.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8545.31,"additional_payer_notes":"APC"}]}]},{"description":"Rpr aa hrn rcr < 3 rdc","code_information":[{"code":"49613","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3422.23,"maximum":8545.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3422.23,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3490.68,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3456.45,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3524.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8545.31,"additional_payer_notes":"APC"}]}]},{"description":"Removal of testis","code_information":[{"code":"54530","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3422.23,"maximum":8545.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3422.23,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3490.68,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3456.45,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3524.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8545.31,"additional_payer_notes":"APC"}]}]},{"description":"Exploration for testis","code_information":[{"code":"54550","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3422.23,"maximum":8545.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3422.23,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3490.68,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3456.45,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3524.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8545.31,"additional_payer_notes":"APC"}]}]},{"description":"Suspension of testis","code_information":[{"code":"54640","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3422.23,"maximum":8545.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3422.23,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3490.68,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3456.45,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3524.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8545.31,"additional_payer_notes":"APC"}]}]},{"description":"Orchiopexy (Fowler-Stephens)","code_information":[{"code":"54650","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3422.23,"maximum":8545.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3422.23,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3490.68,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3456.45,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3524.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8545.31,"additional_payer_notes":"APC"}]}]},{"description":"Removal of hydrocele","code_information":[{"code":"55040","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3422.23,"maximum":8545.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3422.23,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3490.68,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3456.45,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3524.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8545.31,"additional_payer_notes":"APC"}]}]},{"description":"Removal of hydroceles","code_information":[{"code":"55041","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3422.23,"maximum":8545.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3422.23,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3490.68,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3456.45,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3524.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8545.31,"additional_payer_notes":"APC"}]}]},{"description":"Revise hernia & sperm veins","code_information":[{"code":"55540","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3422.23,"maximum":8545.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3422.23,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3490.68,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3456.45,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3524.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8545.31,"additional_payer_notes":"APC"}]}]},{"description":"Appendectomy","code_information":[{"code":"44950","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6187.83,"maximum":15451.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6187.83,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6311.59,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6249.71,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6373.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":15451.01,"additional_payer_notes":"APC"}]}]},{"description":"Plmt access bil tree sm bwl","code_information":[{"code":"47541","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6187.83,"maximum":15451.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6187.83,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6311.59,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6249.71,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6373.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":15451.01,"additional_payer_notes":"APC"}]}]},{"description":"Biliary endo perq dx w/speci","code_information":[{"code":"47552","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6187.83,"maximum":15451.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6187.83,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6311.59,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6249.71,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6373.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":15451.01,"additional_payer_notes":"APC"}]}]},{"description":"Biliary endoscopy thru skin","code_information":[{"code":"47553","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6187.83,"maximum":15451.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6187.83,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6311.59,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6249.71,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6373.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":15451.01,"additional_payer_notes":"APC"}]}]},{"description":"Biliary endoscopy thru skin","code_information":[{"code":"47555","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6187.83,"maximum":15451.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6187.83,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6311.59,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6249.71,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6373.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":15451.01,"additional_payer_notes":"APC"}]}]},{"description":"Exploration behind abdomen","code_information":[{"code":"49010","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6187.83,"maximum":15451.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6187.83,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6311.59,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6249.71,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6373.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":15451.01,"additional_payer_notes":"APC"}]}]},{"description":"Removal of omentum","code_information":[{"code":"49255","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6187.83,"maximum":15451.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6187.83,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6311.59,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6249.71,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6373.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":15451.01,"additional_payer_notes":"APC"}]}]},{"description":"Rpr ing hernia init reduce","code_information":[{"code":"49500","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6187.83,"maximum":15451.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6187.83,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6311.59,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6249.71,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6373.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":15451.01,"additional_payer_notes":"APC"}]}]},{"description":"Rerepair ing hernia blocked","code_information":[{"code":"49521","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6187.83,"maximum":15451.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6187.83,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6311.59,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6249.71,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6373.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":15451.01,"additional_payer_notes":"APC"}]}]},{"description":"Rpr aa hrn 1st 3-10 rdc","code_information":[{"code":"49593","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6187.83,"maximum":15451.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6187.83,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6311.59,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6249.71,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6373.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":15451.01,"additional_payer_notes":"APC"}]}]},{"description":"Rpr aa hrn 1st > 10 rdc","code_information":[{"code":"49595","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6187.83,"maximum":15451.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6187.83,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6311.59,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6249.71,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6373.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":15451.01,"additional_payer_notes":"APC"}]}]},{"description":"Rpr aa hrn rcr 3-10 rdc","code_information":[{"code":"49615","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6187.83,"maximum":15451.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6187.83,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6311.59,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6249.71,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6373.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":15451.01,"additional_payer_notes":"APC"}]}]},{"description":"Revise spermatic cord veins","code_information":[{"code":"55535","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6187.83,"maximum":15451.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6187.83,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6311.59,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6249.71,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6373.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":15451.01,"additional_payer_notes":"APC"}]}]},{"description":"Inst pleu-perit shnt w pump","code_information":[{"code":"C8006","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6187.83,"maximum":15451.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6187.83,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6311.59,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6249.71,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6373.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":15451.01,"additional_payer_notes":"APC"}]}]},{"description":"Thoracoscopy diagnostic","code_information":[{"code":"32601","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5778.46,"maximum":14428.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5778.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5894.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5836.24,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5951.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14428.81,"additional_payer_notes":"APC"}]}]},{"description":"Thoracoscopy w/bx med space","code_information":[{"code":"32606","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5778.46,"maximum":14428.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5778.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5894.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5836.24,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5951.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14428.81,"additional_payer_notes":"APC"}]}]},{"description":"Thoracoscopy w/bx pleura","code_information":[{"code":"32609","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5778.46,"maximum":14428.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5778.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5894.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5836.24,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5951.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14428.81,"additional_payer_notes":"APC"}]}]},{"description":"Perq rf ablate tx pul tumor","code_information":[{"code":"32998","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5778.46,"maximum":14428.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5778.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5894.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5836.24,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5951.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14428.81,"additional_payer_notes":"APC"}]}]},{"description":"Laparoscope proc spleen","code_information":[{"code":"38129","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5778.46,"maximum":14428.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5778.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5894.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5836.24,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5951.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14428.81,"additional_payer_notes":"APC"}]}]},{"description":"Explore deep node(s) neck","code_information":[{"code":"38542","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5778.46,"maximum":14428.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5778.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5894.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5836.24,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5951.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14428.81,"additional_payer_notes":"APC"}]}]},{"description":"Laparoscopy lymph node biop","code_information":[{"code":"38570","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5778.46,"maximum":14428.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5778.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5894.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5836.24,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5951.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14428.81,"additional_payer_notes":"APC"}]}]},{"description":"Laparoscope proc lymphatic","code_information":[{"code":"38589","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5778.46,"maximum":14428.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5778.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5894.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5836.24,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5951.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14428.81,"additional_payer_notes":"APC"}]}]},{"description":"Remove armpit lymph nodes","code_information":[{"code":"38740","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5778.46,"maximum":14428.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5778.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5894.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5836.24,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5951.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14428.81,"additional_payer_notes":"APC"}]}]},{"description":"Remove armpit lymph nodes","code_information":[{"code":"38745","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5778.46,"maximum":14428.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5778.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5894.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5836.24,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5951.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14428.81,"additional_payer_notes":"APC"}]}]},{"description":"Mediastinoscpy w/medstnl bx","code_information":[{"code":"39401","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5778.46,"maximum":14428.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5778.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5894.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5836.24,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5951.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14428.81,"additional_payer_notes":"APC"}]}]},{"description":"Mediastinoscpy w/lmph nod bx","code_information":[{"code":"39402","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5778.46,"maximum":14428.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5778.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5894.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5836.24,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5951.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14428.81,"additional_payer_notes":"APC"}]}]},{"description":"Rmvl esophgl sphnctr dev","code_information":[{"code":"43285","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5778.46,"maximum":14428.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5778.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5894.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5836.24,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5951.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14428.81,"additional_payer_notes":"APC"}]}]},{"description":"Laparoscope proc esoph","code_information":[{"code":"43289","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5778.46,"maximum":14428.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5778.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5894.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5836.24,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5951.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14428.81,"additional_payer_notes":"APC"}]}]},{"description":"Laparoscopy vagus nerve","code_information":[{"code":"43651","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5778.46,"maximum":14428.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5778.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5894.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5836.24,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5951.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14428.81,"additional_payer_notes":"APC"}]}]},{"description":"Laparoscopy vagus nerve","code_information":[{"code":"43652","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5778.46,"maximum":14428.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5778.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5894.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5836.24,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5951.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14428.81,"additional_payer_notes":"APC"}]}]},{"description":"Laparoscopy gastrostomy","code_information":[{"code":"43653","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5778.46,"maximum":14428.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5778.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5894.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5836.24,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5951.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14428.81,"additional_payer_notes":"APC"}]}]},{"description":"Laparoscope proc stom","code_information":[{"code":"43659","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5778.46,"maximum":14428.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5778.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5894.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5836.24,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5951.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14428.81,"additional_payer_notes":"APC"}]}]},{"description":"Lap replace gastr adj device","code_information":[{"code":"43773","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5778.46,"maximum":14428.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5778.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5894.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5836.24,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5951.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14428.81,"additional_payer_notes":"APC"}]}]},{"description":"Lap enterolysis","code_information":[{"code":"44180","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5778.46,"maximum":14428.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5778.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5894.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5836.24,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5951.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14428.81,"additional_payer_notes":"APC"}]}]},{"description":"Lap jejunostomy","code_information":[{"code":"44186","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5778.46,"maximum":14428.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5778.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5894.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5836.24,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5951.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14428.81,"additional_payer_notes":"APC"}]}]},{"description":"Laparoscope proc intestine","code_information":[{"code":"44238","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5778.46,"maximum":14428.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5778.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5894.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5836.24,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5951.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14428.81,"additional_payer_notes":"APC"}]}]},{"description":"Laparoscopy appendectomy","code_information":[{"code":"44970","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5778.46,"maximum":14428.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5778.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5894.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5836.24,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5951.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14428.81,"additional_payer_notes":"APC"}]}]},{"description":"Laparoscope proc app","code_information":[{"code":"44979","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5778.46,"maximum":14428.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5778.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5894.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5836.24,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5951.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14428.81,"additional_payer_notes":"APC"}]}]},{"description":"Laparoscope proc rectum","code_information":[{"code":"45499","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5778.46,"maximum":14428.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5778.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5894.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5836.24,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5951.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14428.81,"additional_payer_notes":"APC"}]}]},{"description":"Laparoscope procedure liver","code_information":[{"code":"47379","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5778.46,"maximum":14428.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5778.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5894.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5836.24,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5951.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14428.81,"additional_payer_notes":"APC"}]}]},{"description":"Percut ablate liver rf","code_information":[{"code":"47382","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5778.46,"maximum":14428.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5778.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5894.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5836.24,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5951.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14428.81,"additional_payer_notes":"APC"}]}]},{"description":"Perq plmt bile duct stent","code_information":[{"code":"47538","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5778.46,"maximum":14428.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5778.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5894.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5836.24,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5951.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14428.81,"additional_payer_notes":"APC"}]}]},{"description":"Perq plmt bile duct stent","code_information":[{"code":"47539","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5778.46,"maximum":14428.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5778.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5894.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5836.24,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5951.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14428.81,"additional_payer_notes":"APC"}]}]},{"description":"Perq plmt bile duct stent","code_information":[{"code":"47540","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5778.46,"maximum":14428.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5778.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5894.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5836.24,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5951.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14428.81,"additional_payer_notes":"APC"}]}]},{"description":"Laparoscopic cholecystectomy","code_information":[{"code":"47562","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5778.46,"maximum":14428.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5778.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5894.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5836.24,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5951.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14428.81,"additional_payer_notes":"APC"}]}]},{"description":"Laparo cholecystectomy/graph","code_information":[{"code":"47563","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5778.46,"maximum":14428.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5778.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5894.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5836.24,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5951.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14428.81,"additional_payer_notes":"APC"}]}]},{"description":"Laparoscope proc biliary","code_information":[{"code":"47579","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5778.46,"maximum":14428.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5778.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5894.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5836.24,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5951.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14428.81,"additional_payer_notes":"APC"}]}]},{"description":"Diag laparo separate proc","code_information":[{"code":"49320","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5778.46,"maximum":14428.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5778.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5894.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5836.24,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5951.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14428.81,"additional_payer_notes":"APC"}]}]},{"description":"Laparoscopy biopsy","code_information":[{"code":"49321","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5778.46,"maximum":14428.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5778.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5894.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5836.24,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5951.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14428.81,"additional_payer_notes":"APC"}]}]},{"description":"Laparoscopy aspiration","code_information":[{"code":"49322","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5778.46,"maximum":14428.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5778.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5894.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5836.24,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5951.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14428.81,"additional_payer_notes":"APC"}]}]},{"description":"Laparo drain lymphocele","code_information":[{"code":"49323","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5778.46,"maximum":14428.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5778.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5894.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5836.24,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5951.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14428.81,"additional_payer_notes":"APC"}]}]},{"description":"Lap insert tunnel ip cath","code_information":[{"code":"49324","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5778.46,"maximum":14428.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5778.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5894.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5836.24,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5951.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14428.81,"additional_payer_notes":"APC"}]}]},{"description":"Lap Revision Perm IP Cath","code_information":[{"code":"49325","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5778.46,"maximum":14428.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5778.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5894.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5836.24,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5951.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14428.81,"additional_payer_notes":"APC"}]}]},{"description":"Laparo proc abdm/per/oment","code_information":[{"code":"49329","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5778.46,"maximum":14428.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5778.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5894.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5836.24,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5951.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14428.81,"additional_payer_notes":"APC"}]}]},{"description":"Rpr hern preemie reduc","code_information":[{"code":"49491","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5778.46,"maximum":14428.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5778.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5894.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5836.24,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5951.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14428.81,"additional_payer_notes":"APC"}]}]},{"description":"Repair lumbar hernia","code_information":[{"code":"49540","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5778.46,"maximum":14428.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5778.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5894.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5836.24,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5951.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14428.81,"additional_payer_notes":"APC"}]}]},{"description":"Rpr aa hrn 1st < 3 ncr/strn","code_information":[{"code":"49592","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5778.46,"maximum":14428.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5778.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5894.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5836.24,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5951.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14428.81,"additional_payer_notes":"APC"}]}]},{"description":"Rpr aa hrn 1st 3-10 ncr/strn","code_information":[{"code":"49594","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5778.46,"maximum":14428.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5778.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5894.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5836.24,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5951.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14428.81,"additional_payer_notes":"APC"}]}]},{"description":"Rpr aa hrn rcr < 3 ncr/strn","code_information":[{"code":"49614","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5778.46,"maximum":14428.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5778.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5894.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5836.24,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5951.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14428.81,"additional_payer_notes":"APC"}]}]},{"description":"Lap ing hernia repair init","code_information":[{"code":"49650","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5778.46,"maximum":14428.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5778.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5894.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5836.24,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5951.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14428.81,"additional_payer_notes":"APC"}]}]},{"description":"Lap ing hernia repair recur","code_information":[{"code":"49651","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5778.46,"maximum":14428.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5778.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5894.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5836.24,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5951.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14428.81,"additional_payer_notes":"APC"}]}]},{"description":"Laparo proc hernia repair","code_information":[{"code":"49659","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5778.46,"maximum":14428.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5778.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5894.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5836.24,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5951.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14428.81,"additional_payer_notes":"APC"}]}]},{"description":"Laparoscope proc renal","code_information":[{"code":"50549","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5778.46,"maximum":14428.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5778.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5894.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5836.24,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5951.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14428.81,"additional_payer_notes":"APC"}]}]},{"description":"Perc rf ablate renal tumor","code_information":[{"code":"50592","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5778.46,"maximum":14428.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5778.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5894.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5836.24,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5951.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14428.81,"additional_payer_notes":"APC"}]}]},{"description":"Laparoscopy ureterolithotomy","code_information":[{"code":"50945","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5778.46,"maximum":14428.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5778.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5894.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5836.24,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5951.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14428.81,"additional_payer_notes":"APC"}]}]},{"description":"Laparoscope proc ureter","code_information":[{"code":"50949","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5778.46,"maximum":14428.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5778.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5894.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5836.24,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5951.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14428.81,"additional_payer_notes":"APC"}]}]},{"description":"Removal of bladder cyst","code_information":[{"code":"51500","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5778.46,"maximum":14428.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5778.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5894.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5836.24,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5951.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14428.81,"additional_payer_notes":"APC"}]}]},{"description":"Laparo urethral suspension","code_information":[{"code":"51990","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5778.46,"maximum":14428.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5778.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5894.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5836.24,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5951.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14428.81,"additional_payer_notes":"APC"}]}]},{"description":"Laparo sling operation","code_information":[{"code":"51992","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5778.46,"maximum":14428.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5778.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5894.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5836.24,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5951.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14428.81,"additional_payer_notes":"APC"}]}]},{"description":"Laparoscope proc bla","code_information":[{"code":"51999","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5778.46,"maximum":14428.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5778.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5894.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5836.24,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5951.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14428.81,"additional_payer_notes":"APC"}]}]},{"description":"Laparoscopy orchiectomy","code_information":[{"code":"54690","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5778.46,"maximum":14428.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5778.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5894.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5836.24,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5951.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14428.81,"additional_payer_notes":"APC"}]}]},{"description":"Laparoscopy orchiopexy","code_information":[{"code":"54692","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5778.46,"maximum":14428.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5778.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5894.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5836.24,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5951.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14428.81,"additional_payer_notes":"APC"}]}]},{"description":"Laparoscope proc testis","code_information":[{"code":"54699","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5778.46,"maximum":14428.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5778.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5894.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5836.24,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5951.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14428.81,"additional_payer_notes":"APC"}]}]},{"description":"Laparo ligate spermatic vein","code_information":[{"code":"55550","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5778.46,"maximum":14428.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5778.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5894.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5836.24,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5951.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14428.81,"additional_payer_notes":"APC"}]}]},{"description":"Laparo proc spermatic cord","code_information":[{"code":"55559","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5778.46,"maximum":14428.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5778.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5894.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5836.24,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5951.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14428.81,"additional_payer_notes":"APC"}]}]},{"description":"Laparoscopic myomectomy","code_information":[{"code":"58545","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5778.46,"maximum":14428.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5778.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5894.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5836.24,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5951.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14428.81,"additional_payer_notes":"APC"}]}]},{"description":"Laparo-asst vag hysterectomy","code_information":[{"code":"58550","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5778.46,"maximum":14428.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5778.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5894.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5836.24,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5951.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14428.81,"additional_payer_notes":"APC"}]}]},{"description":"Laparo proc uterus","code_information":[{"code":"58578","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5778.46,"maximum":14428.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5778.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5894.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5836.24,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5951.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14428.81,"additional_payer_notes":"APC"}]}]},{"description":"Laparoscopy lysis","code_information":[{"code":"58660","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5778.46,"maximum":14428.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5778.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5894.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5836.24,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5951.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14428.81,"additional_payer_notes":"APC"}]}]},{"description":"Laparoscopy remove adnexa","code_information":[{"code":"58661","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5778.46,"maximum":14428.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5778.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5894.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5836.24,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5951.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14428.81,"additional_payer_notes":"APC"}]}]},{"description":"Laparoscopy excise lesions","code_information":[{"code":"58662","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5778.46,"maximum":14428.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5778.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5894.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5836.24,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5951.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14428.81,"additional_payer_notes":"APC"}]}]},{"description":"Laparoscopy tubal cautery","code_information":[{"code":"58670","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5778.46,"maximum":14428.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5778.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5894.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5836.24,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5951.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14428.81,"additional_payer_notes":"APC"}]}]},{"description":"Laparoscopy tubal block","code_information":[{"code":"58671","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5778.46,"maximum":14428.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5778.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5894.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5836.24,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5951.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14428.81,"additional_payer_notes":"APC"}]}]},{"description":"Laparoscopy fimbrioplasty","code_information":[{"code":"58672","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5778.46,"maximum":14428.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5778.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5894.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5836.24,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5951.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14428.81,"additional_payer_notes":"APC"}]}]},{"description":"Laparo proc oviduct-ovary","code_information":[{"code":"58679","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5778.46,"maximum":14428.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5778.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5894.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5836.24,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5951.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14428.81,"additional_payer_notes":"APC"}]}]},{"description":"Treat ectopic pregnancy","code_information":[{"code":"59150","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5778.46,"maximum":14428.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5778.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5894.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5836.24,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5951.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14428.81,"additional_payer_notes":"APC"}]}]},{"description":"Treat ectopic pregnancy","code_information":[{"code":"59151","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5778.46,"maximum":14428.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5778.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5894.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5836.24,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5951.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14428.81,"additional_payer_notes":"APC"}]}]},{"description":"Laparo proc ob care/deliver","code_information":[{"code":"59898","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5778.46,"maximum":14428.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5778.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5894.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5836.24,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5951.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14428.81,"additional_payer_notes":"APC"}]}]},{"description":"Remove thyroid lesion","code_information":[{"code":"60200","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5778.46,"maximum":14428.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5778.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5894.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5836.24,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5951.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14428.81,"additional_payer_notes":"APC"}]}]},{"description":"Partial thyroid excision","code_information":[{"code":"60210","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5778.46,"maximum":14428.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5778.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5894.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5836.24,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5951.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14428.81,"additional_payer_notes":"APC"}]}]},{"description":"Partial thyroid excision","code_information":[{"code":"60212","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5778.46,"maximum":14428.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5778.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5894.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5836.24,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5951.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14428.81,"additional_payer_notes":"APC"}]}]},{"description":"Partial removal of thyroid","code_information":[{"code":"60220","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5778.46,"maximum":14428.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5778.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5894.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5836.24,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5951.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14428.81,"additional_payer_notes":"APC"}]}]},{"description":"Partial removal of thyroid","code_information":[{"code":"60225","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5778.46,"maximum":14428.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5778.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5894.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5836.24,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5951.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14428.81,"additional_payer_notes":"APC"}]}]},{"description":"Removal of thyroid","code_information":[{"code":"60240","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5778.46,"maximum":14428.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5778.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5894.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5836.24,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5951.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14428.81,"additional_payer_notes":"APC"}]}]},{"description":"Remove thyroid duct lesion","code_information":[{"code":"60280","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5778.46,"maximum":14428.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5778.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5894.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5836.24,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5951.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14428.81,"additional_payer_notes":"APC"}]}]},{"description":"Remove thyroid duct lesion","code_information":[{"code":"60281","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5778.46,"maximum":14428.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5778.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5894.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5836.24,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5951.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14428.81,"additional_payer_notes":"APC"}]}]},{"description":"Laparo proc endocrine","code_information":[{"code":"60659","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5778.46,"maximum":14428.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5778.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5894.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5836.24,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5951.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14428.81,"additional_payer_notes":"APC"}]}]},{"description":"Endocrine surgery procedure","code_information":[{"code":"60699","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5778.46,"maximum":14428.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5778.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5894.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5836.24,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5951.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14428.81,"additional_payer_notes":"APC"}]}]},{"description":"Ire abltj 1+tum organ perq","code_information":[{"code":"0600T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10160.25,"maximum":25370.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10160.25,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10363.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10261.85,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10465.05,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":25370.14,"additional_payer_notes":"APC"}]}]},{"description":"Ire abltj 1+tumors open","code_information":[{"code":"0601T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10160.25,"maximum":25370.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10160.25,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10363.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10261.85,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10465.05,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":25370.14,"additional_payer_notes":"APC"}]}]},{"description":"Laps repos lead isdss 1st ld","code_information":[{"code":"0677T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10160.25,"maximum":25370.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10160.25,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10363.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10261.85,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10465.05,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":25370.14,"additional_payer_notes":"APC"}]}]},{"description":"Laps rmvl lead isdss","code_information":[{"code":"0679T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10160.25,"maximum":25370.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10160.25,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10363.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10261.85,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10465.05,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":25370.14,"additional_payer_notes":"APC"}]}]},{"description":"Thoracoscopy wbx sac","code_information":[{"code":"32604","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10160.25,"maximum":25370.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10160.25,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10363.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10261.85,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10465.05,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":25370.14,"additional_payer_notes":"APC"}]}]},{"description":"Thoracoscopy w/bx infiltrate","code_information":[{"code":"32607","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10160.25,"maximum":25370.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10160.25,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10363.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10261.85,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10465.05,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":25370.14,"additional_payer_notes":"APC"}]}]},{"description":"Thoracoscopy w/bx nodule","code_information":[{"code":"32608","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10160.25,"maximum":25370.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10160.25,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10363.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10261.85,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10465.05,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":25370.14,"additional_payer_notes":"APC"}]}]},{"description":"Ablate pulm tumor perq crybl","code_information":[{"code":"32994","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10160.25,"maximum":25370.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10160.25,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10363.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10261.85,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10465.05,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":25370.14,"additional_payer_notes":"APC"}]}]},{"description":"Laparoscopy splenectomy","code_information":[{"code":"38120","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10160.25,"maximum":25370.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10160.25,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10363.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10261.85,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10465.05,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":25370.14,"additional_payer_notes":"APC"}]}]},{"description":"Laparoscopy lymphadenectomy","code_information":[{"code":"38571","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10160.25,"maximum":25370.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10160.25,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10363.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10261.85,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10465.05,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":25370.14,"additional_payer_notes":"APC"}]}]},{"description":"Laparoscopy lymphadenectomy","code_information":[{"code":"38572","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10160.25,"maximum":25370.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10160.25,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10363.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10261.85,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10465.05,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":25370.14,"additional_payer_notes":"APC"}]}]},{"description":"Laps pelvic lymphadec","code_information":[{"code":"38573","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10160.25,"maximum":25370.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10160.25,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10363.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10261.85,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10465.05,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":25370.14,"additional_payer_notes":"APC"}]}]},{"description":"Egd esophagogastrc fndoplsty","code_information":[{"code":"43210","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10160.25,"maximum":25370.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10160.25,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10363.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10261.85,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10465.05,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":25370.14,"additional_payer_notes":"APC"}]}]},{"description":"Laparoscopy fundoplasty","code_information":[{"code":"43280","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10160.25,"maximum":25370.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10160.25,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10363.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10261.85,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10465.05,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":25370.14,"additional_payer_notes":"APC"}]}]},{"description":"Lap paraesophag hern repair","code_information":[{"code":"43281","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10160.25,"maximum":25370.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10160.25,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10363.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10261.85,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10465.05,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":25370.14,"additional_payer_notes":"APC"}]}]},{"description":"Lap paraesoph her rpr w/mesh","code_information":[{"code":"43282","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10160.25,"maximum":25370.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10160.25,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10363.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10261.85,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10465.05,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":25370.14,"additional_payer_notes":"APC"}]}]},{"description":"Laps esophgl sphnctr agmntj","code_information":[{"code":"43284","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10160.25,"maximum":25370.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10160.25,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10363.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10261.85,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10465.05,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":25370.14,"additional_payer_notes":"APC"}]}]},{"description":"Lap revise/remv eltrd antrum","code_information":[{"code":"43648","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10160.25,"maximum":25370.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10160.25,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10363.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10261.85,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10465.05,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":25370.14,"additional_payer_notes":"APC"}]}]},{"description":"Lap place gastr adj device","code_information":[{"code":"43770","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10160.25,"maximum":25370.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10160.25,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10363.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10261.85,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10465.05,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":25370.14,"additional_payer_notes":"APC"}]}]},{"description":"Gstr rstcv px trnsorl esg","code_information":[{"code":"43889","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10160.25,"maximum":25370.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10160.25,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10363.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10261.85,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10465.05,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":25370.14,"additional_payer_notes":"APC"}]}]},{"description":"Laparo ablate liver tumor rf","code_information":[{"code":"47370","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10160.25,"maximum":25370.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10160.25,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10363.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10261.85,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10465.05,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":25370.14,"additional_payer_notes":"APC"}]}]},{"description":"Laparo ablate liver cryosurg","code_information":[{"code":"47371","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10160.25,"maximum":25370.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10160.25,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10363.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10261.85,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10465.05,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":25370.14,"additional_payer_notes":"APC"}]}]},{"description":"Perq abltj lvr cryoablation","code_information":[{"code":"47383","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10160.25,"maximum":25370.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10160.25,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10363.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10261.85,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10465.05,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":25370.14,"additional_payer_notes":"APC"}]}]},{"description":"Abltj ire liver 1+ tum perq","code_information":[{"code":"47384","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10160.25,"maximum":25370.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10160.25,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10363.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10261.85,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10465.05,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":25370.14,"additional_payer_notes":"APC"}]}]},{"description":"Biliary endoscopy thru skin","code_information":[{"code":"47554","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10160.25,"maximum":25370.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10160.25,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10363.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10261.85,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10465.05,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":25370.14,"additional_payer_notes":"APC"}]}]},{"description":"Biliary endoscopy thru skin","code_information":[{"code":"47556","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10160.25,"maximum":25370.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10160.25,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10363.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10261.85,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10465.05,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":25370.14,"additional_payer_notes":"APC"}]}]},{"description":"Laparo cholecystectomy/explr","code_information":[{"code":"47564","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10160.25,"maximum":25370.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10160.25,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10363.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10261.85,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10465.05,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":25370.14,"additional_payer_notes":"APC"}]}]},{"description":"Laparo ablate renal cyst","code_information":[{"code":"50541","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10160.25,"maximum":25370.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10160.25,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10363.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10261.85,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10465.05,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":25370.14,"additional_payer_notes":"APC"}]}]},{"description":"Laparo ablate renal mass","code_information":[{"code":"50542","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10160.25,"maximum":25370.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10160.25,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10363.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10261.85,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10465.05,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":25370.14,"additional_payer_notes":"APC"}]}]},{"description":"Laparo partial nephrectomy","code_information":[{"code":"50543","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10160.25,"maximum":25370.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10160.25,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10363.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10261.85,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10465.05,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":25370.14,"additional_payer_notes":"APC"}]}]},{"description":"Laparoscopy pyeloplasty","code_information":[{"code":"50544","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10160.25,"maximum":25370.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10160.25,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10363.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10261.85,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10465.05,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":25370.14,"additional_payer_notes":"APC"}]}]},{"description":"Perc cryo ablate renal tum","code_information":[{"code":"50593","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10160.25,"maximum":25370.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10160.25,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10363.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10261.85,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10465.05,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":25370.14,"additional_payer_notes":"APC"}]}]},{"description":"Laparo New Ureter/Bladder","code_information":[{"code":"50947","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10160.25,"maximum":25370.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10160.25,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10363.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10261.85,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10465.05,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":25370.14,"additional_payer_notes":"APC"}]}]},{"description":"Laparo New Ureter/Bladder","code_information":[{"code":"50948","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10160.25,"maximum":25370.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10160.25,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10363.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10261.85,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10465.05,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":25370.14,"additional_payer_notes":"APC"}]}]},{"description":"Laparo radical prostatectomy","code_information":[{"code":"55866","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10160.25,"maximum":25370.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10160.25,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10363.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10261.85,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10465.05,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":25370.14,"additional_payer_notes":"APC"}]}]},{"description":"Laps surg prst8ect smpl stot","code_information":[{"code":"55867","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10160.25,"maximum":25370.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10160.25,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10363.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10261.85,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10465.05,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":25370.14,"additional_payer_notes":"APC"}]}]},{"description":"Lap srg prst8ct lymph nod bx","code_information":[{"code":"55868","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10160.25,"maximum":25370.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10160.25,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10363.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10261.85,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10465.05,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":25370.14,"additional_payer_notes":"APC"}]}]},{"description":"Lap srg prst8ct bi pl lmphad","code_information":[{"code":"55869","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10160.25,"maximum":25370.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10160.25,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10363.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10261.85,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10465.05,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":25370.14,"additional_payer_notes":"APC"}]}]},{"description":"Abltj ire prst8 1+ tum perq","code_information":[{"code":"55877","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10160.25,"maximum":25370.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10160.25,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10363.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10261.85,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10465.05,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":25370.14,"additional_payer_notes":"APC"}]}]},{"description":"Repair paravag defect lap","code_information":[{"code":"57423","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10160.25,"maximum":25370.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10160.25,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10363.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10261.85,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10465.05,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":25370.14,"additional_payer_notes":"APC"}]}]},{"description":"Laparoscopy surg colpopexy","code_information":[{"code":"57425","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10160.25,"maximum":25370.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10160.25,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10363.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10261.85,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10465.05,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":25370.14,"additional_payer_notes":"APC"}]}]},{"description":"Lsh uterus 250 g or less","code_information":[{"code":"58541","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10160.25,"maximum":25370.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10160.25,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10363.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10261.85,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10465.05,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":25370.14,"additional_payer_notes":"APC"}]}]},{"description":"Lsh w/t/o ut 250 g or less","code_information":[{"code":"58542","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10160.25,"maximum":25370.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10160.25,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10363.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10261.85,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10465.05,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":25370.14,"additional_payer_notes":"APC"}]}]},{"description":"LSH Uterus Above 250 g","code_information":[{"code":"58543","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10160.25,"maximum":25370.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10160.25,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10363.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10261.85,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10465.05,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":25370.14,"additional_payer_notes":"APC"}]}]},{"description":"LSH w/t/o Uterus Above 250 g","code_information":[{"code":"58544","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10160.25,"maximum":25370.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10160.25,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10363.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10261.85,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10465.05,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":25370.14,"additional_payer_notes":"APC"}]}]},{"description":"Laparo-myomectomy complex","code_information":[{"code":"58546","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10160.25,"maximum":25370.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10160.25,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10363.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10261.85,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10465.05,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":25370.14,"additional_payer_notes":"APC"}]}]},{"description":"Laparo-vag hyst incl t/o","code_information":[{"code":"58552","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10160.25,"maximum":25370.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10160.25,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10363.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10261.85,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10465.05,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":25370.14,"additional_payer_notes":"APC"}]}]},{"description":"Laparo-vag hyst complex","code_information":[{"code":"58553","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10160.25,"maximum":25370.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10160.25,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10363.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10261.85,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10465.05,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":25370.14,"additional_payer_notes":"APC"}]}]},{"description":"Laparo-vag hyst w/t/o compl","code_information":[{"code":"58554","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10160.25,"maximum":25370.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10160.25,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10363.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10261.85,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10465.05,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":25370.14,"additional_payer_notes":"APC"}]}]},{"description":"Tlh uterus 250 g or less","code_information":[{"code":"58570","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10160.25,"maximum":25370.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10160.25,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10363.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10261.85,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10465.05,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":25370.14,"additional_payer_notes":"APC"}]}]},{"description":"Tlh w/t/o 250 g or less","code_information":[{"code":"58571","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10160.25,"maximum":25370.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10160.25,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10363.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10261.85,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10465.05,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":25370.14,"additional_payer_notes":"APC"}]}]},{"description":"Tlh uterus over 250 g","code_information":[{"code":"58572","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10160.25,"maximum":25370.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10160.25,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10363.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10261.85,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10465.05,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":25370.14,"additional_payer_notes":"APC"}]}]},{"description":"Tlh w/t/o uterus over 250 g","code_information":[{"code":"58573","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10160.25,"maximum":25370.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10160.25,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10363.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10261.85,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10465.05,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":25370.14,"additional_payer_notes":"APC"}]}]},{"description":"Laparoscopy salpingostomy","code_information":[{"code":"58673","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10160.25,"maximum":25370.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10160.25,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10363.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10261.85,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10465.05,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":25370.14,"additional_payer_notes":"APC"}]}]},{"description":"Laps abltj uterine fibroids","code_information":[{"code":"58674","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10160.25,"maximum":25370.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10160.25,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10363.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10261.85,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10465.05,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":25370.14,"additional_payer_notes":"APC"}]}]},{"description":"Endo outlet restrict w/tube","code_information":[{"code":"C9785","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10160.25,"maximum":25370.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10160.25,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10363.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10261.85,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10465.05,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":25370.14,"additional_payer_notes":"APC"}]}]},{"description":"Endo defect closure GI tract","code_information":[{"code":"C9901","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10160.25,"maximum":25370.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10160.25,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10363.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10261.85,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10465.05,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":25370.14,"additional_payer_notes":"APC"}]}]},{"description":"Temp fml iu vlv-pmp 1st insj","code_information":[{"code":"0596T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":666.49,"maximum":1664.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":666.49,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":679.82,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":673.16,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":686.49,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1664.23,"additional_payer_notes":"APC"}]}]},{"description":"Temp fml iu valve-pmp rplcmt","code_information":[{"code":"0597T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":666.49,"maximum":1664.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":666.49,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":679.82,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":673.16,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":686.49,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1664.23,"additional_payer_notes":"APC"}]}]},{"description":"Remove renal tube w/fluoro","code_information":[{"code":"50389","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":666.49,"maximum":1664.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":666.49,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":679.82,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":673.16,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":686.49,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1664.23,"additional_payer_notes":"APC"}]}]},{"description":"Measure kidney pressure","code_information":[{"code":"50396","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":666.49,"maximum":1664.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":666.49,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":679.82,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":673.16,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":686.49,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1664.23,"additional_payer_notes":"APC"}]}]},{"description":"Njx px nfrosgrm &/urtrgrm","code_information":[{"code":"50430","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":666.49,"maximum":1664.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":666.49,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":679.82,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":673.16,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":686.49,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1664.23,"additional_payer_notes":"APC"}]}]},{"description":"Njx px nfrosgrm &/urtrgrm","code_information":[{"code":"50431","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":666.49,"maximum":1664.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":666.49,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":679.82,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":673.16,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":686.49,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1664.23,"additional_payer_notes":"APC"}]}]},{"description":"Kidney endoscopy","code_information":[{"code":"50572","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":666.49,"maximum":1664.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":666.49,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":679.82,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":673.16,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":686.49,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1664.23,"additional_payer_notes":"APC"}]}]},{"description":"Change of bladder tube","code_information":[{"code":"51710","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":666.49,"maximum":1664.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":666.49,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":679.82,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":673.16,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":686.49,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1664.23,"additional_payer_notes":"APC"}]}]},{"description":"Treatment of bladder lesion","code_information":[{"code":"51720","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":666.49,"maximum":1664.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":666.49,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":679.82,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":673.16,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":686.49,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1664.23,"additional_payer_notes":"APC"}]}]},{"description":"Cystometrogram w/up","code_information":[{"code":"51727","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":666.49,"maximum":1664.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":666.49,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":679.82,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":673.16,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":686.49,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1664.23,"additional_payer_notes":"APC"}]}]},{"description":"Cystometrogram w/vp","code_information":[{"code":"51728","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":666.49,"maximum":1664.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":666.49,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":679.82,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":673.16,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":686.49,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1664.23,"additional_payer_notes":"APC"}]}]},{"description":"Cystometrogram w/vp&up","code_information":[{"code":"51729","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":666.49,"maximum":1664.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":666.49,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":679.82,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":673.16,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":686.49,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1664.23,"additional_payer_notes":"APC"}]}]},{"description":"Cystoscopy","code_information":[{"code":"52000","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":666.49,"maximum":1664.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":666.49,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":679.82,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":673.16,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":686.49,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1664.23,"additional_payer_notes":"APC"}]}]},{"description":"Cystoscopy & duct catheter","code_information":[{"code":"52010","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":666.49,"maximum":1664.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":666.49,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":679.82,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":673.16,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":686.49,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1664.23,"additional_payer_notes":"APC"}]}]},{"description":"Cystoscopy and treatment","code_information":[{"code":"52285","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":666.49,"maximum":1664.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":666.49,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":679.82,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":673.16,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":686.49,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1664.23,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of urinary leakage","code_information":[{"code":"53080","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":666.49,"maximum":1664.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":666.49,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":679.82,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":673.16,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":686.49,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1664.23,"additional_payer_notes":"APC"}]}]},{"description":"Dilate urethra stricture","code_information":[{"code":"53620","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":666.49,"maximum":1664.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":666.49,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":679.82,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":673.16,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":686.49,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1664.23,"additional_payer_notes":"APC"}]}]},{"description":"Circumcision neonate","code_information":[{"code":"54160","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":666.49,"maximum":1664.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":666.49,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":679.82,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":673.16,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":686.49,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1664.23,"additional_payer_notes":"APC"}]}]},{"description":"Renal abscess open drain","code_information":[{"code":"50020","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1998.04,"maximum":4989.10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1998.04,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2038.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2018.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2057.98,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4989.1,"additional_payer_notes":"APC"}]}]},{"description":"Change ureter stent percut","code_information":[{"code":"50382","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1998.04,"maximum":4989.10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1998.04,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2038.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2018.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2057.98,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4989.1,"additional_payer_notes":"APC"}]}]},{"description":"Remove ureter stent percut","code_information":[{"code":"50384","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1998.04,"maximum":4989.10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1998.04,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2038.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2018.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2057.98,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4989.1,"additional_payer_notes":"APC"}]}]},{"description":"Change stent via transureth","code_information":[{"code":"50385","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1998.04,"maximum":4989.10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1998.04,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2038.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2018.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2057.98,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4989.1,"additional_payer_notes":"APC"}]}]},{"description":"Remove stent via transureth","code_information":[{"code":"50386","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1998.04,"maximum":4989.10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1998.04,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2038.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2018.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2057.98,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4989.1,"additional_payer_notes":"APC"}]}]},{"description":"Change nephroureteral cath","code_information":[{"code":"50387","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1998.04,"maximum":4989.10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1998.04,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2038.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2018.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2057.98,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4989.1,"additional_payer_notes":"APC"}]}]},{"description":"Plmt nephrostomy catheter","code_information":[{"code":"50432","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1998.04,"maximum":4989.10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1998.04,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2038.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2018.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2057.98,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4989.1,"additional_payer_notes":"APC"}]}]},{"description":"Convert nephrostomy catheter","code_information":[{"code":"50434","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1998.04,"maximum":4989.10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1998.04,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2038.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2018.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2057.98,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4989.1,"additional_payer_notes":"APC"}]}]},{"description":"Exchange nephrostomy cath","code_information":[{"code":"50435","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1998.04,"maximum":4989.10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1998.04,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2038.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2018.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2057.98,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4989.1,"additional_payer_notes":"APC"}]}]},{"description":"Change of ureter tube/stent","code_information":[{"code":"50688","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1998.04,"maximum":4989.10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1998.04,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2038.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2018.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2057.98,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4989.1,"additional_payer_notes":"APC"}]}]},{"description":"Incise & drain bladder","code_information":[{"code":"51040","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1998.04,"maximum":4989.10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1998.04,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2038.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2018.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2057.98,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4989.1,"additional_payer_notes":"APC"}]}]},{"description":"Incise bladder/drain ureter","code_information":[{"code":"51045","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1998.04,"maximum":4989.10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1998.04,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2038.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2018.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2057.98,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4989.1,"additional_payer_notes":"APC"}]}]},{"description":"Removal of ureter stone","code_information":[{"code":"51060","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1998.04,"maximum":4989.10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1998.04,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2038.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2018.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2057.98,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4989.1,"additional_payer_notes":"APC"}]}]},{"description":"Drain bl w/cath insertion","code_information":[{"code":"51102","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1998.04,"maximum":4989.10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1998.04,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2038.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2018.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2057.98,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4989.1,"additional_payer_notes":"APC"}]}]},{"description":"Cystoscopy & ureter catheter","code_information":[{"code":"52005","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1998.04,"maximum":4989.10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1998.04,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2038.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2018.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2057.98,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4989.1,"additional_payer_notes":"APC"}]}]},{"description":"Cystoscopy w/biopsy(s)","code_information":[{"code":"52204","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1998.04,"maximum":4989.10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1998.04,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2038.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2018.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2057.98,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4989.1,"additional_payer_notes":"APC"}]}]},{"description":"Cystoscopy and treatment","code_information":[{"code":"52260","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1998.04,"maximum":4989.10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1998.04,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2038.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2018.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2057.98,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4989.1,"additional_payer_notes":"APC"}]}]},{"description":"Cystoscopy and treatment","code_information":[{"code":"52265","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1998.04,"maximum":4989.10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1998.04,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2038.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2018.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2057.98,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4989.1,"additional_payer_notes":"APC"}]}]},{"description":"Cystoscopy & revise urethra","code_information":[{"code":"52270","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1998.04,"maximum":4989.10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1998.04,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2038.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2018.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2057.98,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4989.1,"additional_payer_notes":"APC"}]}]},{"description":"Cystoscopy & revise urethra","code_information":[{"code":"52275","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1998.04,"maximum":4989.10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1998.04,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2038.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2018.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2057.98,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4989.1,"additional_payer_notes":"APC"}]}]},{"description":"Cystoscopy and treatment","code_information":[{"code":"52276","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1998.04,"maximum":4989.10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1998.04,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2038.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2018.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2057.98,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4989.1,"additional_payer_notes":"APC"}]}]},{"description":"Cystoscopy and treatment","code_information":[{"code":"52281","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1998.04,"maximum":4989.10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1998.04,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2038.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2018.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2057.98,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4989.1,"additional_payer_notes":"APC"}]}]},{"description":"Cystoscopy and treatment","code_information":[{"code":"52283","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1998.04,"maximum":4989.10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1998.04,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2038.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2018.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2057.98,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4989.1,"additional_payer_notes":"APC"}]}]},{"description":"Cystoscopy chemodenervation","code_information":[{"code":"52287","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1998.04,"maximum":4989.10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1998.04,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2038.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2018.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2057.98,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4989.1,"additional_payer_notes":"APC"}]}]},{"description":"Cystoscopy and treatment","code_information":[{"code":"52290","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1998.04,"maximum":4989.10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1998.04,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2038.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2018.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2057.98,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4989.1,"additional_payer_notes":"APC"}]}]},{"description":"Cystoscopy and treatment","code_information":[{"code":"52310","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1998.04,"maximum":4989.10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1998.04,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2038.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2018.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2057.98,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4989.1,"additional_payer_notes":"APC"}]}]},{"description":"Cystoscopy and treatment","code_information":[{"code":"52315","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1998.04,"maximum":4989.10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1998.04,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2038.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2018.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2057.98,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4989.1,"additional_payer_notes":"APC"}]}]},{"description":"Incision of urethra","code_information":[{"code":"53000","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1998.04,"maximum":4989.10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1998.04,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2038.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2018.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2057.98,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4989.1,"additional_payer_notes":"APC"}]}]},{"description":"Incision of urethra","code_information":[{"code":"53020","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1998.04,"maximum":4989.10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1998.04,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2038.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2018.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2057.98,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4989.1,"additional_payer_notes":"APC"}]}]},{"description":"Incision of urethra","code_information":[{"code":"53025","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1998.04,"maximum":4989.10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1998.04,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2038.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2018.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2057.98,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4989.1,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of urethra abscess","code_information":[{"code":"53060","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1998.04,"maximum":4989.10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1998.04,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2038.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2018.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2057.98,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4989.1,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of urinary leakage","code_information":[{"code":"53085","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1998.04,"maximum":4989.10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1998.04,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2038.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2018.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2057.98,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4989.1,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy of urethra","code_information":[{"code":"53200","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1998.04,"maximum":4989.10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1998.04,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2038.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2018.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2057.98,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4989.1,"additional_payer_notes":"APC"}]}]},{"description":"Treatment of urethra lesion","code_information":[{"code":"53265","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1998.04,"maximum":4989.10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1998.04,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2038.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2018.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2057.98,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4989.1,"additional_payer_notes":"APC"}]}]},{"description":"Dilation of urethra","code_information":[{"code":"53665","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1998.04,"maximum":4989.10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1998.04,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2038.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2018.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2057.98,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4989.1,"additional_payer_notes":"APC"}]}]},{"description":"Insert prost urethral stent","code_information":[{"code":"53855","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1998.04,"maximum":4989.10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1998.04,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2038.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2018.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2057.98,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4989.1,"additional_payer_notes":"APC"}]}]},{"description":"Transurethral rf treatment","code_information":[{"code":"53860","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1998.04,"maximum":4989.10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1998.04,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2038.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2018.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2057.98,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4989.1,"additional_payer_notes":"APC"}]}]},{"description":"Slitting of prepuce","code_information":[{"code":"54001","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1998.04,"maximum":4989.10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1998.04,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2038.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2018.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2057.98,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4989.1,"additional_payer_notes":"APC"}]}]},{"description":"Circumcision w/regionl block","code_information":[{"code":"54150","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1998.04,"maximum":4989.10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1998.04,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2038.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2018.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2057.98,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4989.1,"additional_payer_notes":"APC"}]}]},{"description":"Circum 28 days or older","code_information":[{"code":"54161","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1998.04,"maximum":4989.10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1998.04,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2038.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2018.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2057.98,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4989.1,"additional_payer_notes":"APC"}]}]},{"description":"Lysis penil circumic lesion","code_information":[{"code":"54162","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1998.04,"maximum":4989.10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1998.04,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2038.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2018.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2057.98,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4989.1,"additional_payer_notes":"APC"}]}]},{"description":"Repair of circumcision","code_information":[{"code":"54163","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1998.04,"maximum":4989.10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1998.04,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2038.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2018.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2057.98,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4989.1,"additional_payer_notes":"APC"}]}]},{"description":"Frenulotomy of penis","code_information":[{"code":"54164","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1998.04,"maximum":4989.10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1998.04,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2038.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2018.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2057.98,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4989.1,"additional_payer_notes":"APC"}]}]},{"description":"Repair penis","code_information":[{"code":"54380","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1998.04,"maximum":4989.10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1998.04,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2038.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2018.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2057.98,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4989.1,"additional_payer_notes":"APC"}]}]},{"description":"Repair penis","code_information":[{"code":"54385","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1998.04,"maximum":4989.10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1998.04,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2038.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2018.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2057.98,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4989.1,"additional_payer_notes":"APC"}]}]},{"description":"Exploration for testis","code_information":[{"code":"54560","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1998.04,"maximum":4989.10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1998.04,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2038.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2018.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2057.98,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4989.1,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of scrotum","code_information":[{"code":"54700","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1998.04,"maximum":4989.10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1998.04,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2038.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2018.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2057.98,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4989.1,"additional_payer_notes":"APC"}]}]},{"description":"Remove epididymis lesion","code_information":[{"code":"54840","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1998.04,"maximum":4989.10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1998.04,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2038.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2018.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2057.98,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4989.1,"additional_payer_notes":"APC"}]}]},{"description":"Fusion of spermatic ducts","code_information":[{"code":"54900","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1998.04,"maximum":4989.10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1998.04,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2038.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2018.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2057.98,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4989.1,"additional_payer_notes":"APC"}]}]},{"description":"Removal of scrotum lesion","code_information":[{"code":"55120","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1998.04,"maximum":4989.10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1998.04,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2038.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2018.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2057.98,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4989.1,"additional_payer_notes":"APC"}]}]},{"description":"Removal of sperm duct(s)","code_information":[{"code":"55250","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1998.04,"maximum":4989.10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1998.04,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2038.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2018.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2057.98,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4989.1,"additional_payer_notes":"APC"}]}]},{"description":"Incise sperm duct pouch","code_information":[{"code":"55600","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1998.04,"maximum":4989.10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1998.04,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2038.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2018.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2057.98,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4989.1,"additional_payer_notes":"APC"}]}]},{"description":"X-ray guide gu dilation","code_information":[{"code":"74485","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1998.04,"maximum":4989.10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1998.04,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2038.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2018.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2057.98,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4989.1,"additional_payer_notes":"APC"}]}]},{"description":"Penile venous occlusion","code_information":[{"code":"37790","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3369.26,"maximum":8413.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3369.26,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3436.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3402.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3470.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8413.04,"additional_payer_notes":"APC"}]}]},{"description":"Plmt nephroureteral catheter","code_information":[{"code":"50433","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3369.26,"maximum":8413.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3369.26,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3436.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3402.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3470.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8413.04,"additional_payer_notes":"APC"}]}]},{"description":"Dilat xst trc ndurlgc px","code_information":[{"code":"50436","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3369.26,"maximum":8413.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3369.26,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3436.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3402.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3470.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8413.04,"additional_payer_notes":"APC"}]}]},{"description":"Dilat xst trc new access rcs","code_information":[{"code":"50437","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3369.26,"maximum":8413.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3369.26,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3436.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3402.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3470.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8413.04,"additional_payer_notes":"APC"}]}]},{"description":"Kidney endoscopy","code_information":[{"code":"50570","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3369.26,"maximum":8413.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3369.26,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3436.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3402.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3470.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8413.04,"additional_payer_notes":"APC"}]}]},{"description":"Kidney endoscopy & biopsy","code_information":[{"code":"50574","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3369.26,"maximum":8413.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3369.26,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3436.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3402.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3470.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8413.04,"additional_payer_notes":"APC"}]}]},{"description":"Fragmenting of kidney stone","code_information":[{"code":"50590","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3369.26,"maximum":8413.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3369.26,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3436.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3402.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3470.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8413.04,"additional_payer_notes":"APC"}]}]},{"description":"Plmt ureteral stent prq","code_information":[{"code":"50693","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3369.26,"maximum":8413.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3369.26,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3436.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3402.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3470.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8413.04,"additional_payer_notes":"APC"}]}]},{"description":"Plmt ureteral stent prq","code_information":[{"code":"50694","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3369.26,"maximum":8413.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3369.26,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3436.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3402.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3470.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8413.04,"additional_payer_notes":"APC"}]}]},{"description":"Plmt ureteral stent prq","code_information":[{"code":"50695","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3369.26,"maximum":8413.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3369.26,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3436.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3402.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3470.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8413.04,"additional_payer_notes":"APC"}]}]},{"description":"Revise ureter","code_information":[{"code":"50727","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3369.26,"maximum":8413.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3369.26,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3436.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3402.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3470.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8413.04,"additional_payer_notes":"APC"}]}]},{"description":"Endoscopy of ureter","code_information":[{"code":"50951","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3369.26,"maximum":8413.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3369.26,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3436.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3402.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3470.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8413.04,"additional_payer_notes":"APC"}]}]},{"description":"Endoscopy of ureter","code_information":[{"code":"50953","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3369.26,"maximum":8413.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3369.26,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3436.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3402.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3470.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8413.04,"additional_payer_notes":"APC"}]}]},{"description":"Ureter endoscopy","code_information":[{"code":"50970","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3369.26,"maximum":8413.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3369.26,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3436.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3402.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3470.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8413.04,"additional_payer_notes":"APC"}]}]},{"description":"Ureter endoscopy & catheter","code_information":[{"code":"50972","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3369.26,"maximum":8413.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3369.26,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3436.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3402.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3470.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8413.04,"additional_payer_notes":"APC"}]}]},{"description":"Incise & treat bladder","code_information":[{"code":"51020","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3369.26,"maximum":8413.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3369.26,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3436.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3402.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3470.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8413.04,"additional_payer_notes":"APC"}]}]},{"description":"Remove ureter calculus","code_information":[{"code":"51065","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3369.26,"maximum":8413.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3369.26,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3436.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3402.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3470.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8413.04,"additional_payer_notes":"APC"}]}]},{"description":"Removal of bladder lesion","code_information":[{"code":"51520","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3369.26,"maximum":8413.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3369.26,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3436.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3402.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3470.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8413.04,"additional_payer_notes":"APC"}]}]},{"description":"Repair of ureter lesion","code_information":[{"code":"51535","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3369.26,"maximum":8413.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3369.26,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3436.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3402.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3470.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8413.04,"additional_payer_notes":"APC"}]}]},{"description":"Endoscopic injection/implant","code_information":[{"code":"51715","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3369.26,"maximum":8413.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3369.26,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3436.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3402.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3470.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8413.04,"additional_payer_notes":"APC"}]}]},{"description":"Repair of bladder opening","code_information":[{"code":"51880","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3369.26,"maximum":8413.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3369.26,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3436.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3402.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3470.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8413.04,"additional_payer_notes":"APC"}]}]},{"description":"Cystoscopy removal of clots","code_information":[{"code":"52001","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3369.26,"maximum":8413.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3369.26,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3436.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3402.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3470.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8413.04,"additional_payer_notes":"APC"}]}]},{"description":"Cystoscopy and biopsy","code_information":[{"code":"52007","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3369.26,"maximum":8413.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3369.26,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3436.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3402.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3470.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8413.04,"additional_payer_notes":"APC"}]}]},{"description":"Cystoscopy and treatment","code_information":[{"code":"52214","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3369.26,"maximum":8413.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3369.26,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3436.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3402.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3470.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8413.04,"additional_payer_notes":"APC"}]}]},{"description":"Cystoscopy and treatment","code_information":[{"code":"52224","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3369.26,"maximum":8413.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3369.26,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3436.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3402.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3470.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8413.04,"additional_payer_notes":"APC"}]}]},{"description":"Cystoscopy and treatment","code_information":[{"code":"52234","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3369.26,"maximum":8413.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3369.26,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3436.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3402.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3470.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8413.04,"additional_payer_notes":"APC"}]}]},{"description":"Cystoscopy and treatment","code_information":[{"code":"52235","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3369.26,"maximum":8413.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3369.26,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3436.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3402.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3470.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8413.04,"additional_payer_notes":"APC"}]}]},{"description":"Cystoscopy and radiotracer","code_information":[{"code":"52250","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3369.26,"maximum":8413.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3369.26,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3436.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3402.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3470.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8413.04,"additional_payer_notes":"APC"}]}]},{"description":"Cystoscopy and treatment","code_information":[{"code":"52277","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3369.26,"maximum":8413.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3369.26,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3436.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3402.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3470.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8413.04,"additional_payer_notes":"APC"}]}]},{"description":"Cystoscopy implant stent","code_information":[{"code":"52282","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3369.26,"maximum":8413.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3369.26,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3436.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3402.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3470.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8413.04,"additional_payer_notes":"APC"}]}]},{"description":"Cystoscopy and treatment","code_information":[{"code":"52300","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3369.26,"maximum":8413.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3369.26,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3436.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3402.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3470.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8413.04,"additional_payer_notes":"APC"}]}]},{"description":"Cystoscopy and treatment","code_information":[{"code":"52301","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3369.26,"maximum":8413.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3369.26,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3436.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3402.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3470.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8413.04,"additional_payer_notes":"APC"}]}]},{"description":"Remove bladder stone","code_information":[{"code":"52317","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3369.26,"maximum":8413.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3369.26,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3436.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3402.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3470.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8413.04,"additional_payer_notes":"APC"}]}]},{"description":"Remove bladder stone","code_information":[{"code":"52318","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3369.26,"maximum":8413.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3369.26,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3436.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3402.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3470.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8413.04,"additional_payer_notes":"APC"}]}]},{"description":"Cystoscopy and treatment","code_information":[{"code":"52320","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3369.26,"maximum":8413.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3369.26,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3436.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3402.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3470.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8413.04,"additional_payer_notes":"APC"}]}]},{"description":"Cystoscopy and treatment","code_information":[{"code":"52330","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3369.26,"maximum":8413.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3369.26,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3436.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3402.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3470.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8413.04,"additional_payer_notes":"APC"}]}]},{"description":"Cystoscopy and treatment","code_information":[{"code":"52332","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3369.26,"maximum":8413.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3369.26,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3436.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3402.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3470.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8413.04,"additional_payer_notes":"APC"}]}]},{"description":"Create passage to kidney","code_information":[{"code":"52334","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3369.26,"maximum":8413.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3369.26,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3436.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3402.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3470.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8413.04,"additional_payer_notes":"APC"}]}]},{"description":"Cysto W/Ureter Stricture Tx","code_information":[{"code":"52341","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3369.26,"maximum":8413.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3369.26,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3436.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3402.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3470.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8413.04,"additional_payer_notes":"APC"}]}]},{"description":"Cysto W/Up Stricture Tx","code_information":[{"code":"52342","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3369.26,"maximum":8413.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3369.26,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3436.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3402.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3470.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8413.04,"additional_payer_notes":"APC"}]}]},{"description":"Cysto W/Renal Stricture Tx","code_information":[{"code":"52343","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3369.26,"maximum":8413.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3369.26,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3436.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3402.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3470.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8413.04,"additional_payer_notes":"APC"}]}]},{"description":"Cysto/uretero stricture tx","code_information":[{"code":"52344","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3369.26,"maximum":8413.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3369.26,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3436.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3402.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3470.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8413.04,"additional_payer_notes":"APC"}]}]},{"description":"Cysto/Uretero W/Up Stricture","code_information":[{"code":"52345","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3369.26,"maximum":8413.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3369.26,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3436.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3402.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3470.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8413.04,"additional_payer_notes":"APC"}]}]},{"description":"Cystouretero & or pyeloscope","code_information":[{"code":"52351","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3369.26,"maximum":8413.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3369.26,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3436.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3402.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3470.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8413.04,"additional_payer_notes":"APC"}]}]},{"description":"Cystouretero w/stone remove","code_information":[{"code":"52352","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3369.26,"maximum":8413.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3369.26,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3436.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3402.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3470.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8413.04,"additional_payer_notes":"APC"}]}]},{"description":"Cystouretero W/Congen Repr","code_information":[{"code":"52400","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3369.26,"maximum":8413.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3369.26,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3436.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3402.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3470.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8413.04,"additional_payer_notes":"APC"}]}]},{"description":"Cystourethro cut ejacul duct","code_information":[{"code":"52402","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3369.26,"maximum":8413.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3369.26,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3436.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3402.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3470.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8413.04,"additional_payer_notes":"APC"}]}]},{"description":"Incision of prostate","code_information":[{"code":"52450","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3369.26,"maximum":8413.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3369.26,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3436.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3402.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3470.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8413.04,"additional_payer_notes":"APC"}]}]},{"description":"Revision of bladder neck","code_information":[{"code":"52500","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3369.26,"maximum":8413.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3369.26,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3436.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3402.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3470.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8413.04,"additional_payer_notes":"APC"}]}]},{"description":"Relieve bladder contracture","code_information":[{"code":"52640","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3369.26,"maximum":8413.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3369.26,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3436.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3402.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3470.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8413.04,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of prostate abscess","code_information":[{"code":"52700","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3369.26,"maximum":8413.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3369.26,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3436.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3402.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3470.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8413.04,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of urethra abscess","code_information":[{"code":"53040","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3369.26,"maximum":8413.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3369.26,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3436.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3402.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3470.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8413.04,"additional_payer_notes":"APC"}]}]},{"description":"Removal of urethra","code_information":[{"code":"53210","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3369.26,"maximum":8413.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3369.26,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3436.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3402.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3470.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8413.04,"additional_payer_notes":"APC"}]}]},{"description":"Treatment of urethra lesion","code_information":[{"code":"53220","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3369.26,"maximum":8413.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3369.26,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3436.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3402.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3470.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8413.04,"additional_payer_notes":"APC"}]}]},{"description":"Surgery for urethra pouch","code_information":[{"code":"53240","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3369.26,"maximum":8413.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3369.26,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3436.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3402.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3470.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8413.04,"additional_payer_notes":"APC"}]}]},{"description":"Removal of urethra gland","code_information":[{"code":"53250","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3369.26,"maximum":8413.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3369.26,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3436.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3402.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3470.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8413.04,"additional_payer_notes":"APC"}]}]},{"description":"Treatment of urethra lesion","code_information":[{"code":"53260","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3369.26,"maximum":8413.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3369.26,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3436.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3402.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3470.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8413.04,"additional_payer_notes":"APC"}]}]},{"description":"Removal of urethra gland","code_information":[{"code":"53270","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3369.26,"maximum":8413.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3369.26,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3436.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3402.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3470.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8413.04,"additional_payer_notes":"APC"}]}]},{"description":"Repair of urethra defect","code_information":[{"code":"53275","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3369.26,"maximum":8413.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3369.26,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3436.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3402.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3470.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8413.04,"additional_payer_notes":"APC"}]}]},{"description":"Revision of urethra","code_information":[{"code":"53450","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3369.26,"maximum":8413.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3369.26,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3436.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3402.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3470.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8413.04,"additional_payer_notes":"APC"}]}]},{"description":"Tprnl balo cntnc dev rmvl ea","code_information":[{"code":"53453","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3369.26,"maximum":8413.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3369.26,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3436.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3402.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3470.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8413.04,"additional_payer_notes":"APC"}]}]},{"description":"Revision of urethra","code_information":[{"code":"53460","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3369.26,"maximum":8413.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3369.26,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3436.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3402.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3470.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8413.04,"additional_payer_notes":"APC"}]}]},{"description":"Urethrlys transvag w/ scope","code_information":[{"code":"53500","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3369.26,"maximum":8413.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3369.26,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3436.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3402.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3470.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8413.04,"additional_payer_notes":"APC"}]}]},{"description":"Repair of urethra injury","code_information":[{"code":"53502","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3369.26,"maximum":8413.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3369.26,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3436.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3402.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3470.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8413.04,"additional_payer_notes":"APC"}]}]},{"description":"Dilate urethra stricture","code_information":[{"code":"53605","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3369.26,"maximum":8413.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3369.26,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3436.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3402.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3470.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8413.04,"additional_payer_notes":"APC"}]}]},{"description":"Prostatic microwave thermotx","code_information":[{"code":"53850","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3369.26,"maximum":8413.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3369.26,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3436.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3402.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3470.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8413.04,"additional_payer_notes":"APC"}]}]},{"description":"Prostatic rf thermotx","code_information":[{"code":"53852","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3369.26,"maximum":8413.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3369.26,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3436.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3402.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3470.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8413.04,"additional_payer_notes":"APC"}]}]},{"description":"Trurl dstrj prst8 tiss rf wv","code_information":[{"code":"53854","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3369.26,"maximum":8413.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3369.26,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3436.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3402.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3470.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8413.04,"additional_payer_notes":"APC"}]}]},{"description":"Slitting of prepuce","code_information":[{"code":"54000","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3369.26,"maximum":8413.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3369.26,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3436.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3402.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3470.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8413.04,"additional_payer_notes":"APC"}]}]},{"description":"Treatment of penis lesion","code_information":[{"code":"54110","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3369.26,"maximum":8413.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3369.26,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3436.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3402.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3470.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8413.04,"additional_payer_notes":"APC"}]}]},{"description":"Partial removal of penis","code_information":[{"code":"54120","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3369.26,"maximum":8413.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3369.26,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3436.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3402.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3470.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8413.04,"additional_payer_notes":"APC"}]}]},{"description":"Revision of penis","code_information":[{"code":"54300","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3369.26,"maximum":8413.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3369.26,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3436.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3402.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3470.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8413.04,"additional_payer_notes":"APC"}]}]},{"description":"Revision of penis","code_information":[{"code":"54304","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3369.26,"maximum":8413.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3369.26,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3436.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3402.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3470.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8413.04,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruction of urethra","code_information":[{"code":"54312","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3369.26,"maximum":8413.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3369.26,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3436.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3402.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3470.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8413.04,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruction of urethra","code_information":[{"code":"54318","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3369.26,"maximum":8413.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3369.26,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3436.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3402.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3470.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8413.04,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruction of urethra","code_information":[{"code":"54322","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3369.26,"maximum":8413.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3369.26,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3436.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3402.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3470.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8413.04,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruction of urethra","code_information":[{"code":"54324","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3369.26,"maximum":8413.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3369.26,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3436.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3402.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3470.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8413.04,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruction of urethra","code_information":[{"code":"54326","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3369.26,"maximum":8413.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3369.26,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3436.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3402.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3470.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8413.04,"additional_payer_notes":"APC"}]}]},{"description":"Revise penis/urethra","code_information":[{"code":"54328","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3369.26,"maximum":8413.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3369.26,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3436.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3402.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3470.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8413.04,"additional_payer_notes":"APC"}]}]},{"description":"Revise penis/urethra","code_information":[{"code":"54332","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3369.26,"maximum":8413.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3369.26,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3436.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3402.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3470.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8413.04,"additional_payer_notes":"APC"}]}]},{"description":"Revise penis/urethra","code_information":[{"code":"54336","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3369.26,"maximum":8413.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3369.26,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3436.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3402.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3470.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8413.04,"additional_payer_notes":"APC"}]}]},{"description":"Secondary urethral surgery","code_information":[{"code":"54340","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3369.26,"maximum":8413.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3369.26,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3436.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3402.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3470.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8413.04,"additional_payer_notes":"APC"}]}]},{"description":"Penis plastic surgery","code_information":[{"code":"54360","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3369.26,"maximum":8413.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3369.26,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3436.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3402.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3470.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8413.04,"additional_payer_notes":"APC"}]}]},{"description":"Remove muti-comp penis pros","code_information":[{"code":"54406","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3369.26,"maximum":8413.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3369.26,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3436.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3402.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3470.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8413.04,"additional_payer_notes":"APC"}]}]},{"description":"Remove self-contd penis pros","code_information":[{"code":"54415","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3369.26,"maximum":8413.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3369.26,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3436.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3402.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3470.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8413.04,"additional_payer_notes":"APC"}]}]},{"description":"Revision of penis","code_information":[{"code":"54420","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3369.26,"maximum":8413.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3369.26,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3436.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3402.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3470.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8413.04,"additional_payer_notes":"APC"}]}]},{"description":"Revision of penis","code_information":[{"code":"54435","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3369.26,"maximum":8413.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3369.26,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3436.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3402.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3470.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8413.04,"additional_payer_notes":"APC"}]}]},{"description":"Repair corporeal tear","code_information":[{"code":"54437","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3369.26,"maximum":8413.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3369.26,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3436.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3402.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3470.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8413.04,"additional_payer_notes":"APC"}]}]},{"description":"Repair of penis","code_information":[{"code":"54440","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3369.26,"maximum":8413.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3369.26,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3436.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3402.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3470.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8413.04,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy of testis","code_information":[{"code":"54505","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3369.26,"maximum":8413.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3369.26,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3436.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3402.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3470.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8413.04,"additional_payer_notes":"APC"}]}]},{"description":"Excise Lesion Testis","code_information":[{"code":"54512","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3369.26,"maximum":8413.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3369.26,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3436.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3402.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3470.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8413.04,"additional_payer_notes":"APC"}]}]},{"description":"Removal of testis","code_information":[{"code":"54520","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3369.26,"maximum":8413.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3369.26,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3436.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3402.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3470.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8413.04,"additional_payer_notes":"APC"}]}]},{"description":"Orchiectomy partial","code_information":[{"code":"54522","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3369.26,"maximum":8413.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3369.26,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3436.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3402.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3470.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8413.04,"additional_payer_notes":"APC"}]}]},{"description":"Extensive testis surgery","code_information":[{"code":"54535","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3369.26,"maximum":8413.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3369.26,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3436.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3402.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3470.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8413.04,"additional_payer_notes":"APC"}]}]},{"description":"Reduce testis torsion","code_information":[{"code":"54600","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3369.26,"maximum":8413.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3369.26,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3436.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3402.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3470.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8413.04,"additional_payer_notes":"APC"}]}]},{"description":"Suspension of testis","code_information":[{"code":"54620","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3369.26,"maximum":8413.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3369.26,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3436.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3402.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3470.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8413.04,"additional_payer_notes":"APC"}]}]},{"description":"Repair testis injury","code_information":[{"code":"54670","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3369.26,"maximum":8413.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3369.26,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3436.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3402.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3470.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8413.04,"additional_payer_notes":"APC"}]}]},{"description":"Relocation of testis(es)","code_information":[{"code":"54680","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3369.26,"maximum":8413.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3369.26,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3436.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3402.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3470.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8413.04,"additional_payer_notes":"APC"}]}]},{"description":"Remove epididymis lesion","code_information":[{"code":"54830","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3369.26,"maximum":8413.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3369.26,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3436.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3402.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3470.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8413.04,"additional_payer_notes":"APC"}]}]},{"description":"Removal of epididymis","code_information":[{"code":"54860","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3369.26,"maximum":8413.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3369.26,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3436.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3402.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3470.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8413.04,"additional_payer_notes":"APC"}]}]},{"description":"Removal of epididymis","code_information":[{"code":"54861","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3369.26,"maximum":8413.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3369.26,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3436.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3402.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3470.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8413.04,"additional_payer_notes":"APC"}]}]},{"description":"Explore Epididymis","code_information":[{"code":"54865","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3369.26,"maximum":8413.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3369.26,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3436.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3402.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3470.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8413.04,"additional_payer_notes":"APC"}]}]},{"description":"Fusion of spermatic ducts","code_information":[{"code":"54901","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3369.26,"maximum":8413.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3369.26,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3436.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3402.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3470.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8413.04,"additional_payer_notes":"APC"}]}]},{"description":"Repair of hydrocele","code_information":[{"code":"55060","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3369.26,"maximum":8413.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3369.26,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3436.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3402.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3470.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8413.04,"additional_payer_notes":"APC"}]}]},{"description":"Explore scrotum","code_information":[{"code":"55110","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3369.26,"maximum":8413.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3369.26,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3436.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3402.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3470.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8413.04,"additional_payer_notes":"APC"}]}]},{"description":"Removal of scrotum","code_information":[{"code":"55150","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3369.26,"maximum":8413.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3369.26,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3436.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3402.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3470.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8413.04,"additional_payer_notes":"APC"}]}]},{"description":"Revision of scrotum","code_information":[{"code":"55175","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3369.26,"maximum":8413.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3369.26,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3436.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3402.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3470.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8413.04,"additional_payer_notes":"APC"}]}]},{"description":"Incision of sperm duct","code_information":[{"code":"55200","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3369.26,"maximum":8413.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3369.26,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3436.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3402.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3470.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8413.04,"additional_payer_notes":"APC"}]}]},{"description":"Repair of sperm duct","code_information":[{"code":"55400","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3369.26,"maximum":8413.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3369.26,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3436.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3402.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3470.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8413.04,"additional_payer_notes":"APC"}]}]},{"description":"Removal of hydrocele","code_information":[{"code":"55500","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3369.26,"maximum":8413.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3369.26,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3436.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3402.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3470.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8413.04,"additional_payer_notes":"APC"}]}]},{"description":"Removal of sperm cord lesion","code_information":[{"code":"55520","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3369.26,"maximum":8413.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3369.26,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3436.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3402.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3470.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8413.04,"additional_payer_notes":"APC"}]}]},{"description":"Revise spermatic cord veins","code_information":[{"code":"55530","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3369.26,"maximum":8413.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3369.26,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3436.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3402.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3470.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8413.04,"additional_payer_notes":"APC"}]}]},{"description":"Remove sperm pouch lesion","code_information":[{"code":"55680","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3369.26,"maximum":8413.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3369.26,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3436.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3402.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3470.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8413.04,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy of prostate","code_information":[{"code":"55705","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3369.26,"maximum":8413.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3369.26,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3436.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3402.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3470.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8413.04,"additional_payer_notes":"APC"}]}]},{"description":"Prostate saturation sampling","code_information":[{"code":"55706","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3369.26,"maximum":8413.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3369.26,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3436.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3402.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3470.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8413.04,"additional_payer_notes":"APC"}]}]},{"description":"Bx prst8 trct us guided","code_information":[{"code":"55707","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3369.26,"maximum":8413.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3369.26,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3436.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3402.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3470.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8413.04,"additional_payer_notes":"APC"}]}]},{"description":"Bx prst8 trct us w/mri fus 1","code_information":[{"code":"55708","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3369.26,"maximum":8413.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3369.26,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3436.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3402.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3470.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8413.04,"additional_payer_notes":"APC"}]}]},{"description":"Bx prst8 tprnl us guided","code_information":[{"code":"55709","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3369.26,"maximum":8413.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3369.26,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3436.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3402.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3470.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8413.04,"additional_payer_notes":"APC"}]}]},{"description":"Bx prst8 tprn us w/mri fus 1","code_information":[{"code":"55710","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3369.26,"maximum":8413.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3369.26,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3436.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3402.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3470.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8413.04,"additional_payer_notes":"APC"}]}]},{"description":"Bx prst8 trct mri-us 1st","code_information":[{"code":"55711","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3369.26,"maximum":8413.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3369.26,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3436.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3402.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3470.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8413.04,"additional_payer_notes":"APC"}]}]},{"description":"Bx prst8 tprnl mri-us 1st","code_information":[{"code":"55712","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3369.26,"maximum":8413.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3369.26,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3436.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3402.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3470.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8413.04,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of prostate abscess","code_information":[{"code":"55720","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3369.26,"maximum":8413.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3369.26,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3436.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3402.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3470.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8413.04,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of prostate abscess","code_information":[{"code":"55725","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3369.26,"maximum":8413.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3369.26,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3436.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3402.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3470.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8413.04,"additional_payer_notes":"APC"}]}]},{"description":"Sex transformation f to m","code_information":[{"code":"55980","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3369.26,"maximum":8413.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3369.26,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3436.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3402.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3470.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8413.04,"additional_payer_notes":"APC"}]}]},{"description":"Tprnl focal abltj mal prst8","code_information":[{"code":"0655T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5124.93,"maximum":12796.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5124.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5227.43,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5176.18,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5278.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":12796.96,"additional_payer_notes":"APC"}]}]},{"description":"Tprnl lsr ablt b9 prst8 hypr","code_information":[{"code":"0714T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5124.93,"maximum":12796.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5124.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5227.43,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5176.18,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5278.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":12796.96,"additional_payer_notes":"APC"}]}]},{"description":"Tpla b9 prst8 hyprplsa>=50ml","code_information":[{"code":"0867T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5124.93,"maximum":12796.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5124.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5227.43,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5176.18,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5278.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":12796.96,"additional_payer_notes":"APC"}]}]},{"description":"Kidney endoscopy","code_information":[{"code":"50551","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5124.93,"maximum":12796.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5124.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5227.43,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5176.18,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5278.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":12796.96,"additional_payer_notes":"APC"}]}]},{"description":"Kidney endoscopy","code_information":[{"code":"50553","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5124.93,"maximum":12796.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5124.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5227.43,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5176.18,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5278.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":12796.96,"additional_payer_notes":"APC"}]}]},{"description":"Kidney endoscopy & treatment","code_information":[{"code":"50561","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5124.93,"maximum":12796.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5124.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5227.43,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5176.18,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5278.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":12796.96,"additional_payer_notes":"APC"}]}]},{"description":"Kidney endoscopy","code_information":[{"code":"50575","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5124.93,"maximum":12796.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5124.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5227.43,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5176.18,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5278.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":12796.96,"additional_payer_notes":"APC"}]}]},{"description":"Kidney endoscopy & treatment","code_information":[{"code":"50580","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5124.93,"maximum":12796.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5124.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5227.43,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5176.18,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5278.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":12796.96,"additional_payer_notes":"APC"}]}]},{"description":"Ureter endoscopy & biopsy","code_information":[{"code":"50955","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5124.93,"maximum":12796.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5124.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5227.43,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5176.18,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5278.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":12796.96,"additional_payer_notes":"APC"}]}]},{"description":"Ureter endoscopy & treatment","code_information":[{"code":"50957","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5124.93,"maximum":12796.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5124.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5227.43,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5176.18,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5278.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":12796.96,"additional_payer_notes":"APC"}]}]},{"description":"Ureter endoscopy & treatment","code_information":[{"code":"50961","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5124.93,"maximum":12796.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5124.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5227.43,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5176.18,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5278.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":12796.96,"additional_payer_notes":"APC"}]}]},{"description":"Ureter endoscopy & biopsy","code_information":[{"code":"50974","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5124.93,"maximum":12796.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5124.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5227.43,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5176.18,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5278.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":12796.96,"additional_payer_notes":"APC"}]}]},{"description":"Ureter endoscopy & treatment","code_information":[{"code":"50976","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5124.93,"maximum":12796.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5124.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5227.43,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5176.18,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5278.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":12796.96,"additional_payer_notes":"APC"}]}]},{"description":"Ureter endoscopy & treatment","code_information":[{"code":"50980","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5124.93,"maximum":12796.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5124.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5227.43,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5176.18,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5278.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":12796.96,"additional_payer_notes":"APC"}]}]},{"description":"Removal of bladder stone","code_information":[{"code":"51050","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5124.93,"maximum":12796.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5124.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5227.43,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5176.18,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5278.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":12796.96,"additional_payer_notes":"APC"}]}]},{"description":"Cystoscopy and treatment","code_information":[{"code":"52240","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5124.93,"maximum":12796.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5124.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5227.43,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5176.18,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5278.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":12796.96,"additional_payer_notes":"APC"}]}]},{"description":"Cysto rx balo cath urtl strx","code_information":[{"code":"52284","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5124.93,"maximum":12796.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5124.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5227.43,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5176.18,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5278.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":12796.96,"additional_payer_notes":"APC"}]}]},{"description":"Cystoscopy and treatment","code_information":[{"code":"52305","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5124.93,"maximum":12796.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5124.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5227.43,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5176.18,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5278.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":12796.96,"additional_payer_notes":"APC"}]}]},{"description":"Cystoscopy stone removal","code_information":[{"code":"52325","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5124.93,"maximum":12796.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5124.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5227.43,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5176.18,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5278.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":12796.96,"additional_payer_notes":"APC"}]}]},{"description":"Cystoscopy inject material","code_information":[{"code":"52327","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5124.93,"maximum":12796.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5124.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5227.43,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5176.18,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5278.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":12796.96,"additional_payer_notes":"APC"}]}]},{"description":"Cystouretero W/Renal Strict","code_information":[{"code":"52346","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5124.93,"maximum":12796.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5124.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5227.43,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5176.18,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5278.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":12796.96,"additional_payer_notes":"APC"}]}]},{"description":"Cystouretero W/Lithotripsy","code_information":[{"code":"52353","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5124.93,"maximum":12796.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5124.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5227.43,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5176.18,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5278.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":12796.96,"additional_payer_notes":"APC"}]}]},{"description":"Cystouretero W/Biopsy","code_information":[{"code":"52354","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5124.93,"maximum":12796.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5124.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5227.43,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5176.18,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5278.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":12796.96,"additional_payer_notes":"APC"}]}]},{"description":"Cystouretero W/Excise Tumor","code_information":[{"code":"52355","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5124.93,"maximum":12796.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5124.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5227.43,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5176.18,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5278.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":12796.96,"additional_payer_notes":"APC"}]}]},{"description":"Cysto/uretero w/lithotripsy","code_information":[{"code":"52356","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5124.93,"maximum":12796.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5124.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5227.43,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5176.18,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5278.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":12796.96,"additional_payer_notes":"APC"}]}]},{"description":"Prostatectomy (TURP)","code_information":[{"code":"52601","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5124.93,"maximum":12796.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5124.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5227.43,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5176.18,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5278.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":12796.96,"additional_payer_notes":"APC"}]}]},{"description":"Remove prostate regrowth","code_information":[{"code":"52630","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5124.93,"maximum":12796.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5124.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5227.43,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5176.18,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5278.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":12796.96,"additional_payer_notes":"APC"}]}]},{"description":"Laser surgery of prostate","code_information":[{"code":"52648","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5124.93,"maximum":12796.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5124.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5227.43,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5176.18,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5278.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":12796.96,"additional_payer_notes":"APC"}]}]},{"description":"Prostate laser enucleation","code_information":[{"code":"52649","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5124.93,"maximum":12796.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5124.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5227.43,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5176.18,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5278.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":12796.96,"additional_payer_notes":"APC"}]}]},{"description":"Incision of urethra","code_information":[{"code":"53010","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5124.93,"maximum":12796.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5124.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5227.43,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5176.18,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5278.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":12796.96,"additional_payer_notes":"APC"}]}]},{"description":"Removal of urethra","code_information":[{"code":"53215","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5124.93,"maximum":12796.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5124.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5227.43,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5176.18,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5278.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":12796.96,"additional_payer_notes":"APC"}]}]},{"description":"Removal of urethra lesion","code_information":[{"code":"53230","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5124.93,"maximum":12796.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5124.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5227.43,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5176.18,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5278.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":12796.96,"additional_payer_notes":"APC"}]}]},{"description":"Removal of urethra lesion","code_information":[{"code":"53235","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5124.93,"maximum":12796.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5124.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5227.43,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5176.18,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5278.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":12796.96,"additional_payer_notes":"APC"}]}]},{"description":"Revise urethra stage 1","code_information":[{"code":"53400","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5124.93,"maximum":12796.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5124.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5227.43,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5176.18,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5278.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":12796.96,"additional_payer_notes":"APC"}]}]},{"description":"Revise urethra stage 2","code_information":[{"code":"53405","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5124.93,"maximum":12796.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5124.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5227.43,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5176.18,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5278.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":12796.96,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruction of urethra","code_information":[{"code":"53410","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5124.93,"maximum":12796.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5124.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5227.43,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5176.18,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5278.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":12796.96,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruct urethra stage 1","code_information":[{"code":"53420","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5124.93,"maximum":12796.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5124.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5227.43,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5176.18,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5278.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":12796.96,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruct urethra stage 2","code_information":[{"code":"53425","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5124.93,"maximum":12796.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5124.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5227.43,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5176.18,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5278.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":12796.96,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruction of urethra","code_information":[{"code":"53430","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5124.93,"maximum":12796.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5124.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5227.43,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5176.18,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5278.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":12796.96,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruct urethra/bladder","code_information":[{"code":"53431","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5124.93,"maximum":12796.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5124.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5227.43,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5176.18,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5278.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":12796.96,"additional_payer_notes":"APC"}]}]},{"description":"Remove/revise male sling","code_information":[{"code":"53442","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5124.93,"maximum":12796.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5124.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5227.43,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5176.18,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5278.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":12796.96,"additional_payer_notes":"APC"}]}]},{"description":"Remove uro sphincter","code_information":[{"code":"53446","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5124.93,"maximum":12796.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5124.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5227.43,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5176.18,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5278.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":12796.96,"additional_payer_notes":"APC"}]}]},{"description":"Repair of urethra injury","code_information":[{"code":"53505","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5124.93,"maximum":12796.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5124.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5227.43,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5176.18,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5278.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":12796.96,"additional_payer_notes":"APC"}]}]},{"description":"Repair of urethra injury","code_information":[{"code":"53510","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5124.93,"maximum":12796.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5124.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5227.43,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5176.18,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5278.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":12796.96,"additional_payer_notes":"APC"}]}]},{"description":"Repair of urethra injury","code_information":[{"code":"53515","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5124.93,"maximum":12796.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5124.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5227.43,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5176.18,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5278.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":12796.96,"additional_payer_notes":"APC"}]}]},{"description":"Repair of urethra defect","code_information":[{"code":"53520","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5124.93,"maximum":12796.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5124.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5227.43,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5176.18,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5278.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":12796.96,"additional_payer_notes":"APC"}]}]},{"description":"Treat penis lesion graft","code_information":[{"code":"54111","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5124.93,"maximum":12796.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5124.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5227.43,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5176.18,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5278.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":12796.96,"additional_payer_notes":"APC"}]}]},{"description":"Treatment of penis lesion","code_information":[{"code":"54205","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5124.93,"maximum":12796.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5124.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5227.43,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5176.18,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5278.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":12796.96,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruction of urethra","code_information":[{"code":"54308","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5124.93,"maximum":12796.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5124.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5227.43,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5176.18,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5278.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":12796.96,"additional_payer_notes":"APC"}]}]},{"description":"Secondary urethral surgery","code_information":[{"code":"54348","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5124.93,"maximum":12796.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5124.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5227.43,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5176.18,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5278.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":12796.96,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruct urethra/penis","code_information":[{"code":"54352","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5124.93,"maximum":12796.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5124.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5227.43,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5176.18,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5278.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":12796.96,"additional_payer_notes":"APC"}]}]},{"description":"Repair multi-comp penis pros","code_information":[{"code":"54408","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5124.93,"maximum":12796.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5124.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5227.43,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5176.18,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5278.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":12796.96,"additional_payer_notes":"APC"}]}]},{"description":"Revision of testis","code_information":[{"code":"54660","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5124.93,"maximum":12796.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5124.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5227.43,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5176.18,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5278.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":12796.96,"additional_payer_notes":"APC"}]}]},{"description":"Revision of scrotum","code_information":[{"code":"55180","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5124.93,"maximum":12796.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5124.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5227.43,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5176.18,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5278.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":12796.96,"additional_payer_notes":"APC"}]}]},{"description":"Bx prst8 in-bore ct/mri bx 1","code_information":[{"code":"55713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5124.93,"maximum":12796.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5124.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5227.43,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5176.18,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5278.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":12796.96,"additional_payer_notes":"APC"}]}]},{"description":"Bx prst8 in-bore ct/mri 1","code_information":[{"code":"55714","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5124.93,"maximum":12796.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5124.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5227.43,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5176.18,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5278.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":12796.96,"additional_payer_notes":"APC"}]}]},{"description":"Surgical exposure prostate","code_information":[{"code":"55860","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5124.93,"maximum":12796.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5124.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5227.43,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5176.18,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5278.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":12796.96,"additional_payer_notes":"APC"}]}]},{"description":"Tprnl plmt biodegrdabl matrl","code_information":[{"code":"55874","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5124.93,"maximum":12796.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5124.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5227.43,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5176.18,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5278.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":12796.96,"additional_payer_notes":"APC"}]}]},{"description":"Transperi needle place pros","code_information":[{"code":"55875","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5124.93,"maximum":12796.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5124.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5227.43,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5176.18,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5278.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":12796.96,"additional_payer_notes":"APC"}]}]},{"description":"Cystoscopy prostatic imp 1-3","code_information":[{"code":"C9739","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5124.93,"maximum":12796.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5124.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5227.43,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5176.18,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5278.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":12796.96,"additional_payer_notes":"APC"}]}]},{"description":"Abltj b9 prst8 tissue hifu","code_information":[{"code":"0950T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9048.27,"maximum":22593.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9048.27,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9229.23,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9138.75,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9319.72,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":22593.53,"additional_payer_notes":"APC"}]}]},{"description":"Cysto lo-nrg lithtrp&mcrsphr","code_information":[{"code":"0991T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9048.27,"maximum":22593.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9048.27,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9229.23,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9138.75,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9319.72,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":22593.53,"additional_payer_notes":"APC"}]}]},{"description":"Removal of kidney stone","code_information":[{"code":"50080","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9048.27,"maximum":22593.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9048.27,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9229.23,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9138.75,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9319.72,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":22593.53,"additional_payer_notes":"APC"}]}]},{"description":"Removal of kidney stone","code_information":[{"code":"50081","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9048.27,"maximum":22593.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9048.27,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9229.23,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9138.75,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9319.72,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":22593.53,"additional_payer_notes":"APC"}]}]},{"description":"Kidney endoscopy & biopsy","code_information":[{"code":"50555","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9048.27,"maximum":22593.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9048.27,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9229.23,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9138.75,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9319.72,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":22593.53,"additional_payer_notes":"APC"}]}]},{"description":"Kidney endoscopy & treatment","code_information":[{"code":"50557","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9048.27,"maximum":22593.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9048.27,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9229.23,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9138.75,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9319.72,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":22593.53,"additional_payer_notes":"APC"}]}]},{"description":"Renal scope w/tumor resect","code_information":[{"code":"50562","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9048.27,"maximum":22593.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9048.27,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9229.23,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9138.75,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9319.72,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":22593.53,"additional_payer_notes":"APC"}]}]},{"description":"Kidney endoscopy & treatment","code_information":[{"code":"50576","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9048.27,"maximum":22593.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9048.27,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9229.23,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9138.75,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9319.72,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":22593.53,"additional_payer_notes":"APC"}]}]},{"description":"Repair of bladder wound","code_information":[{"code":"51860","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9048.27,"maximum":22593.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9048.27,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9229.23,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9138.75,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9319.72,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":22593.53,"additional_payer_notes":"APC"}]}]},{"description":"Cysto 1st trurl prst8 comis","code_information":[{"code":"52443","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9048.27,"maximum":22593.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9048.27,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9229.23,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9138.75,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9319.72,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":22593.53,"additional_payer_notes":"APC"}]}]},{"description":"Trurl rbtc wtrjt rescj prst8","code_information":[{"code":"52597","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9048.27,"maximum":22593.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9048.27,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9229.23,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9138.75,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9319.72,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":22593.53,"additional_payer_notes":"APC"}]}]},{"description":"Repair uro sphincter","code_information":[{"code":"53449","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9048.27,"maximum":22593.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9048.27,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9229.23,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9138.75,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9319.72,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":22593.53,"additional_payer_notes":"APC"}]}]},{"description":"Tprnl balo cntnc dev uni","code_information":[{"code":"53452","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9048.27,"maximum":22593.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9048.27,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9229.23,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9138.75,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9319.72,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":22593.53,"additional_payer_notes":"APC"}]}]},{"description":"Cysto insj dev ischmc rmdlg","code_information":[{"code":"53865","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9048.27,"maximum":22593.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9048.27,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9229.23,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9138.75,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9319.72,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":22593.53,"additional_payer_notes":"APC"}]}]},{"description":"Treat penis lesion graft","code_information":[{"code":"54112","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9048.27,"maximum":22593.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9048.27,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9229.23,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9138.75,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9319.72,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":22593.53,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruction of urethra","code_information":[{"code":"54316","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9048.27,"maximum":22593.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9048.27,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9229.23,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9138.75,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9319.72,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":22593.53,"additional_payer_notes":"APC"}]}]},{"description":"Secondary urethral surgery","code_information":[{"code":"54344","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9048.27,"maximum":22593.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9048.27,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9229.23,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9138.75,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9319.72,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":22593.53,"additional_payer_notes":"APC"}]}]},{"description":"Cryoablate Prostate","code_information":[{"code":"55873","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9048.27,"maximum":22593.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9048.27,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9229.23,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9138.75,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9319.72,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":22593.53,"additional_payer_notes":"APC"}]}]},{"description":"Abltj mal prst8 tiss hifu","code_information":[{"code":"55880","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9048.27,"maximum":22593.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9048.27,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9229.23,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9138.75,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9319.72,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":22593.53,"additional_payer_notes":"APC"}]}]},{"description":"Cysto impl 4 or more","code_information":[{"code":"C9740","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9048.27,"maximum":22593.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9048.27,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9229.23,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9138.75,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9319.72,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":22593.53,"additional_payer_notes":"APC"}]}]},{"description":"Cysto, litho, vacuum kidney","code_information":[{"code":"C9761","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9048.27,"maximum":22593.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9048.27,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9229.23,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9138.75,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9319.72,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":22593.53,"additional_payer_notes":"APC"}]}]},{"description":"Insert tandem cuff","code_information":[{"code":"53444","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":19810.52,"maximum":49466.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19810.52,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20206.73,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20008.63,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20404.84,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":49466.87,"additional_payer_notes":"APC"}]}]},{"description":"Insert uro/ves nck sphincter","code_information":[{"code":"53445","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":19810.52,"maximum":49466.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19810.52,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20206.73,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20008.63,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20404.84,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":49466.87,"additional_payer_notes":"APC"}]}]},{"description":"Remove/replace ur sphincter","code_information":[{"code":"53447","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":19810.52,"maximum":49466.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19810.52,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20206.73,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20008.63,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20404.84,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":49466.87,"additional_payer_notes":"APC"}]}]},{"description":"Insert self-contd prosthesis","code_information":[{"code":"54401","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":19810.52,"maximum":49466.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19810.52,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20206.73,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20008.63,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20404.84,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":49466.87,"additional_payer_notes":"APC"}]}]},{"description":"Insert multi-comp penis pros","code_information":[{"code":"54405","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":19810.52,"maximum":49466.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19810.52,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20206.73,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20008.63,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20404.84,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":49466.87,"additional_payer_notes":"APC"}]}]},{"description":"Remove/replace penis prosth","code_information":[{"code":"54410","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":19810.52,"maximum":49466.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19810.52,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20206.73,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20008.63,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20404.84,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":49466.87,"additional_payer_notes":"APC"}]}]},{"description":"Remov/replc penis pros comp","code_information":[{"code":"54411","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":19810.52,"maximum":49466.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19810.52,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20206.73,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20008.63,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20404.84,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":49466.87,"additional_payer_notes":"APC"}]}]},{"description":"Remv/repl penis contain pros","code_information":[{"code":"54416","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":19810.52,"maximum":49466.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19810.52,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20206.73,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20008.63,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20404.84,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":49466.87,"additional_payer_notes":"APC"}]}]},{"description":"Remv/replc penis pros compl","code_information":[{"code":"54417","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":19810.52,"maximum":49466.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19810.52,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20206.73,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20008.63,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20404.84,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":49466.87,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of gland abscess","code_information":[{"code":"56420","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":193.24,"maximum":482.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":193.24,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":197.1,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":195.17,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":199.04,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":482.52,"additional_payer_notes":"APC"}]}]},{"description":"Exam of vulva w/scope","code_information":[{"code":"56820","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":193.24,"maximum":482.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":193.24,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":197.1,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":195.17,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":199.04,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":482.52,"additional_payer_notes":"APC"}]}]},{"description":"Insert pessary/other device","code_information":[{"code":"57160","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":193.24,"maximum":482.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":193.24,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":197.1,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":195.17,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":199.04,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":482.52,"additional_payer_notes":"APC"}]}]},{"description":"Fitting of diaphragm/cap","code_information":[{"code":"57170","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":193.24,"maximum":482.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":193.24,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":197.1,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":195.17,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":199.04,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":482.52,"additional_payer_notes":"APC"}]}]},{"description":"Treat vaginal bleeding","code_information":[{"code":"57180","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":193.24,"maximum":482.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":193.24,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":197.1,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":195.17,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":199.04,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":482.52,"additional_payer_notes":"APC"}]}]},{"description":"Exam of cervix w/scope","code_information":[{"code":"57452","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":193.24,"maximum":482.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":193.24,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":197.1,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":195.17,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":199.04,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":482.52,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy of uterus lining","code_information":[{"code":"58100","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":193.24,"maximum":482.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":193.24,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":197.1,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":195.17,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":199.04,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":482.52,"additional_payer_notes":"APC"}]}]},{"description":"Artificial insemination","code_information":[{"code":"58322","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":193.24,"maximum":482.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":193.24,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":197.1,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":195.17,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":199.04,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":482.52,"additional_payer_notes":"APC"}]}]},{"description":"Sperm washing","code_information":[{"code":"58323","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":193.24,"maximum":482.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":193.24,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":197.1,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":195.17,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":199.04,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":482.52,"additional_payer_notes":"APC"}]}]},{"description":"Hysteroscope procedure","code_information":[{"code":"58579","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":193.24,"maximum":482.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":193.24,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":197.1,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":195.17,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":199.04,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":482.52,"additional_payer_notes":"APC"}]}]},{"description":"Genital surgery procedure","code_information":[{"code":"58999","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":193.24,"maximum":482.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":193.24,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":197.1,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":195.17,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":199.04,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":482.52,"additional_payer_notes":"APC"}]}]},{"description":"Fetal contract stress test","code_information":[{"code":"59020","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":193.24,"maximum":482.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":193.24,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":197.1,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":195.17,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":199.04,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":482.52,"additional_payer_notes":"APC"}]}]},{"description":"Fetal non-stress test","code_information":[{"code":"59025","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":193.24,"maximum":482.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":193.24,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":197.1,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":195.17,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":199.04,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":482.52,"additional_payer_notes":"APC"}]}]},{"description":"Fetal invas px w/us","code_information":[{"code":"59897","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":193.24,"maximum":482.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":193.24,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":197.1,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":195.17,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":199.04,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":482.52,"additional_payer_notes":"APC"}]}]},{"description":"Maternity care procedure","code_information":[{"code":"59899","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":193.24,"maximum":482.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":193.24,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":197.1,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":195.17,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":199.04,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":482.52,"additional_payer_notes":"APC"}]}]},{"description":"Anogenital exam child w imag","code_information":[{"code":"99170","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":193.24,"maximum":482.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":193.24,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":197.1,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":195.17,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":199.04,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":482.52,"additional_payer_notes":"APC"}]}]},{"description":"I & D of vulva/perineum","code_information":[{"code":"56405","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":291.27,"maximum":727.30,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":291.27,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":297.09,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":294.18,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":300.01,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":727.3,"additional_payer_notes":"APC"}]}]},{"description":"Exam/biopsy of vulva w/scope","code_information":[{"code":"56821","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":291.27,"maximum":727.30,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":291.27,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":297.09,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":294.18,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":300.01,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":727.3,"additional_payer_notes":"APC"}]}]},{"description":"Ins vag brachytx device","code_information":[{"code":"57156","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":291.27,"maximum":727.30,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":291.27,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":297.09,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":294.18,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":300.01,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":727.3,"additional_payer_notes":"APC"}]}]},{"description":"Exam of vagina w/scope","code_information":[{"code":"57420","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":291.27,"maximum":727.30,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":291.27,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":297.09,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":294.18,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":300.01,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":727.3,"additional_payer_notes":"APC"}]}]},{"description":"Bx/curett of cervix w/scope","code_information":[{"code":"57454","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":291.27,"maximum":727.30,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":291.27,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":297.09,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":294.18,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":300.01,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":727.3,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy of cervix w/scope","code_information":[{"code":"57455","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":291.27,"maximum":727.30,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":291.27,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":297.09,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":294.18,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":300.01,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":727.3,"additional_payer_notes":"APC"}]}]},{"description":"Endocerv curettage w/scope","code_information":[{"code":"57456","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":291.27,"maximum":727.30,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":291.27,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":297.09,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":294.18,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":300.01,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":727.3,"additional_payer_notes":"APC"}]}]},{"description":"Cryocautery of cervix","code_information":[{"code":"57511","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":291.27,"maximum":727.30,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":291.27,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":297.09,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":294.18,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":300.01,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":727.3,"additional_payer_notes":"APC"}]}]},{"description":"Remove intrauterine device","code_information":[{"code":"58301","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":291.27,"maximum":727.30,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":291.27,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":297.09,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":294.18,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":300.01,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":727.3,"additional_payer_notes":"APC"}]}]},{"description":"Artificial insemination","code_information":[{"code":"58321","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":291.27,"maximum":727.30,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":291.27,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":297.09,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":294.18,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":300.01,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":727.3,"additional_payer_notes":"APC"}]}]},{"description":"Transfer of embryo","code_information":[{"code":"58976","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":291.27,"maximum":727.30,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":291.27,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":297.09,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":294.18,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":300.01,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":727.3,"additional_payer_notes":"APC"}]}]},{"description":"Amniocentesis therapeutic","code_information":[{"code":"59001","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":291.27,"maximum":727.30,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":291.27,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":297.09,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":294.18,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":300.01,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":727.3,"additional_payer_notes":"APC"}]}]},{"description":"Fetal cord puncture prenatal","code_information":[{"code":"59012","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":291.27,"maximum":727.30,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":291.27,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":297.09,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":294.18,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":300.01,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":727.3,"additional_payer_notes":"APC"}]}]},{"description":"Fetal scalp blood sample","code_information":[{"code":"59030","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":291.27,"maximum":727.30,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":291.27,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":297.09,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":294.18,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":300.01,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":727.3,"additional_payer_notes":"APC"}]}]},{"description":"Transabdom amnioinfus w/us","code_information":[{"code":"59070","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":291.27,"maximum":727.30,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":291.27,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":297.09,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":294.18,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":300.01,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":727.3,"additional_payer_notes":"APC"}]}]},{"description":"Umbilical cord occlud w/us","code_information":[{"code":"59072","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":291.27,"maximum":727.30,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":291.27,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":297.09,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":294.18,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":300.01,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":727.3,"additional_payer_notes":"APC"}]}]},{"description":"Fetal fluid drainage w/us","code_information":[{"code":"59074","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":291.27,"maximum":727.30,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":291.27,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":297.09,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":294.18,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":300.01,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":727.3,"additional_payer_notes":"APC"}]}]},{"description":"Fetal shunt placement w/us","code_information":[{"code":"59076","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":291.27,"maximum":727.30,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":291.27,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":297.09,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":294.18,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":300.01,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":727.3,"additional_payer_notes":"APC"}]}]},{"description":"Insert cervical dilator","code_information":[{"code":"59200","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":291.27,"maximum":727.30,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":291.27,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":297.09,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":294.18,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":300.01,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":727.3,"additional_payer_notes":"APC"}]}]},{"description":"Abortion (mpr)","code_information":[{"code":"59866","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":291.27,"maximum":727.30,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":291.27,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":297.09,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":294.18,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":300.01,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":727.3,"additional_payer_notes":"APC"}]}]},{"description":"Us leiomyomata ablate <200","code_information":[{"code":"0071T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3094.12,"maximum":7726.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3094.12,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3156.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3125.06,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3186.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7726.02,"additional_payer_notes":"APC"}]}]},{"description":"Us leiomyomata ablate >200","code_information":[{"code":"0072T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3094.12,"maximum":7726.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3094.12,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3156.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3125.06,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3186.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7726.02,"additional_payer_notes":"APC"}]}]},{"description":"Surgery for vulva lesion","code_information":[{"code":"56440","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3094.12,"maximum":7726.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3094.12,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3156.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3125.06,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3186.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7726.02,"additional_payer_notes":"APC"}]}]},{"description":"Lysis of labial lesion(s)","code_information":[{"code":"56441","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3094.12,"maximum":7726.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3094.12,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3156.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3125.06,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3186.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7726.02,"additional_payer_notes":"APC"}]}]},{"description":"Hymenotomy","code_information":[{"code":"56442","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3094.12,"maximum":7726.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3094.12,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3156.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3125.06,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3186.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7726.02,"additional_payer_notes":"APC"}]}]},{"description":"Partial removal of vulva","code_information":[{"code":"56620","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3094.12,"maximum":7726.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3094.12,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3156.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3125.06,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3186.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7726.02,"additional_payer_notes":"APC"}]}]},{"description":"Complete removal of vulva","code_information":[{"code":"56625","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3094.12,"maximum":7726.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3094.12,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3156.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3125.06,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3186.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7726.02,"additional_payer_notes":"APC"}]}]},{"description":"Partial removal of hymen","code_information":[{"code":"56700","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3094.12,"maximum":7726.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3094.12,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3156.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3125.06,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3186.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7726.02,"additional_payer_notes":"APC"}]}]},{"description":"Remove vagina gland lesion","code_information":[{"code":"56740","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3094.12,"maximum":7726.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3094.12,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3156.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3125.06,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3186.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7726.02,"additional_payer_notes":"APC"}]}]},{"description":"Repair of vagina","code_information":[{"code":"56800","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3094.12,"maximum":7726.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3094.12,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3156.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3125.06,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3186.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7726.02,"additional_payer_notes":"APC"}]}]},{"description":"Repair clitoris","code_information":[{"code":"56805","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3094.12,"maximum":7726.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3094.12,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3156.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3125.06,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3186.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7726.02,"additional_payer_notes":"APC"}]}]},{"description":"Repair of perineum","code_information":[{"code":"56810","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3094.12,"maximum":7726.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3094.12,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3156.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3125.06,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3186.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7726.02,"additional_payer_notes":"APC"}]}]},{"description":"Exploration of vagina","code_information":[{"code":"57000","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3094.12,"maximum":7726.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3094.12,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3156.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3125.06,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3186.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7726.02,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of pelvic abscess","code_information":[{"code":"57010","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3094.12,"maximum":7726.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3094.12,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3156.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3125.06,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3186.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7726.02,"additional_payer_notes":"APC"}]}]},{"description":"Destroy vag lesions simple","code_information":[{"code":"57061","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3094.12,"maximum":7726.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3094.12,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3156.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3125.06,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3186.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7726.02,"additional_payer_notes":"APC"}]}]},{"description":"Destroy vag lesions complex","code_information":[{"code":"57065","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3094.12,"maximum":7726.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3094.12,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3156.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3125.06,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3186.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7726.02,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy of vagina","code_information":[{"code":"57105","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3094.12,"maximum":7726.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3094.12,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3156.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3125.06,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3186.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7726.02,"additional_payer_notes":"APC"}]}]},{"description":"Remove vagina wall partial","code_information":[{"code":"57106","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3094.12,"maximum":7726.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3094.12,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3156.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3125.06,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3186.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7726.02,"additional_payer_notes":"APC"}]}]},{"description":"Remove vagina tissue part","code_information":[{"code":"57107","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3094.12,"maximum":7726.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3094.12,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3156.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3125.06,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3186.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7726.02,"additional_payer_notes":"APC"}]}]},{"description":"Vaginectomy partial w/nodes","code_information":[{"code":"57109","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3094.12,"maximum":7726.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3094.12,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3156.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3125.06,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3186.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7726.02,"additional_payer_notes":"APC"}]}]},{"description":"Remove vagina lesion","code_information":[{"code":"57130","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3094.12,"maximum":7726.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3094.12,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3156.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3125.06,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3186.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7726.02,"additional_payer_notes":"APC"}]}]},{"description":"Remove vagina lesion","code_information":[{"code":"57135","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3094.12,"maximum":7726.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3094.12,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3156.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3125.06,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3186.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7726.02,"additional_payer_notes":"APC"}]}]},{"description":"Repair of vagina","code_information":[{"code":"57200","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3094.12,"maximum":7726.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3094.12,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3156.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3125.06,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3186.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7726.02,"additional_payer_notes":"APC"}]}]},{"description":"Repair vagina/perineum","code_information":[{"code":"57210","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3094.12,"maximum":7726.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3094.12,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3156.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3125.06,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3186.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7726.02,"additional_payer_notes":"APC"}]}]},{"description":"Repair of urethral lesion","code_information":[{"code":"57230","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3094.12,"maximum":7726.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3094.12,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3156.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3125.06,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3186.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7726.02,"additional_payer_notes":"APC"}]}]},{"description":"Revise/Remove Sling Repair","code_information":[{"code":"57287","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3094.12,"maximum":7726.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3094.12,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3156.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3125.06,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3186.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7726.02,"additional_payer_notes":"APC"}]}]},{"description":"Revise vag graft via vagina","code_information":[{"code":"57295","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3094.12,"maximum":7726.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3094.12,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3156.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3125.06,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3186.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7726.02,"additional_payer_notes":"APC"}]}]},{"description":"Repair rectum-vagina fistula","code_information":[{"code":"57300","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3094.12,"maximum":7726.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3094.12,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3156.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3125.06,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3186.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7726.02,"additional_payer_notes":"APC"}]}]},{"description":"Dilation of vagina","code_information":[{"code":"57400","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3094.12,"maximum":7726.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3094.12,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3156.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3125.06,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3186.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7726.02,"additional_payer_notes":"APC"}]}]},{"description":"Pelvic examination","code_information":[{"code":"57410","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3094.12,"maximum":7726.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3094.12,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3156.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3125.06,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3186.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7726.02,"additional_payer_notes":"APC"}]}]},{"description":"Remove vaginal foreign body","code_information":[{"code":"57415","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3094.12,"maximum":7726.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3094.12,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3156.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3125.06,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3186.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7726.02,"additional_payer_notes":"APC"}]}]},{"description":"Bx of cervix w/scope leep","code_information":[{"code":"57460","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3094.12,"maximum":7726.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3094.12,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3156.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3125.06,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3186.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7726.02,"additional_payer_notes":"APC"}]}]},{"description":"Conz of cervix w/scope leep","code_information":[{"code":"57461","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3094.12,"maximum":7726.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3094.12,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3156.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3125.06,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3186.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7726.02,"additional_payer_notes":"APC"}]}]},{"description":"Cauterization of cervix","code_information":[{"code":"57510","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3094.12,"maximum":7726.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3094.12,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3156.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3125.06,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3186.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7726.02,"additional_payer_notes":"APC"}]}]},{"description":"Laser surgery of cervix","code_information":[{"code":"57513","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3094.12,"maximum":7726.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3094.12,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3156.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3125.06,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3186.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7726.02,"additional_payer_notes":"APC"}]}]},{"description":"Conization of cervix","code_information":[{"code":"57520","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3094.12,"maximum":7726.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3094.12,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3156.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3125.06,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3186.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7726.02,"additional_payer_notes":"APC"}]}]},{"description":"Conization of cervix","code_information":[{"code":"57522","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3094.12,"maximum":7726.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3094.12,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3156.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3125.06,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3186.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7726.02,"additional_payer_notes":"APC"}]}]},{"description":"D&C oF Cervical Stump","code_information":[{"code":"57558","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3094.12,"maximum":7726.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3094.12,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3156.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3125.06,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3186.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7726.02,"additional_payer_notes":"APC"}]}]},{"description":"Revision of cervix","code_information":[{"code":"57700","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3094.12,"maximum":7726.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3094.12,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3156.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3125.06,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3186.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7726.02,"additional_payer_notes":"APC"}]}]},{"description":"Revision of cervix","code_information":[{"code":"57720","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3094.12,"maximum":7726.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3094.12,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3156.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3125.06,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3186.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7726.02,"additional_payer_notes":"APC"}]}]},{"description":"Dilation of cervical canal","code_information":[{"code":"57800","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3094.12,"maximum":7726.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3094.12,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3156.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3125.06,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3186.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7726.02,"additional_payer_notes":"APC"}]}]},{"description":"Dilation and curettage","code_information":[{"code":"58120","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3094.12,"maximum":7726.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3094.12,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3156.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3125.06,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3186.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7726.02,"additional_payer_notes":"APC"}]}]},{"description":"Myomectomy vag method","code_information":[{"code":"58145","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3094.12,"maximum":7726.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3094.12,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3156.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3125.06,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3186.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7726.02,"additional_payer_notes":"APC"}]}]},{"description":"Reopen fallopian tube","code_information":[{"code":"58345","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3094.12,"maximum":7726.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3094.12,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3156.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3125.06,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3186.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7726.02,"additional_payer_notes":"APC"}]}]},{"description":"Hysteroscopy dx sep proc","code_information":[{"code":"58555","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3094.12,"maximum":7726.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3094.12,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3156.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3125.06,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3186.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7726.02,"additional_payer_notes":"APC"}]}]},{"description":"Hysteroscopy biopsy","code_information":[{"code":"58558","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3094.12,"maximum":7726.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3094.12,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3156.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3125.06,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3186.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7726.02,"additional_payer_notes":"APC"}]}]},{"description":"Hysteroscopy remove fb","code_information":[{"code":"58562","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3094.12,"maximum":7726.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3094.12,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3156.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3125.06,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3186.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7726.02,"additional_payer_notes":"APC"}]}]},{"description":"Division of fallopian tube","code_information":[{"code":"58600","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3094.12,"maximum":7726.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3094.12,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3156.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3125.06,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3186.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7726.02,"additional_payer_notes":"APC"}]}]},{"description":"Occlude fallopian tube(s)","code_information":[{"code":"58615","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3094.12,"maximum":7726.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3094.12,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3156.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3125.06,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3186.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7726.02,"additional_payer_notes":"APC"}]}]},{"description":"Create new tubal opening","code_information":[{"code":"58770","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3094.12,"maximum":7726.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3094.12,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3156.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3125.06,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3186.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7726.02,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of ovarian cyst(s)","code_information":[{"code":"58800","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3094.12,"maximum":7726.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3094.12,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3156.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3125.06,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3186.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7726.02,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of ovarian cyst(s)","code_information":[{"code":"58805","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3094.12,"maximum":7726.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3094.12,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3156.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3125.06,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3186.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7726.02,"additional_payer_notes":"APC"}]}]},{"description":"Drain ovary abscess open","code_information":[{"code":"58820","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3094.12,"maximum":7726.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3094.12,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3156.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3125.06,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3186.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7726.02,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy of ovary(s)","code_information":[{"code":"58900","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3094.12,"maximum":7726.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3094.12,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3156.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3125.06,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3186.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7726.02,"additional_payer_notes":"APC"}]}]},{"description":"D & c after delivery","code_information":[{"code":"59160","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3094.12,"maximum":7726.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3094.12,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3156.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3125.06,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3186.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7726.02,"additional_payer_notes":"APC"}]}]},{"description":"Episiotomy or vaginal repair","code_information":[{"code":"59300","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3094.12,"maximum":7726.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3094.12,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3156.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3125.06,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3186.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7726.02,"additional_payer_notes":"APC"}]}]},{"description":"Revision of cervix","code_information":[{"code":"59320","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3094.12,"maximum":7726.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3094.12,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3156.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3125.06,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3186.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7726.02,"additional_payer_notes":"APC"}]}]},{"description":"Obstetrical care","code_information":[{"code":"59409","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3094.12,"maximum":7726.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3094.12,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3156.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3125.06,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3186.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7726.02,"additional_payer_notes":"APC"}]}]},{"description":"Antepartum manipulation","code_information":[{"code":"59412","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3094.12,"maximum":7726.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3094.12,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3156.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3125.06,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3186.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7726.02,"additional_payer_notes":"APC"}]}]},{"description":"Deliver placenta","code_information":[{"code":"59414","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3094.12,"maximum":7726.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3094.12,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3156.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3125.06,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3186.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7726.02,"additional_payer_notes":"APC"}]}]},{"description":"Vbac delivery only","code_information":[{"code":"59612","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3094.12,"maximum":7726.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3094.12,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3156.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3125.06,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3186.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7726.02,"additional_payer_notes":"APC"}]}]},{"description":"Treatment of miscarriage","code_information":[{"code":"59812","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3094.12,"maximum":7726.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3094.12,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3156.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3125.06,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3186.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7726.02,"additional_payer_notes":"APC"}]}]},{"description":"Care of miscarriage","code_information":[{"code":"59820","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3094.12,"maximum":7726.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3094.12,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3156.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3125.06,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3186.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7726.02,"additional_payer_notes":"APC"}]}]},{"description":"Treatment of miscarriage","code_information":[{"code":"59821","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3094.12,"maximum":7726.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3094.12,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3156.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3125.06,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3186.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7726.02,"additional_payer_notes":"APC"}]}]},{"description":"Abortion","code_information":[{"code":"59840","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3094.12,"maximum":7726.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3094.12,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3156.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3125.06,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3186.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7726.02,"additional_payer_notes":"APC"}]}]},{"description":"Abortion","code_information":[{"code":"59841","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3094.12,"maximum":7726.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3094.12,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3156.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3125.06,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3186.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7726.02,"additional_payer_notes":"APC"}]}]},{"description":"Evacuate mole of uterus","code_information":[{"code":"59870","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3094.12,"maximum":7726.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3094.12,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3156.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3125.06,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3186.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7726.02,"additional_payer_notes":"APC"}]}]},{"description":"Remove cerclage suture","code_information":[{"code":"59871","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3094.12,"maximum":7726.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3094.12,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3156.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3125.06,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3186.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7726.02,"additional_payer_notes":"APC"}]}]},{"description":"Attach bladder/urethra","code_information":[{"code":"51840","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4781.46,"maximum":11939.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4781.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4877.09,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4829.27,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4924.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":11939.31,"additional_payer_notes":"APC"}]}]},{"description":"Repair bladder neck","code_information":[{"code":"51845","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4781.46,"maximum":11939.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4781.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4877.09,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4829.27,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4924.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":11939.31,"additional_payer_notes":"APC"}]}]},{"description":"Place needles pelvic for rt","code_information":[{"code":"55920","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4781.46,"maximum":11939.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4781.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4877.09,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4829.27,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4924.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":11939.31,"additional_payer_notes":"APC"}]}]},{"description":"Sex transformation m to f","code_information":[{"code":"55970","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4781.46,"maximum":11939.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4781.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4877.09,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4829.27,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4924.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":11939.31,"additional_payer_notes":"APC"}]}]},{"description":"Extensive vulva surgery","code_information":[{"code":"56630","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4781.46,"maximum":11939.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4781.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4877.09,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4829.27,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4924.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":11939.31,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of pelvic fluid","code_information":[{"code":"57020","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4781.46,"maximum":11939.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4781.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4877.09,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4829.27,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4924.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":11939.31,"additional_payer_notes":"APC"}]}]},{"description":"Closure of vagina","code_information":[{"code":"57120","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4781.46,"maximum":11939.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4781.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4877.09,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4829.27,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4924.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":11939.31,"additional_payer_notes":"APC"}]}]},{"description":"Insert uteri tandem/ovoids","code_information":[{"code":"57155","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4781.46,"maximum":11939.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4781.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4877.09,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4829.27,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4924.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":11939.31,"additional_payer_notes":"APC"}]}]},{"description":"Revision of urethra","code_information":[{"code":"57220","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4781.46,"maximum":11939.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4781.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4877.09,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4829.27,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4924.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":11939.31,"additional_payer_notes":"APC"}]}]},{"description":"Repair bladder & vagina","code_information":[{"code":"57240","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4781.46,"maximum":11939.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4781.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4877.09,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4829.27,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4924.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":11939.31,"additional_payer_notes":"APC"}]}]},{"description":"Repair rectum & vagina","code_information":[{"code":"57250","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4781.46,"maximum":11939.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4781.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4877.09,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4829.27,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4924.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":11939.31,"additional_payer_notes":"APC"}]}]},{"description":"Repair of vagina","code_information":[{"code":"57260","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4781.46,"maximum":11939.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4781.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4877.09,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4829.27,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4924.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":11939.31,"additional_payer_notes":"APC"}]}]},{"description":"Extensive repair of vagina","code_information":[{"code":"57265","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4781.46,"maximum":11939.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4781.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4877.09,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4829.27,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4924.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":11939.31,"additional_payer_notes":"APC"}]}]},{"description":"Repair of bowel bulge","code_information":[{"code":"57268","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4781.46,"maximum":11939.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4781.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4877.09,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4829.27,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4924.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":11939.31,"additional_payer_notes":"APC"}]}]},{"description":"Repair paravag defect open","code_information":[{"code":"57284","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4781.46,"maximum":11939.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4781.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4877.09,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4829.27,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4924.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":11939.31,"additional_payer_notes":"APC"}]}]},{"description":"Repair bladder defect","code_information":[{"code":"57288","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4781.46,"maximum":11939.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4781.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4877.09,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4829.27,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4924.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":11939.31,"additional_payer_notes":"APC"}]}]},{"description":"Construction of vagina","code_information":[{"code":"57291","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4781.46,"maximum":11939.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4781.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4877.09,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4829.27,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4924.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":11939.31,"additional_payer_notes":"APC"}]}]},{"description":"Construct vagina with graft","code_information":[{"code":"57292","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4781.46,"maximum":11939.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4781.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4877.09,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4829.27,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4924.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":11939.31,"additional_payer_notes":"APC"}]}]},{"description":"Repair bladder-vagina lesion","code_information":[{"code":"57320","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4781.46,"maximum":11939.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4781.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4877.09,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4829.27,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4924.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":11939.31,"additional_payer_notes":"APC"}]}]},{"description":"Repair vagina","code_information":[{"code":"57335","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4781.46,"maximum":11939.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4781.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4877.09,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4829.27,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4924.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":11939.31,"additional_payer_notes":"APC"}]}]},{"description":"Removal of cervix","code_information":[{"code":"57530","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4781.46,"maximum":11939.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4781.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4877.09,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4829.27,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4924.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":11939.31,"additional_payer_notes":"APC"}]}]},{"description":"Removal of residual cervix","code_information":[{"code":"57550","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4781.46,"maximum":11939.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4781.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4877.09,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4829.27,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4924.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":11939.31,"additional_payer_notes":"APC"}]}]},{"description":"Remove cervix/repair vagina","code_information":[{"code":"57555","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4781.46,"maximum":11939.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4781.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4877.09,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4829.27,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4924.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":11939.31,"additional_payer_notes":"APC"}]}]},{"description":"Remove cervix repair bowel","code_information":[{"code":"57556","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4781.46,"maximum":11939.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4781.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4877.09,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4829.27,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4924.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":11939.31,"additional_payer_notes":"APC"}]}]},{"description":"Vaginal hysterectomy","code_information":[{"code":"58260","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4781.46,"maximum":11939.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4781.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4877.09,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4829.27,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4924.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":11939.31,"additional_payer_notes":"APC"}]}]},{"description":"Vag hyst including t/o","code_information":[{"code":"58262","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4781.46,"maximum":11939.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4781.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4877.09,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4829.27,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4924.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":11939.31,"additional_payer_notes":"APC"}]}]},{"description":"Vag hyst w/t/o & vag repair","code_information":[{"code":"58263","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4781.46,"maximum":11939.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4781.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4877.09,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4829.27,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4924.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":11939.31,"additional_payer_notes":"APC"}]}]},{"description":"Vag hyst w/enterocele repair","code_information":[{"code":"58270","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4781.46,"maximum":11939.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4781.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4877.09,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4829.27,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4924.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":11939.31,"additional_payer_notes":"APC"}]}]},{"description":"Vag hyst incl t/o complex","code_information":[{"code":"58291","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4781.46,"maximum":11939.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4781.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4877.09,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4829.27,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4924.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":11939.31,"additional_payer_notes":"APC"}]}]},{"description":"Vag hyst w/enterocele compl","code_information":[{"code":"58294","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4781.46,"maximum":11939.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4781.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4877.09,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4829.27,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4924.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":11939.31,"additional_payer_notes":"APC"}]}]},{"description":"Insert heyman uteri capsule","code_information":[{"code":"58346","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4781.46,"maximum":11939.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4781.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4877.09,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4829.27,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4924.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":11939.31,"additional_payer_notes":"APC"}]}]},{"description":"Reopen fallopian tube","code_information":[{"code":"58350","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4781.46,"maximum":11939.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4781.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4877.09,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4829.27,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4924.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":11939.31,"additional_payer_notes":"APC"}]}]},{"description":"Endometr ablate thermal","code_information":[{"code":"58353","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4781.46,"maximum":11939.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4781.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4877.09,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4829.27,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4924.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":11939.31,"additional_payer_notes":"APC"}]}]},{"description":"Endometrial cryoablation","code_information":[{"code":"58356","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4781.46,"maximum":11939.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4781.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4877.09,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4829.27,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4924.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":11939.31,"additional_payer_notes":"APC"}]}]},{"description":"Hysteroscopy lysis","code_information":[{"code":"58559","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4781.46,"maximum":11939.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4781.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4877.09,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4829.27,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4924.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":11939.31,"additional_payer_notes":"APC"}]}]},{"description":"Hysteroscopy resect septum","code_information":[{"code":"58560","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4781.46,"maximum":11939.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4781.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4877.09,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4829.27,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4924.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":11939.31,"additional_payer_notes":"APC"}]}]},{"description":"Hysteroscopy remove myoma","code_information":[{"code":"58561","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4781.46,"maximum":11939.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4781.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4877.09,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4829.27,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4924.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":11939.31,"additional_payer_notes":"APC"}]}]},{"description":"Hysteroscopy ablation","code_information":[{"code":"58563","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4781.46,"maximum":11939.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4781.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4877.09,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4829.27,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4924.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":11939.31,"additional_payer_notes":"APC"}]}]},{"description":"Hysteroscopy sterilization","code_information":[{"code":"58565","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4781.46,"maximum":11939.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4781.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4877.09,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4829.27,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4924.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":11939.31,"additional_payer_notes":"APC"}]}]},{"description":"Removal of ovarian cyst(s)","code_information":[{"code":"58925","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4781.46,"maximum":11939.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4781.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4877.09,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4829.27,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4924.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":11939.31,"additional_payer_notes":"APC"}]}]},{"description":"Remove uterus lesion","code_information":[{"code":"59100","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4781.46,"maximum":11939.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4781.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4877.09,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4829.27,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4924.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":11939.31,"additional_payer_notes":"APC"}]}]},{"description":"Colpopexy, min/inv, ex-perit","code_information":[{"code":"C9778","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4781.46,"maximum":11939.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4781.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4877.09,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4829.27,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4924.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":11939.31,"additional_payer_notes":"APC"}]}]},{"description":"Colpopexy extraperitoneal","code_information":[{"code":"57282","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7087.85,"maximum":17698.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7087.85,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7229.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7300.48,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17698.36,"additional_payer_notes":"APC"}]}]},{"description":"Colpopexy intraperitoneal","code_information":[{"code":"57283","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7087.85,"maximum":17698.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7087.85,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7229.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7300.48,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17698.36,"additional_payer_notes":"APC"}]}]},{"description":"Repair paravag defect vag","code_information":[{"code":"57285","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7087.85,"maximum":17698.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7087.85,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7229.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7300.48,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17698.36,"additional_payer_notes":"APC"}]}]},{"description":"Repair bladder & vagina","code_information":[{"code":"57289","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7087.85,"maximum":17698.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7087.85,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7229.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7300.48,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17698.36,"additional_payer_notes":"APC"}]}]},{"description":"Repair urethrovaginal lesion","code_information":[{"code":"57310","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7087.85,"maximum":17698.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7087.85,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7229.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7300.48,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17698.36,"additional_payer_notes":"APC"}]}]},{"description":"Repair bladder-vagina lesion","code_information":[{"code":"57330","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7087.85,"maximum":17698.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7087.85,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7229.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7300.48,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17698.36,"additional_payer_notes":"APC"}]}]},{"description":"Revise prosth vag graft lap","code_information":[{"code":"57426","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7087.85,"maximum":17698.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7087.85,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7229.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7300.48,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17698.36,"additional_payer_notes":"APC"}]}]},{"description":"Vag hyst complex","code_information":[{"code":"58290","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7087.85,"maximum":17698.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7087.85,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7229.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7300.48,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17698.36,"additional_payer_notes":"APC"}]}]},{"description":"Vag hyst t/o & repair compl","code_information":[{"code":"58292","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7087.85,"maximum":17698.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7087.85,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7229.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7300.48,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17698.36,"additional_payer_notes":"APC"}]}]},{"description":"Transcrv abltj utrn fibrd rf","code_information":[{"code":"58580","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7087.85,"maximum":17698.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7087.85,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7229.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7300.48,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17698.36,"additional_payer_notes":"APC"}]}]},{"description":"Partial removal of ovary(s)","code_information":[{"code":"58920","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7087.85,"maximum":17698.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7087.85,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7229.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7158.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7300.48,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17698.36,"additional_payer_notes":"APC"}]}]},{"description":"Abltj perc uxtr/perph nrv","code_information":[{"code":"0440T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1866.46,"maximum":4660.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1866.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1903.79,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1885.13,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1922.45,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4660.55,"additional_payer_notes":"APC"}]}]},{"description":"Abltj perc lxtr/perph nrv","code_information":[{"code":"0441T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1866.46,"maximum":4660.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1866.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1903.79,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1885.13,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1922.45,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4660.55,"additional_payer_notes":"APC"}]}]},{"description":"Neurectomy hamstring","code_information":[{"code":"27325","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1866.46,"maximum":4660.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1866.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1903.79,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1885.13,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1922.45,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4660.55,"additional_payer_notes":"APC"}]}]},{"description":"Neurectomy popliteal","code_information":[{"code":"27326","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1866.46,"maximum":4660.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1866.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1903.79,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1885.13,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1922.45,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4660.55,"additional_payer_notes":"APC"}]}]},{"description":"Decompression of tibia nerve","code_information":[{"code":"28035","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1866.46,"maximum":4660.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1866.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1903.79,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1885.13,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1922.45,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4660.55,"additional_payer_notes":"APC"}]}]},{"description":"Neurectomy foot","code_information":[{"code":"28055","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1866.46,"maximum":4660.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1866.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1903.79,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1885.13,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1922.45,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4660.55,"additional_payer_notes":"APC"}]}]},{"description":"Treat trigeminal nerve","code_information":[{"code":"61790","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1866.46,"maximum":4660.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1866.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1903.79,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1885.13,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1922.45,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4660.55,"additional_payer_notes":"APC"}]}]},{"description":"Treat trigeminal tract","code_information":[{"code":"61791","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1866.46,"maximum":4660.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1866.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1903.79,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1885.13,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1922.45,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4660.55,"additional_payer_notes":"APC"}]}]},{"description":"Replace/irrigate catheter","code_information":[{"code":"62194","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1866.46,"maximum":4660.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1866.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1903.79,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1885.13,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1922.45,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4660.55,"additional_payer_notes":"APC"}]}]},{"description":"Percutaneous diskectomy","code_information":[{"code":"62287","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1866.46,"maximum":4660.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1866.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1903.79,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1885.13,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1922.45,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4660.55,"additional_payer_notes":"APC"}]}]},{"description":"Injection into disk lesion","code_information":[{"code":"62292","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1866.46,"maximum":4660.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1866.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1903.79,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1885.13,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1922.45,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4660.55,"additional_payer_notes":"APC"}]}]},{"description":"Remove spinal canal catheter","code_information":[{"code":"62355","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1866.46,"maximum":4660.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1866.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1903.79,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1885.13,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1922.45,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4660.55,"additional_payer_notes":"APC"}]}]},{"description":"Remove spinal cord lesion","code_information":[{"code":"63600","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1866.46,"maximum":4660.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1866.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1903.79,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1885.13,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1922.45,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4660.55,"additional_payer_notes":"APC"}]}]},{"description":"Stimulation of spinal cord","code_information":[{"code":"63610","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1866.46,"maximum":4660.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1866.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1903.79,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1885.13,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1922.45,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4660.55,"additional_payer_notes":"APC"}]}]},{"description":"Remove spine eltrd perq aray","code_information":[{"code":"63661","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1866.46,"maximum":4660.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1866.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1903.79,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1885.13,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1922.45,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4660.55,"additional_payer_notes":"APC"}]}]},{"description":"Removal of spinal shunt","code_information":[{"code":"63746","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1866.46,"maximum":4660.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1866.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1903.79,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1885.13,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1922.45,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4660.55,"additional_payer_notes":"APC"}]}]},{"description":"Injection treatment of nerve","code_information":[{"code":"64605","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1866.46,"maximum":4660.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1866.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1903.79,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1885.13,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1922.45,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4660.55,"additional_payer_notes":"APC"}]}]},{"description":"Injection treatment of nerve","code_information":[{"code":"64610","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1866.46,"maximum":4660.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1866.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1903.79,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1885.13,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1922.45,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4660.55,"additional_payer_notes":"APC"}]}]},{"description":"Dstrj nulyt agt gnclr nrv","code_information":[{"code":"64624","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1866.46,"maximum":4660.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1866.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1903.79,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1885.13,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1922.45,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4660.55,"additional_payer_notes":"APC"}]}]},{"description":"Rf abltj nrv nrvtg si jt","code_information":[{"code":"64625","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1866.46,"maximum":4660.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1866.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1903.79,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1885.13,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1922.45,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4660.55,"additional_payer_notes":"APC"}]}]},{"description":"Destroy cerv/thor facet jnt","code_information":[{"code":"64633","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1866.46,"maximum":4660.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1866.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1903.79,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1885.13,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1922.45,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4660.55,"additional_payer_notes":"APC"}]}]},{"description":"Destroy lumb/sac facet jnt","code_information":[{"code":"64635","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1866.46,"maximum":4660.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1866.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1903.79,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1885.13,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1922.45,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4660.55,"additional_payer_notes":"APC"}]}]},{"description":"Revise finger/toe nerve","code_information":[{"code":"64702","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1866.46,"maximum":4660.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1866.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1903.79,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1885.13,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1922.45,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4660.55,"additional_payer_notes":"APC"}]}]},{"description":"Revise hand/foot nerve","code_information":[{"code":"64704","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1866.46,"maximum":4660.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1866.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1903.79,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1885.13,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1922.45,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4660.55,"additional_payer_notes":"APC"}]}]},{"description":"Revise arm/leg nerve","code_information":[{"code":"64708","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1866.46,"maximum":4660.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1866.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1903.79,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1885.13,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1922.45,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4660.55,"additional_payer_notes":"APC"}]}]},{"description":"Revision of sciatic nerve","code_information":[{"code":"64712","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1866.46,"maximum":4660.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1866.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1903.79,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1885.13,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1922.45,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4660.55,"additional_payer_notes":"APC"}]}]},{"description":"Revision of arm nerve(s)","code_information":[{"code":"64713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1866.46,"maximum":4660.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1866.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1903.79,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1885.13,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1922.45,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4660.55,"additional_payer_notes":"APC"}]}]},{"description":"Revise low back nerve(s)","code_information":[{"code":"64714","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1866.46,"maximum":4660.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1866.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1903.79,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1885.13,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1922.45,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4660.55,"additional_payer_notes":"APC"}]}]},{"description":"Revision of cranial nerve","code_information":[{"code":"64716","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1866.46,"maximum":4660.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1866.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1903.79,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1885.13,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1922.45,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4660.55,"additional_payer_notes":"APC"}]}]},{"description":"Revise ulnar nerve at elbow","code_information":[{"code":"64718","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1866.46,"maximum":4660.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1866.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1903.79,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1885.13,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1922.45,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4660.55,"additional_payer_notes":"APC"}]}]},{"description":"Revise ulnar nerve at wrist","code_information":[{"code":"64719","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1866.46,"maximum":4660.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1866.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1903.79,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1885.13,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1922.45,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4660.55,"additional_payer_notes":"APC"}]}]},{"description":"Carpal tunnel surgery","code_information":[{"code":"64721","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1866.46,"maximum":4660.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1866.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1903.79,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1885.13,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1922.45,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4660.55,"additional_payer_notes":"APC"}]}]},{"description":"Relieve pressure on nerve(s)","code_information":[{"code":"64722","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1866.46,"maximum":4660.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1866.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1903.79,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1885.13,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1922.45,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4660.55,"additional_payer_notes":"APC"}]}]},{"description":"Release foot/toe nerve","code_information":[{"code":"64726","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1866.46,"maximum":4660.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1866.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1903.79,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1885.13,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1922.45,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4660.55,"additional_payer_notes":"APC"}]}]},{"description":"Dcmprn median nrv carpl tunl","code_information":[{"code":"64728","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1866.46,"maximum":4660.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1866.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1903.79,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1885.13,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1922.45,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4660.55,"additional_payer_notes":"APC"}]}]},{"description":"Incision of brow nerve","code_information":[{"code":"64732","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1866.46,"maximum":4660.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1866.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1903.79,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1885.13,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1922.45,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4660.55,"additional_payer_notes":"APC"}]}]},{"description":"Incision of cheek nerve","code_information":[{"code":"64734","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1866.46,"maximum":4660.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1866.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1903.79,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1885.13,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1922.45,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4660.55,"additional_payer_notes":"APC"}]}]},{"description":"Incision of chin nerve","code_information":[{"code":"64736","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1866.46,"maximum":4660.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1866.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1903.79,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1885.13,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1922.45,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4660.55,"additional_payer_notes":"APC"}]}]},{"description":"Incision of jaw nerve","code_information":[{"code":"64738","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1866.46,"maximum":4660.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1866.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1903.79,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1885.13,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1922.45,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4660.55,"additional_payer_notes":"APC"}]}]},{"description":"Incision of tongue nerve","code_information":[{"code":"64740","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1866.46,"maximum":4660.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1866.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1903.79,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1885.13,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1922.45,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4660.55,"additional_payer_notes":"APC"}]}]},{"description":"Incision of facial nerve","code_information":[{"code":"64742","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1866.46,"maximum":4660.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1866.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1903.79,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1885.13,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1922.45,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4660.55,"additional_payer_notes":"APC"}]}]},{"description":"Incise nerve back of head","code_information":[{"code":"64744","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1866.46,"maximum":4660.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1866.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1903.79,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1885.13,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1922.45,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4660.55,"additional_payer_notes":"APC"}]}]},{"description":"Incise diaphragm nerve","code_information":[{"code":"64746","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1866.46,"maximum":4660.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1866.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1903.79,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1885.13,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1922.45,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4660.55,"additional_payer_notes":"APC"}]}]},{"description":"Incise hip/thigh nerve","code_information":[{"code":"64763","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1866.46,"maximum":4660.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1866.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1903.79,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1885.13,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1922.45,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4660.55,"additional_payer_notes":"APC"}]}]},{"description":"Incise hip/thigh nerve","code_information":[{"code":"64766","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1866.46,"maximum":4660.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1866.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1903.79,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1885.13,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1922.45,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4660.55,"additional_payer_notes":"APC"}]}]},{"description":"Sever cranial nerve","code_information":[{"code":"64771","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1866.46,"maximum":4660.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1866.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1903.79,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1885.13,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1922.45,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4660.55,"additional_payer_notes":"APC"}]}]},{"description":"Incision of spinal nerve","code_information":[{"code":"64772","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1866.46,"maximum":4660.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1866.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1903.79,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1885.13,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1922.45,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4660.55,"additional_payer_notes":"APC"}]}]},{"description":"Remove skin nerve lesion","code_information":[{"code":"64774","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1866.46,"maximum":4660.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1866.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1903.79,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1885.13,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1922.45,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4660.55,"additional_payer_notes":"APC"}]}]},{"description":"Remove digit nerve lesion","code_information":[{"code":"64776","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1866.46,"maximum":4660.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1866.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1903.79,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1885.13,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1922.45,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4660.55,"additional_payer_notes":"APC"}]}]},{"description":"Remove limb nerve lesion","code_information":[{"code":"64782","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1866.46,"maximum":4660.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1866.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1903.79,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1885.13,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1922.45,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4660.55,"additional_payer_notes":"APC"}]}]},{"description":"Remove nerve lesion","code_information":[{"code":"64784","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1866.46,"maximum":4660.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1866.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1903.79,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1885.13,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1922.45,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4660.55,"additional_payer_notes":"APC"}]}]},{"description":"Remove skin nerve lesion","code_information":[{"code":"64788","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1866.46,"maximum":4660.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1866.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1903.79,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1885.13,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1922.45,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4660.55,"additional_payer_notes":"APC"}]}]},{"description":"Removal of nerve lesion","code_information":[{"code":"64790","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1866.46,"maximum":4660.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1866.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1903.79,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1885.13,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1922.45,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4660.55,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy of nerve","code_information":[{"code":"64795","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1866.46,"maximum":4660.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1866.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1903.79,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1885.13,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1922.45,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4660.55,"additional_payer_notes":"APC"}]}]},{"description":"Sympathectomy cervical","code_information":[{"code":"64802","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1866.46,"maximum":4660.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1866.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1903.79,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1885.13,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1922.45,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4660.55,"additional_payer_notes":"APC"}]}]},{"description":"Remove sympathetic nerves","code_information":[{"code":"64804","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1866.46,"maximum":4660.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1866.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1903.79,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1885.13,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1922.45,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4660.55,"additional_payer_notes":"APC"}]}]},{"description":"Sympathectomy digital artery","code_information":[{"code":"64820","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1866.46,"maximum":4660.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1866.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1903.79,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1885.13,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1922.45,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4660.55,"additional_payer_notes":"APC"}]}]},{"description":"Repair of digit nerve","code_information":[{"code":"64831","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1866.46,"maximum":4660.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1866.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1903.79,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1885.13,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1922.45,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4660.55,"additional_payer_notes":"APC"}]}]},{"description":"Repair sciatic nerve","code_information":[{"code":"64858","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1866.46,"maximum":4660.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1866.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1903.79,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1885.13,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1922.45,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4660.55,"additional_payer_notes":"APC"}]}]},{"description":"Repair of arm nerves","code_information":[{"code":"64861","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1866.46,"maximum":4660.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1866.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1903.79,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1885.13,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1922.45,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4660.55,"additional_payer_notes":"APC"}]}]},{"description":"Discography cerv/thor spine","code_information":[{"code":"72285","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1866.46,"maximum":4660.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1866.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1903.79,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1885.13,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1922.45,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4660.55,"additional_payer_notes":"APC"}]}]},{"description":"X-ray of lower spine disk","code_information":[{"code":"72295","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1866.46,"maximum":4660.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1866.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1903.79,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1885.13,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1922.45,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4660.55,"additional_payer_notes":"APC"}]}]},{"description":"Ther injection carp tunnel","code_information":[{"code":"20526","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":293.39,"maximum":732.60,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":293.39,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":299.26,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":296.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":302.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":732.6,"additional_payer_notes":"APC"}]}]},{"description":"Inj dupuytren cord w/enzyme","code_information":[{"code":"20527","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":293.39,"maximum":732.60,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":293.39,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":299.26,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":296.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":302.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":732.6,"additional_payer_notes":"APC"}]}]},{"description":"Inj tendon sheath/ligament","code_information":[{"code":"20550","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":293.39,"maximum":732.60,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":293.39,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":299.26,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":296.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":302.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":732.6,"additional_payer_notes":"APC"}]}]},{"description":"Inj tendon origin/insertion","code_information":[{"code":"20551","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":293.39,"maximum":732.60,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":293.39,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":299.26,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":296.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":302.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":732.6,"additional_payer_notes":"APC"}]}]},{"description":"Inj trigger point 1/2 muscl","code_information":[{"code":"20552","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":293.39,"maximum":732.60,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":293.39,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":299.26,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":296.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":302.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":732.6,"additional_payer_notes":"APC"}]}]},{"description":"Inject trigger points 3/>","code_information":[{"code":"20553","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":293.39,"maximum":732.60,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":293.39,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":299.26,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":296.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":302.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":732.6,"additional_payer_notes":"APC"}]}]},{"description":"Drain/inj joint/bursa w/o us","code_information":[{"code":"20600","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":293.39,"maximum":732.60,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":293.39,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":299.26,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":296.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":302.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":732.6,"additional_payer_notes":"APC"}]}]},{"description":"Drain/inj joint/bursa w/us","code_information":[{"code":"20604","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":293.39,"maximum":732.60,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":293.39,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":299.26,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":296.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":302.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":732.6,"additional_payer_notes":"APC"}]}]},{"description":"Drain/inj joint/bursa w/o us","code_information":[{"code":"20605","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":293.39,"maximum":732.60,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":293.39,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":299.26,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":296.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":302.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":732.6,"additional_payer_notes":"APC"}]}]},{"description":"Drain/inj joint/bursa w/o us","code_information":[{"code":"20610","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":293.39,"maximum":732.60,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":293.39,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":299.26,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":296.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":302.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":732.6,"additional_payer_notes":"APC"}]}]},{"description":"Drain/inj joint/bursa w/us","code_information":[{"code":"20611","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":293.39,"maximum":732.60,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":293.39,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":299.26,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":296.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":302.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":732.6,"additional_payer_notes":"APC"}]}]},{"description":"Aspirate/inj ganglion cyst","code_information":[{"code":"20612","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":293.39,"maximum":732.60,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":293.39,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":299.26,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":296.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":302.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":732.6,"additional_payer_notes":"APC"}]}]},{"description":"Remove brain canal fluid","code_information":[{"code":"61050","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":293.39,"maximum":732.60,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":293.39,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":299.26,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":296.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":302.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":732.6,"additional_payer_notes":"APC"}]}]},{"description":"Injection into brain canal","code_information":[{"code":"61055","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":293.39,"maximum":732.60,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":293.39,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":299.26,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":296.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":302.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":732.6,"additional_payer_notes":"APC"}]}]},{"description":"N block inj trigeminal","code_information":[{"code":"64400","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":293.39,"maximum":732.60,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":293.39,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":299.26,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":296.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":302.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":732.6,"additional_payer_notes":"APC"}]}]},{"description":"N block inj occipital","code_information":[{"code":"64405","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":293.39,"maximum":732.60,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":293.39,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":299.26,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":296.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":302.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":732.6,"additional_payer_notes":"APC"}]}]},{"description":"N block inj vagus","code_information":[{"code":"64408","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":293.39,"maximum":732.60,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":293.39,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":299.26,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":296.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":302.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":732.6,"additional_payer_notes":"APC"}]}]},{"description":"N block inj plantar digit","code_information":[{"code":"64455","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":293.39,"maximum":732.60,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":293.39,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":299.26,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":296.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":302.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":732.6,"additional_payer_notes":"APC"}]}]},{"description":"N block spenopalatine gangl","code_information":[{"code":"64505","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":293.39,"maximum":732.60,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":293.39,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":299.26,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":296.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":302.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":732.6,"additional_payer_notes":"APC"}]}]},{"description":"Neuroeltrd stim post tibial","code_information":[{"code":"64566","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":293.39,"maximum":732.60,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":293.39,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":299.26,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":296.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":302.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":732.6,"additional_payer_notes":"APC"}]}]},{"description":"Chemodenerv saliv glands","code_information":[{"code":"64611","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":293.39,"maximum":732.60,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":293.39,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":299.26,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":296.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":302.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":732.6,"additional_payer_notes":"APC"}]}]},{"description":"Destroy nerve face muscle","code_information":[{"code":"64612","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":293.39,"maximum":732.60,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":293.39,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":299.26,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":296.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":302.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":732.6,"additional_payer_notes":"APC"}]}]},{"description":"Chemodenerv musc migraine","code_information":[{"code":"64615","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":293.39,"maximum":732.60,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":293.39,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":299.26,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":296.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":302.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":732.6,"additional_payer_notes":"APC"}]}]},{"description":"Chemodenerv musc neck dyston","code_information":[{"code":"64616","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":293.39,"maximum":732.60,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":293.39,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":299.26,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":296.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":302.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":732.6,"additional_payer_notes":"APC"}]}]},{"description":"N block inj common digit","code_information":[{"code":"64632","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":293.39,"maximum":732.60,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":293.39,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":299.26,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":296.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":302.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":732.6,"additional_payer_notes":"APC"}]}]},{"description":"Chemodenerv eccrine glands","code_information":[{"code":"64650","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":293.39,"maximum":732.60,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":293.39,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":299.26,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":296.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":302.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":732.6,"additional_payer_notes":"APC"}]}]},{"description":"Chemodenerv eccrine glands","code_information":[{"code":"64653","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":293.39,"maximum":732.60,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":293.39,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":299.26,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":296.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":302.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":732.6,"additional_payer_notes":"APC"}]}]},{"description":"Nervous system surgery","code_information":[{"code":"64999","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":293.39,"maximum":732.60,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":293.39,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":299.26,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":296.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":302.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":732.6,"additional_payer_notes":"APC"}]}]},{"description":"Spin/brain pump refil & main","code_information":[{"code":"95991","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":293.39,"maximum":732.60,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":293.39,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":299.26,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":296.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":302.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":732.6,"additional_payer_notes":"APC"}]}]},{"description":"Drain/inj joint/bursa w/us","code_information":[{"code":"20606","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":674.70,"maximum":1684.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":674.7,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":688.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":681.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":694.94,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1684.72,"additional_payer_notes":"APC"}]}]},{"description":"Remove cranial cavity fluid","code_information":[{"code":"61000","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":674.70,"maximum":1684.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":674.7,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":688.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":681.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":694.94,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1684.72,"additional_payer_notes":"APC"}]}]},{"description":"Remove cranial cavity fluid","code_information":[{"code":"61001","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":674.70,"maximum":1684.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":674.7,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":688.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":681.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":694.94,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1684.72,"additional_payer_notes":"APC"}]}]},{"description":"Injection into brain canal","code_information":[{"code":"61026","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":674.70,"maximum":1684.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":674.7,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":688.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":681.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":694.94,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1684.72,"additional_payer_notes":"APC"}]}]},{"description":"Brain canal shunt procedure","code_information":[{"code":"61070","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":674.70,"maximum":1684.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":674.7,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":688.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":681.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":694.94,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1684.72,"additional_payer_notes":"APC"}]}]},{"description":"Spinal fluid tap diagnostic","code_information":[{"code":"62270","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":674.70,"maximum":1684.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":674.7,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":688.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":681.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":694.94,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1684.72,"additional_payer_notes":"APC"}]}]},{"description":"Drain cerebro spinal fluid","code_information":[{"code":"62272","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":674.70,"maximum":1684.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":674.7,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":688.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":681.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":694.94,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1684.72,"additional_payer_notes":"APC"}]}]},{"description":"Inject epidural patch","code_information":[{"code":"62273","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":674.70,"maximum":1684.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":674.7,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":688.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":681.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":694.94,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1684.72,"additional_payer_notes":"APC"}]}]},{"description":"Njx interlaminar crv/thrc","code_information":[{"code":"62320","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":674.70,"maximum":1684.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":674.7,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":688.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":681.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":694.94,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1684.72,"additional_payer_notes":"APC"}]}]},{"description":"Njx interlaminar crv/thrc","code_information":[{"code":"62321","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":674.70,"maximum":1684.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":674.7,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":688.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":681.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":694.94,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1684.72,"additional_payer_notes":"APC"}]}]},{"description":"Njx interlaminar lmbr/sac","code_information":[{"code":"62323","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":674.70,"maximum":1684.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":674.7,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":688.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":681.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":694.94,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1684.72,"additional_payer_notes":"APC"}]}]},{"description":"Dx lmbr spi pnxr w/fluor/ct","code_information":[{"code":"62328","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":674.70,"maximum":1684.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":674.7,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":688.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":681.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":694.94,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1684.72,"additional_payer_notes":"APC"}]}]},{"description":"Ther spi pnxr csf fluor/ct","code_information":[{"code":"62329","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":674.70,"maximum":1684.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":674.7,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":688.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":681.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":694.94,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1684.72,"additional_payer_notes":"APC"}]}]},{"description":"N block inj suprascapular","code_information":[{"code":"64418","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":674.70,"maximum":1684.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":674.7,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":688.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":681.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":694.94,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1684.72,"additional_payer_notes":"APC"}]}]},{"description":"N block inj intercost sng","code_information":[{"code":"64420","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":674.70,"maximum":1684.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":674.7,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":688.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":681.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":694.94,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1684.72,"additional_payer_notes":"APC"}]}]},{"description":"N block inj ilio-ing/hypogi","code_information":[{"code":"64425","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":674.70,"maximum":1684.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":674.7,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":688.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":681.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":694.94,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1684.72,"additional_payer_notes":"APC"}]}]},{"description":"N block inj paracervical","code_information":[{"code":"64435","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":674.70,"maximum":1684.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":674.7,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":688.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":681.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":694.94,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1684.72,"additional_payer_notes":"APC"}]}]},{"description":"N block inj sciatic sng","code_information":[{"code":"64445","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":674.70,"maximum":1684.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":674.7,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":688.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":681.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":694.94,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1684.72,"additional_payer_notes":"APC"}]}]},{"description":"N block inj fem single","code_information":[{"code":"64447","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":674.70,"maximum":1684.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":674.7,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":688.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":681.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":694.94,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1684.72,"additional_payer_notes":"APC"}]}]},{"description":"N block other peripheral","code_information":[{"code":"64450","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":674.70,"maximum":1684.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":674.7,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":688.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":681.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":694.94,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1684.72,"additional_payer_notes":"APC"}]}]},{"description":"Njx aa&/strd nrv nrvtg si jt","code_information":[{"code":"64451","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":674.70,"maximum":1684.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":674.7,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":688.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":681.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":694.94,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1684.72,"additional_payer_notes":"APC"}]}]},{"description":"Njx aa&/strd gnclr nrv brnch","code_information":[{"code":"64454","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":674.70,"maximum":1684.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":674.7,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":688.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":681.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":694.94,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1684.72,"additional_payer_notes":"APC"}]}]},{"description":"Pvb thoracic single inj site","code_information":[{"code":"64461","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":674.70,"maximum":1684.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":674.7,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":688.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":681.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":694.94,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1684.72,"additional_payer_notes":"APC"}]}]},{"description":"Pvb thoracic cont infusion","code_information":[{"code":"64463","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":674.70,"maximum":1684.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":674.7,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":688.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":681.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":694.94,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1684.72,"additional_payer_notes":"APC"}]}]},{"description":"Chemodener muscle larynx emg","code_information":[{"code":"64617","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":674.70,"maximum":1684.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":674.7,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":688.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":681.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":694.94,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1684.72,"additional_payer_notes":"APC"}]}]},{"description":"Chemodenerv 1 extremity 1-4","code_information":[{"code":"64642","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":674.70,"maximum":1684.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":674.7,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":688.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":681.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":694.94,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1684.72,"additional_payer_notes":"APC"}]}]},{"description":"Chemodenerv 1 extrem 5/> mus","code_information":[{"code":"64644","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":674.70,"maximum":1684.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":674.7,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":688.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":681.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":694.94,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1684.72,"additional_payer_notes":"APC"}]}]},{"description":"Chemodenerv trunk musc 1-5","code_information":[{"code":"64646","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":674.70,"maximum":1684.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":674.7,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":688.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":681.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":694.94,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1684.72,"additional_payer_notes":"APC"}]}]},{"description":"Chemodenerv trunk musc 6/>","code_information":[{"code":"64647","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":674.70,"maximum":1684.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":674.7,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":688.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":681.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":694.94,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1684.72,"additional_payer_notes":"APC"}]}]},{"description":"Inj for sacroiliac jt anesth","code_information":[{"code":"G0260","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":674.70,"maximum":1684.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":674.7,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":688.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":681.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":694.94,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1684.72,"additional_payer_notes":"APC"}]}]},{"description":"Njx paravert w/us cer/thor","code_information":[{"code":"0213T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":845.40,"maximum":2110.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":845.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":862.31,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":853.85,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":870.76,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2110.96,"additional_payer_notes":"APC"}]}]},{"description":"Njx paravert w/us lumb/sac","code_information":[{"code":"0216T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":845.40,"maximum":2110.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":845.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":862.31,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":853.85,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":870.76,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2110.96,"additional_payer_notes":"APC"}]}]},{"description":"Remove brain cavity fluid","code_information":[{"code":"61020","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":845.40,"maximum":2110.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":845.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":862.31,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":853.85,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":870.76,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2110.96,"additional_payer_notes":"APC"}]}]},{"description":"Epidural lysis mult sessions","code_information":[{"code":"62263","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":845.40,"maximum":2110.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":845.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":862.31,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":853.85,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":870.76,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2110.96,"additional_payer_notes":"APC"}]}]},{"description":"Epidural lysis on single day","code_information":[{"code":"62264","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":845.40,"maximum":2110.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":845.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":862.31,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":853.85,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":870.76,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2110.96,"additional_payer_notes":"APC"}]}]},{"description":"Drain spinal cord cyst","code_information":[{"code":"62268","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":845.40,"maximum":2110.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":845.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":862.31,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":853.85,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":870.76,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2110.96,"additional_payer_notes":"APC"}]}]},{"description":"Treat spinal cord lesion","code_information":[{"code":"62280","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":845.40,"maximum":2110.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":845.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":862.31,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":853.85,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":870.76,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2110.96,"additional_payer_notes":"APC"}]}]},{"description":"Treat spinal cord lesion","code_information":[{"code":"62281","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":845.40,"maximum":2110.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":845.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":862.31,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":853.85,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":870.76,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2110.96,"additional_payer_notes":"APC"}]}]},{"description":"Treat spinal canal lesion","code_information":[{"code":"62282","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":845.40,"maximum":2110.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":845.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":862.31,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":853.85,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":870.76,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2110.96,"additional_payer_notes":"APC"}]}]},{"description":"Injection into spinal artery","code_information":[{"code":"62294","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":845.40,"maximum":2110.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":845.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":862.31,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":853.85,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":870.76,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2110.96,"additional_payer_notes":"APC"}]}]},{"description":"Njx interlaminar lmbr/sac","code_information":[{"code":"62322","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":845.40,"maximum":2110.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":845.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":862.31,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":853.85,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":870.76,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2110.96,"additional_payer_notes":"APC"}]}]},{"description":"Njx interlaminar crv/thrc","code_information":[{"code":"62324","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":845.40,"maximum":2110.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":845.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":862.31,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":853.85,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":870.76,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2110.96,"additional_payer_notes":"APC"}]}]},{"description":"Njx interlaminar crv/thrc","code_information":[{"code":"62325","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":845.40,"maximum":2110.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":845.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":862.31,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":853.85,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":870.76,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2110.96,"additional_payer_notes":"APC"}]}]},{"description":"Njx interlaminar lmbr/sac","code_information":[{"code":"62326","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":845.40,"maximum":2110.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":845.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":862.31,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":853.85,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":870.76,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2110.96,"additional_payer_notes":"APC"}]}]},{"description":"Njx interlaminar lmbr/sac","code_information":[{"code":"62327","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":845.40,"maximum":2110.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":845.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":862.31,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":853.85,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":870.76,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2110.96,"additional_payer_notes":"APC"}]}]},{"description":"N block inj brachial plexus","code_information":[{"code":"64415","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":845.40,"maximum":2110.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":845.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":862.31,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":853.85,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":870.76,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2110.96,"additional_payer_notes":"APC"}]}]},{"description":"N block cont infuse b plex","code_information":[{"code":"64416","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":845.40,"maximum":2110.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":845.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":862.31,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":853.85,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":870.76,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2110.96,"additional_payer_notes":"APC"}]}]},{"description":"N block inj axillary","code_information":[{"code":"64417","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":845.40,"maximum":2110.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":845.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":862.31,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":853.85,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":870.76,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2110.96,"additional_payer_notes":"APC"}]}]},{"description":"N block inj intercost mlt","code_information":[{"code":"64421","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":845.40,"maximum":2110.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":845.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":862.31,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":853.85,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":870.76,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2110.96,"additional_payer_notes":"APC"}]}]},{"description":"N block inj pudendal","code_information":[{"code":"64430","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":845.40,"maximum":2110.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":845.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":862.31,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":853.85,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":870.76,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2110.96,"additional_payer_notes":"APC"}]}]},{"description":"N blk inj sciatic cont inf","code_information":[{"code":"64446","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":845.40,"maximum":2110.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":845.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":862.31,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":853.85,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":870.76,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2110.96,"additional_payer_notes":"APC"}]}]},{"description":"N block inj fem cont inf","code_information":[{"code":"64448","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":845.40,"maximum":2110.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":845.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":862.31,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":853.85,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":870.76,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2110.96,"additional_payer_notes":"APC"}]}]},{"description":"N block inj lumbar plexus","code_information":[{"code":"64449","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":845.40,"maximum":2110.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":845.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":862.31,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":853.85,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":870.76,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2110.96,"additional_payer_notes":"APC"}]}]},{"description":"Inj foramen epidural c/t","code_information":[{"code":"64479","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":845.40,"maximum":2110.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":845.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":862.31,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":853.85,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":870.76,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2110.96,"additional_payer_notes":"APC"}]}]},{"description":"Inj foramen epidural l/s","code_information":[{"code":"64483","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":845.40,"maximum":2110.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":845.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":862.31,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":853.85,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":870.76,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2110.96,"additional_payer_notes":"APC"}]}]},{"description":"Inj paravert f jnt c/t 1 lev","code_information":[{"code":"64490","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":845.40,"maximum":2110.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":845.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":862.31,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":853.85,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":870.76,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2110.96,"additional_payer_notes":"APC"}]}]},{"description":"Inj paravert f jnt l/s 1 lev","code_information":[{"code":"64493","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":845.40,"maximum":2110.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":845.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":862.31,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":853.85,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":870.76,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2110.96,"additional_payer_notes":"APC"}]}]},{"description":"N block stellate ganglion","code_information":[{"code":"64510","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":845.40,"maximum":2110.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":845.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":862.31,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":853.85,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":870.76,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2110.96,"additional_payer_notes":"APC"}]}]},{"description":"N block inj hypogas plxs","code_information":[{"code":"64517","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":845.40,"maximum":2110.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":845.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":862.31,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":853.85,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":870.76,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2110.96,"additional_payer_notes":"APC"}]}]},{"description":"N block lumbar/thoracic","code_information":[{"code":"64520","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":845.40,"maximum":2110.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":845.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":862.31,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":853.85,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":870.76,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2110.96,"additional_payer_notes":"APC"}]}]},{"description":"N block inj celiac pelus","code_information":[{"code":"64530","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":845.40,"maximum":2110.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":845.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":862.31,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":853.85,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":870.76,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2110.96,"additional_payer_notes":"APC"}]}]},{"description":"Injection treatment of nerve","code_information":[{"code":"64600","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":845.40,"maximum":2110.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":845.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":862.31,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":853.85,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":870.76,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2110.96,"additional_payer_notes":"APC"}]}]},{"description":"Injection treatment of nerve","code_information":[{"code":"64620","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":845.40,"maximum":2110.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":845.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":862.31,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":853.85,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":870.76,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2110.96,"additional_payer_notes":"APC"}]}]},{"description":"Injection treatment of nerve","code_information":[{"code":"64630","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":845.40,"maximum":2110.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":845.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":862.31,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":853.85,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":870.76,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2110.96,"additional_payer_notes":"APC"}]}]},{"description":"Injection treatment of nerve","code_information":[{"code":"64640","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":845.40,"maximum":2110.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":845.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":862.31,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":853.85,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":870.76,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2110.96,"additional_payer_notes":"APC"}]}]},{"description":"Injection treatment of nerve","code_information":[{"code":"64680","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":845.40,"maximum":2110.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":845.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":862.31,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":853.85,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":870.76,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2110.96,"additional_payer_notes":"APC"}]}]},{"description":"Injection treatment of nerve","code_information":[{"code":"64681","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":845.40,"maximum":2110.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":845.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":862.31,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":853.85,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":870.76,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2110.96,"additional_payer_notes":"APC"}]}]},{"description":"Revision/removal isdns ptn","code_information":[{"code":"0588T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3341.66,"maximum":8344.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3341.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3408.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3375.08,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3441.91,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8344.13,"additional_payer_notes":"APC"}]}]},{"description":"Rlcj pulse gen only isdss","code_information":[{"code":"0681T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3341.66,"maximum":8344.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3341.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3408.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3375.08,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3441.91,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8344.13,"additional_payer_notes":"APC"}]}]},{"description":"Removal pulse gen only isdss","code_information":[{"code":"0682T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3341.66,"maximum":8344.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3341.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3408.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3375.08,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3441.91,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8344.13,"additional_payer_notes":"APC"}]}]},{"description":"Revj/rmvl nea spi w/nstim","code_information":[{"code":"0785T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3341.66,"maximum":8344.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3341.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3408.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3375.08,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3441.91,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8344.13,"additional_payer_notes":"APC"}]}]},{"description":"Revj/rmvl nea sac w/nstim","code_information":[{"code":"0787T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3341.66,"maximum":8344.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3341.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3408.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3375.08,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3441.91,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8344.13,"additional_payer_notes":"APC"}]}]},{"description":"Revj/rmvl ins ptn subq","code_information":[{"code":"0818T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3341.66,"maximum":8344.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3341.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3408.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3375.08,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3441.91,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8344.13,"additional_payer_notes":"APC"}]}]},{"description":"Revj/rmvl ins ptn subf","code_information":[{"code":"0819T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3341.66,"maximum":8344.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3341.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3408.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3375.08,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3441.91,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8344.13,"additional_payer_notes":"APC"}]}]},{"description":"Rmvl int nstim sys vagus nrv","code_information":[{"code":"0910T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3341.66,"maximum":8344.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3341.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3408.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3375.08,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3441.91,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8344.13,"additional_payer_notes":"APC"}]}]},{"description":"Revj/rmvl ins ptn subq&subf","code_information":[{"code":"0989T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3341.66,"maximum":8344.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3341.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3408.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3375.08,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3441.91,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8344.13,"additional_payer_notes":"APC"}]}]},{"description":"Rev/rmv lw esoph sphnc npg/r","code_information":[{"code":"1015T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3341.66,"maximum":8344.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3341.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3408.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3375.08,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3441.91,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8344.13,"additional_payer_notes":"APC"}]}]},{"description":"Rmvl phrnc nrv stim sys","code_information":[{"code":"33278","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3341.66,"maximum":8344.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3341.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3408.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3375.08,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3441.91,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8344.13,"additional_payer_notes":"APC"}]}]},{"description":"Rmvl phrnc nrv stim transvns","code_information":[{"code":"33279","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3341.66,"maximum":8344.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3341.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3408.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3375.08,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3441.91,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8344.13,"additional_payer_notes":"APC"}]}]},{"description":"Rmvl phrnc nrv stim pg only","code_information":[{"code":"33280","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3341.66,"maximum":8344.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3341.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3408.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3375.08,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3441.91,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8344.13,"additional_payer_notes":"APC"}]}]},{"description":"Reposg phrnc nrv stim trnsvn","code_information":[{"code":"33281","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3341.66,"maximum":8344.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3341.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3408.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3375.08,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3441.91,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8344.13,"additional_payer_notes":"APC"}]}]},{"description":"Revise/remove neuroelectrode","code_information":[{"code":"61880","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3341.66,"maximum":8344.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3341.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3408.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3375.08,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3441.91,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8344.13,"additional_payer_notes":"APC"}]}]},{"description":"Remove spine eltrd plate","code_information":[{"code":"63662","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3341.66,"maximum":8344.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3341.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3408.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3375.08,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3441.91,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8344.13,"additional_payer_notes":"APC"}]}]},{"description":"Revise/remove neuroreceiver","code_information":[{"code":"63688","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3341.66,"maximum":8344.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3341.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3408.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3375.08,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3441.91,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8344.13,"additional_payer_notes":"APC"}]}]},{"description":"Revise/remove neuroelectrode","code_information":[{"code":"64585","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3341.66,"maximum":8344.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3341.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3408.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3375.08,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3441.91,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8344.13,"additional_payer_notes":"APC"}]}]},{"description":"Revise/rmv pn/gastr stimul","code_information":[{"code":"64595","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3341.66,"maximum":8344.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3341.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3408.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3375.08,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3441.91,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8344.13,"additional_payer_notes":"APC"}]}]},{"description":"Revj/rmvl nea pn w/int nstim","code_information":[{"code":"64598","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3341.66,"maximum":8344.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3341.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3408.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3375.08,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3441.91,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8344.13,"additional_payer_notes":"APC"}]}]},{"description":"Revj/rplcmt bat mod sys lead","code_information":[{"code":"64655","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3341.66,"maximum":8344.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3341.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3408.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3375.08,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3441.91,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8344.13,"additional_payer_notes":"APC"}]}]},{"description":"Rmvl bat modul sys lead only","code_information":[{"code":"64658","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3341.66,"maximum":8344.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3341.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3408.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3375.08,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3441.91,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8344.13,"additional_payer_notes":"APC"}]}]},{"description":"Rmvl bat modulj sys pg only","code_information":[{"code":"64659","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3341.66,"maximum":8344.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3341.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3408.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3375.08,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3441.91,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8344.13,"additional_payer_notes":"APC"}]}]},{"description":"Perq impltj/rplcmt isdns ptn","code_information":[{"code":"0587T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6091.46,"maximum":15210.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6091.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6213.29,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6152.37,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6274.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":15210.37,"additional_payer_notes":"APC"}]}]},{"description":"Implant neuroelectrodes","code_information":[{"code":"63650","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6091.46,"maximum":15210.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6091.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6213.29,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6152.37,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6274.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":15210.37,"additional_payer_notes":"APC"}]}]},{"description":"Revise spine eltrd perq aray","code_information":[{"code":"63663","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6091.46,"maximum":15210.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6091.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6213.29,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6152.37,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6274.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":15210.37,"additional_payer_notes":"APC"}]}]},{"description":"Implant neuroelectrodes","code_information":[{"code":"64555","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6091.46,"maximum":15210.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6091.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6213.29,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6152.37,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6274.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":15210.37,"additional_payer_notes":"APC"}]}]},{"description":"Implant neuroelectrodes","code_information":[{"code":"64561","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6091.46,"maximum":15210.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6091.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6213.29,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6152.37,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6274.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":15210.37,"additional_payer_notes":"APC"}]}]},{"description":"Implant neuroelectrodes","code_information":[{"code":"64581","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6091.46,"maximum":15210.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6091.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6213.29,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6152.37,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6274.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":15210.37,"additional_payer_notes":"APC"}]}]},{"description":"Insj/rplcmt pg only isdss","code_information":[{"code":"0680T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18543.09,"maximum":46302.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18543.09,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18913.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18728.52,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19099.38,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":46302.09,"additional_payer_notes":"APC"}]}]},{"description":"Opn insj/rplcmt ins ptn subq","code_information":[{"code":"0816T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18543.09,"maximum":46302.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18543.09,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18913.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18728.52,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19099.38,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":46302.09,"additional_payer_notes":"APC"}]}]},{"description":"Opn insj/rplcmt ins ptn subf","code_information":[{"code":"0817T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18543.09,"maximum":46302.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18543.09,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18913.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18728.52,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19099.38,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":46302.09,"additional_payer_notes":"APC"}]}]},{"description":"Lap srg imp/rpl eso nea&pg/r","code_information":[{"code":"1013T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18543.09,"maximum":46302.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18543.09,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18913.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18728.52,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19099.38,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":46302.09,"additional_payer_notes":"APC"}]}]},{"description":"Implant neuroelectrodes","code_information":[{"code":"63655","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18543.09,"maximum":46302.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18543.09,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18913.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18728.52,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19099.38,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":46302.09,"additional_payer_notes":"APC"}]}]},{"description":"Implant neuroelectrodes","code_information":[{"code":"64580","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18543.09,"maximum":46302.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18543.09,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18913.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18728.52,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19099.38,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":46302.09,"additional_payer_notes":"APC"}]}]},{"description":"Insrt/redo pn/gastr stimul","code_information":[{"code":"64590","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18543.09,"maximum":46302.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18543.09,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18913.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18728.52,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19099.38,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":46302.09,"additional_payer_notes":"APC"}]}]},{"description":"RSA lower extr exam","code_information":[{"code":"0350T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":83.18,"maximum":207.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":83.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84.84,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84.01,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":85.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":207.7,"additional_payer_notes":"APC"}]}]},{"description":"Tactile breast img uni/bi","code_information":[{"code":"0422T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":83.18,"maximum":207.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":83.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84.84,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84.01,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":85.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":207.7,"additional_payer_notes":"APC"}]}]},{"description":"Ct scan f/biomchn ct alys","code_information":[{"code":"0558T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":83.18,"maximum":207.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":83.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84.84,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84.01,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":85.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":207.7,"additional_payer_notes":"APC"}]}]},{"description":"Quan us tis charac w/o dx us","code_information":[{"code":"0689T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":83.18,"maximum":207.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":83.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84.84,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84.01,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":85.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":207.7,"additional_payer_notes":"APC"}]}]},{"description":"X-ray eye for foreign body","code_information":[{"code":"70030","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":83.18,"maximum":207.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":83.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84.84,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84.01,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":85.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":207.7,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam of jaw <4views","code_information":[{"code":"70100","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":83.18,"maximum":207.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":83.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84.84,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84.01,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":85.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":207.7,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam of facial bones","code_information":[{"code":"70140","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":83.18,"maximum":207.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":83.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84.84,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84.01,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":85.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":207.7,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam of nasal bones","code_information":[{"code":"70160","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":83.18,"maximum":207.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":83.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84.84,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84.01,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":85.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":207.7,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam of eye sockets","code_information":[{"code":"70190","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":83.18,"maximum":207.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":83.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84.84,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84.01,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":85.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":207.7,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam of sinuses","code_information":[{"code":"70210","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":83.18,"maximum":207.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":83.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84.84,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84.01,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":85.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":207.7,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam of sinuses","code_information":[{"code":"70220","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":83.18,"maximum":207.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":83.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84.84,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84.01,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":85.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":207.7,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam pituitary saddle","code_information":[{"code":"70240","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":83.18,"maximum":207.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":83.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84.84,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84.01,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":85.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":207.7,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam of teeth","code_information":[{"code":"70300","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":83.18,"maximum":207.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":83.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84.84,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84.01,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":85.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":207.7,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam of jaw joint","code_information":[{"code":"70328","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":83.18,"maximum":207.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":83.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84.84,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84.01,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":85.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":207.7,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam of jaw joints","code_information":[{"code":"70330","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":83.18,"maximum":207.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":83.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84.84,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84.01,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":85.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":207.7,"additional_payer_notes":"APC"}]}]},{"description":"X-ray head for orthodontia","code_information":[{"code":"70350","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":83.18,"maximum":207.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":83.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84.84,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84.01,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":85.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":207.7,"additional_payer_notes":"APC"}]}]},{"description":"Panoramic x-ray of jaws","code_information":[{"code":"70355","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":83.18,"maximum":207.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":83.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84.84,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84.01,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":85.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":207.7,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam of neck","code_information":[{"code":"70360","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":83.18,"maximum":207.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":83.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84.84,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84.01,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":85.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":207.7,"additional_payer_notes":"APC"}]}]},{"description":"Throat x-ray & fluoroscopy","code_information":[{"code":"70370","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":83.18,"maximum":207.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":83.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84.84,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84.01,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":85.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":207.7,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam of salivary gland","code_information":[{"code":"70380","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":83.18,"maximum":207.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":83.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84.84,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84.01,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":85.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":207.7,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam chest 1 view","code_information":[{"code":"71045","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":83.18,"maximum":207.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":83.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84.84,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84.01,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":85.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":207.7,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam chest 2 views","code_information":[{"code":"71046","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":83.18,"maximum":207.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":83.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84.84,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84.01,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":85.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":207.7,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam chest 3 views","code_information":[{"code":"71047","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":83.18,"maximum":207.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":83.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84.84,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84.01,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":85.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":207.7,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam ribs uni 2 views","code_information":[{"code":"71100","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":83.18,"maximum":207.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":83.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84.84,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84.01,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":85.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":207.7,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam breastbone 2/>vws","code_information":[{"code":"71120","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":83.18,"maximum":207.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":83.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84.84,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84.01,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":85.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":207.7,"additional_payer_notes":"APC"}]}]},{"description":"X-ray strenoclavic jt 3/>vws","code_information":[{"code":"71130","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":83.18,"maximum":207.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":83.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84.84,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84.01,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":85.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":207.7,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam of spine 1 view","code_information":[{"code":"72020","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":83.18,"maximum":207.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":83.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84.84,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84.01,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":85.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":207.7,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam neck spine 2-3 vw","code_information":[{"code":"72040","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":83.18,"maximum":207.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":83.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84.84,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84.01,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":85.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":207.7,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam thoracolmb 2/> vw","code_information":[{"code":"72080","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":83.18,"maximum":207.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":83.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84.84,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84.01,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":85.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":207.7,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam entire spi 1 vw","code_information":[{"code":"72081","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":83.18,"maximum":207.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":83.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84.84,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84.01,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":85.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":207.7,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam sacrum tailbone","code_information":[{"code":"72220","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":83.18,"maximum":207.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":83.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84.84,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84.01,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":85.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":207.7,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam of collar bone","code_information":[{"code":"73000","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":83.18,"maximum":207.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":83.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84.84,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84.01,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":85.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":207.7,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam of shoulder","code_information":[{"code":"73020","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":83.18,"maximum":207.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":83.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84.84,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84.01,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":85.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":207.7,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam of shoulder","code_information":[{"code":"73030","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":83.18,"maximum":207.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":83.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84.84,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84.01,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":85.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":207.7,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam of shoulders","code_information":[{"code":"73050","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":83.18,"maximum":207.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":83.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84.84,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84.01,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":85.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":207.7,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam of humerus","code_information":[{"code":"73060","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":83.18,"maximum":207.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":83.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84.84,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84.01,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":85.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":207.7,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam of elbow","code_information":[{"code":"73070","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":83.18,"maximum":207.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":83.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84.84,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84.01,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":85.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":207.7,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam of elbow","code_information":[{"code":"73080","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":83.18,"maximum":207.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":83.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84.84,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84.01,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":85.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":207.7,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam of forearm","code_information":[{"code":"73090","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":83.18,"maximum":207.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":83.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84.84,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84.01,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":85.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":207.7,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam of wrist","code_information":[{"code":"73100","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":83.18,"maximum":207.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":83.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84.84,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84.01,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":85.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":207.7,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam of wrist","code_information":[{"code":"73110","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":83.18,"maximum":207.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":83.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84.84,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84.01,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":85.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":207.7,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam of hand","code_information":[{"code":"73130","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":83.18,"maximum":207.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":83.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84.84,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84.01,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":85.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":207.7,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam of finger(s)","code_information":[{"code":"73140","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":83.18,"maximum":207.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":83.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84.84,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84.01,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":85.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":207.7,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam hip uni 1 view","code_information":[{"code":"73501","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":83.18,"maximum":207.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":83.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84.84,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84.01,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":85.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":207.7,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam hip uni 2-3 views","code_information":[{"code":"73502","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":83.18,"maximum":207.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":83.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84.84,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84.01,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":85.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":207.7,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam of femur 1","code_information":[{"code":"73551","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":83.18,"maximum":207.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":83.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84.84,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84.01,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":85.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":207.7,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam of femur 2/>","code_information":[{"code":"73552","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":83.18,"maximum":207.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":83.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84.84,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84.01,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":85.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":207.7,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam of knee 1 or 2","code_information":[{"code":"73560","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":83.18,"maximum":207.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":83.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84.84,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84.01,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":85.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":207.7,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam of knee 3","code_information":[{"code":"73562","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":83.18,"maximum":207.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":83.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84.84,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84.01,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":85.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":207.7,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam of knees","code_information":[{"code":"73565","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":83.18,"maximum":207.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":83.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84.84,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84.01,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":85.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":207.7,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam of lower leg","code_information":[{"code":"73590","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":83.18,"maximum":207.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":83.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84.84,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84.01,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":85.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":207.7,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam of leg infant","code_information":[{"code":"73592","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":83.18,"maximum":207.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":83.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84.84,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84.01,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":85.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":207.7,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam of ankle","code_information":[{"code":"73600","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":83.18,"maximum":207.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":83.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84.84,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84.01,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":85.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":207.7,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam of ankle","code_information":[{"code":"73610","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":83.18,"maximum":207.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":83.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84.84,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84.01,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":85.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":207.7,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam of foot","code_information":[{"code":"73620","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":83.18,"maximum":207.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":83.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84.84,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84.01,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":85.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":207.7,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam of foot","code_information":[{"code":"73630","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":83.18,"maximum":207.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":83.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84.84,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84.01,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":85.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":207.7,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam of heel","code_information":[{"code":"73650","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":83.18,"maximum":207.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":83.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84.84,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84.01,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":85.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":207.7,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam of toe(s)","code_information":[{"code":"73660","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":83.18,"maximum":207.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":83.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84.84,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84.01,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":85.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":207.7,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam abdomen 1 view","code_information":[{"code":"74018","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":83.18,"maximum":207.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":83.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84.84,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84.01,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":85.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":207.7,"additional_payer_notes":"APC"}]}]},{"description":"Ct hrt w/o dye w/ca test","code_information":[{"code":"75571","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":83.18,"maximum":207.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":83.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84.84,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84.01,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":85.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":207.7,"additional_payer_notes":"APC"}]}]},{"description":"X-ray nose to rectum","code_information":[{"code":"76010","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":83.18,"maximum":207.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":83.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84.84,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84.01,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":85.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":207.7,"additional_payer_notes":"APC"}]}]},{"description":"Mr safety deter phys/qhp","code_information":[{"code":"76016","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":83.18,"maximum":207.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":83.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84.84,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84.01,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":85.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":207.7,"additional_payer_notes":"APC"}]}]},{"description":"CAT scan follow-up study","code_information":[{"code":"76380","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":83.18,"maximum":207.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":83.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84.84,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84.01,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":85.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":207.7,"additional_payer_notes":"APC"}]}]},{"description":"Mr spectroscopy","code_information":[{"code":"76390","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":83.18,"maximum":207.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":83.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84.84,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84.01,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":85.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":207.7,"additional_payer_notes":"APC"}]}]},{"description":"Fluoroscopic procedure","code_information":[{"code":"76496","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":83.18,"maximum":207.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":83.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84.84,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84.01,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":85.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":207.7,"additional_payer_notes":"APC"}]}]},{"description":"Ct procedure","code_information":[{"code":"76497","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":83.18,"maximum":207.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":83.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84.84,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84.01,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":85.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":207.7,"additional_payer_notes":"APC"}]}]},{"description":"Mri procedure","code_information":[{"code":"76498","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":83.18,"maximum":207.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":83.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84.84,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84.01,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":85.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":207.7,"additional_payer_notes":"APC"}]}]},{"description":"Radiographic procedure","code_information":[{"code":"76499","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":83.18,"maximum":207.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":83.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84.84,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84.01,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":85.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":207.7,"additional_payer_notes":"APC"}]}]},{"description":"Echo exam of eye","code_information":[{"code":"76529","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":83.18,"maximum":207.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":83.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84.84,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84.01,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":85.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":207.7,"additional_payer_notes":"APC"}]}]},{"description":"Ultrasound breast limited","code_information":[{"code":"76642","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":83.18,"maximum":207.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":83.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84.84,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84.01,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":85.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":207.7,"additional_payer_notes":"APC"}]}]},{"description":"Us exam infant hips dynamic","code_information":[{"code":"76885","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":83.18,"maximum":207.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":83.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84.84,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84.01,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":85.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":207.7,"additional_payer_notes":"APC"}]}]},{"description":"Us exam infant hips static","code_information":[{"code":"76886","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":83.18,"maximum":207.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":83.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84.84,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84.01,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":85.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":207.7,"additional_payer_notes":"APC"}]}]},{"description":"Echo examination procedure","code_information":[{"code":"76999","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":83.18,"maximum":207.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":83.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84.84,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84.01,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":85.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":207.7,"additional_payer_notes":"APC"}]}]},{"description":"X-Ray Stress View","code_information":[{"code":"77071","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":83.18,"maximum":207.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":83.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84.84,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84.01,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":85.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":207.7,"additional_payer_notes":"APC"}]}]},{"description":"Ct bone density axial","code_information":[{"code":"77078","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":83.18,"maximum":207.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":83.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84.84,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84.01,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":85.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":207.7,"additional_payer_notes":"APC"}]}]},{"description":"Dxa bone density/peripheral","code_information":[{"code":"77081","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":83.18,"maximum":207.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":83.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84.84,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84.01,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":85.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":207.7,"additional_payer_notes":"APC"}]}]},{"description":"Fracture assessment via dxa","code_information":[{"code":"77086","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":83.18,"maximum":207.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":83.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84.84,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84.01,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":85.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":207.7,"additional_payer_notes":"APC"}]}]},{"description":"Tbs techl prep&transmis data","code_information":[{"code":"77090","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":83.18,"maximum":207.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":83.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84.84,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84.01,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":85.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":207.7,"additional_payer_notes":"APC"}]}]},{"description":"Tbs techl calculation only","code_information":[{"code":"77091","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":83.18,"maximum":207.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":83.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84.84,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84.01,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":85.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":207.7,"additional_payer_notes":"APC"}]}]},{"description":"Intraoral periapical first","code_information":[{"code":"D0220","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":83.18,"maximum":207.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":83.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84.84,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84.01,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":85.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":207.7,"additional_payer_notes":"APC"}]}]},{"description":"Intraoral occlusal film","code_information":[{"code":"D0240","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":83.18,"maximum":207.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":83.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84.84,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84.01,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":85.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":207.7,"additional_payer_notes":"APC"}]}]},{"description":"Extraoral 2d project image","code_information":[{"code":"D0250","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":83.18,"maximum":207.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":83.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84.84,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84.01,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":85.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":207.7,"additional_payer_notes":"APC"}]}]},{"description":"Extraoral posterior image","code_information":[{"code":"D0251","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":83.18,"maximum":207.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":83.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84.84,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84.01,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":85.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":207.7,"additional_payer_notes":"APC"}]}]},{"description":"Dental bitewing single image","code_information":[{"code":"D0270","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":83.18,"maximum":207.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":83.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84.84,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84.01,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":85.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":207.7,"additional_payer_notes":"APC"}]}]},{"description":"Dental bitewings two images","code_information":[{"code":"D0272","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":83.18,"maximum":207.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":83.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84.84,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84.01,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":85.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":207.7,"additional_payer_notes":"APC"}]}]},{"description":"Other tmj images by report","code_information":[{"code":"D0321","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":83.18,"maximum":207.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":83.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84.84,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84.01,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":85.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":207.7,"additional_payer_notes":"APC"}]}]},{"description":"2d cephalometric image","code_information":[{"code":"D0340","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":83.18,"maximum":207.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":83.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84.84,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84.01,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":85.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":207.7,"additional_payer_notes":"APC"}]}]},{"description":"Oral/facial photo images","code_information":[{"code":"D0350","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":83.18,"maximum":207.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":83.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84.84,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84.01,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":85.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":207.7,"additional_payer_notes":"APC"}]}]},{"description":"Sialoendoscopy capt & interp","code_information":[{"code":"D0371","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":83.18,"maximum":207.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":83.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84.84,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84.01,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":85.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":207.7,"additional_payer_notes":"APC"}]}]},{"description":"Trtmnt simulation 3d image","code_information":[{"code":"D0393","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":83.18,"maximum":207.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":83.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84.84,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84.01,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":85.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":207.7,"additional_payer_notes":"APC"}]}]},{"description":"Digital sub 2 or more images","code_information":[{"code":"D0394","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":83.18,"maximum":207.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":83.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84.84,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84.01,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":85.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":207.7,"additional_payer_notes":"APC"}]}]},{"description":"Fusion 2 or more 3d images","code_information":[{"code":"D0395","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":83.18,"maximum":207.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":83.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84.84,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84.01,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":85.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":207.7,"additional_payer_notes":"APC"}]}]},{"description":"Fracture of lower extremity M >=61.50","code_information":[{"code":"D0701","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":83.18,"maximum":207.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":83.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84.84,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84.01,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":85.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":207.7,"additional_payer_notes":"APC"}]}]},{"description":"Fracture of lower extremity M >=52.50 and M <61.50","code_information":[{"code":"D0702","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":83.18,"maximum":207.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":83.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84.84,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84.01,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":85.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":207.7,"additional_payer_notes":"APC"}]}]},{"description":"Fracture of lower extremity M >=41.50 and M <52.50","code_information":[{"code":"D0703","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":83.18,"maximum":207.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":83.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84.84,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84.01,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":85.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":207.7,"additional_payer_notes":"APC"}]}]},{"description":"Extra oral post radio image","code_information":[{"code":"D0705","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":83.18,"maximum":207.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":83.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84.84,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84.01,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":85.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":207.7,"additional_payer_notes":"APC"}]}]},{"description":"Intraoral occlus radio image","code_information":[{"code":"D0706","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":83.18,"maximum":207.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":83.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84.84,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84.01,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":85.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":207.7,"additional_payer_notes":"APC"}]}]},{"description":"Intraoral periap radio image","code_information":[{"code":"D0707","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":83.18,"maximum":207.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":83.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84.84,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84.01,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":85.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":207.7,"additional_payer_notes":"APC"}]}]},{"description":"Intraoral bite radio image","code_information":[{"code":"D0708","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":83.18,"maximum":207.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":83.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84.84,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84.01,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":85.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":207.7,"additional_payer_notes":"APC"}]}]},{"description":"Intraoral cmplt radio images","code_information":[{"code":"D0709","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":83.18,"maximum":207.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":83.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84.84,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84.01,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":85.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":207.7,"additional_payer_notes":"APC"}]}]},{"description":"Software meas of cardiac vol","code_information":[{"code":"G0183","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":83.18,"maximum":207.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":83.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84.84,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84.01,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":85.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":207.7,"additional_payer_notes":"APC"}]}]},{"description":"RSA spine exam","code_information":[{"code":"0348T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":99.93,"maximum":249.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":99.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":101.93,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":100.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":102.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":249.52,"additional_payer_notes":"APC"}]}]},{"description":"RSA upper extr exam","code_information":[{"code":"0349T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":99.93,"maximum":249.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":99.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":101.93,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":100.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":102.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":249.52,"additional_payer_notes":"APC"}]}]},{"description":"Ct breast w/3d uni c-","code_information":[{"code":"0633T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":99.93,"maximum":249.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":99.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":101.93,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":100.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":102.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":249.52,"additional_payer_notes":"APC"}]}]},{"description":"Opto-acoustic img breast uni","code_information":[{"code":"0857T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":99.93,"maximum":249.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":99.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":101.93,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":100.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":102.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":249.52,"additional_payer_notes":"APC"}]}]},{"description":"Ortho impl mvmt alys pair ct","code_information":[{"code":"0946T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":99.93,"maximum":249.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":99.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":101.93,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":100.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":102.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":249.52,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam of jaw 4/> views","code_information":[{"code":"70110","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":99.93,"maximum":249.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":99.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":101.93,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":100.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":102.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":249.52,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam of mastoids","code_information":[{"code":"70120","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":99.93,"maximum":249.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":99.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":101.93,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":100.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":102.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":249.52,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam of mastoids","code_information":[{"code":"70130","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":99.93,"maximum":249.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":99.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":101.93,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":100.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":102.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":249.52,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam of facial bones","code_information":[{"code":"70150","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":99.93,"maximum":249.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":99.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":101.93,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":100.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":102.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":249.52,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam of eye sockets","code_information":[{"code":"70200","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":99.93,"maximum":249.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":99.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":101.93,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":100.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":102.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":249.52,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam of skull","code_information":[{"code":"70250","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":99.93,"maximum":249.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":99.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":101.93,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":100.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":102.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":249.52,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam of skull","code_information":[{"code":"70260","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":99.93,"maximum":249.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":99.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":101.93,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":100.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":102.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":249.52,"additional_payer_notes":"APC"}]}]},{"description":"Ct head/brain w/o dye","code_information":[{"code":"70450","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":99.93,"maximum":249.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":99.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":101.93,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":100.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":102.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":249.52,"additional_payer_notes":"APC"}]}]},{"description":"Ct orbit/ear/fossa w/o dye","code_information":[{"code":"70480","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":99.93,"maximum":249.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":99.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":101.93,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":100.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":102.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":249.52,"additional_payer_notes":"APC"}]}]},{"description":"Ct maxillofacial w/o dye","code_information":[{"code":"70486","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":99.93,"maximum":249.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":99.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":101.93,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":100.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":102.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":249.52,"additional_payer_notes":"APC"}]}]},{"description":"Ct soft tissue neck w/o dye","code_information":[{"code":"70490","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":99.93,"maximum":249.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":99.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":101.93,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":100.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":102.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":249.52,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam chest 4+ views","code_information":[{"code":"71048","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":99.93,"maximum":249.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":99.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":101.93,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":100.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":102.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":249.52,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam unilat ribs/chest","code_information":[{"code":"71101","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":99.93,"maximum":249.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":99.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":101.93,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":100.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":102.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":249.52,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam ribs bil 3 views","code_information":[{"code":"71110","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":99.93,"maximum":249.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":99.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":101.93,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":100.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":102.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":249.52,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam ribs/chest4/> vws","code_information":[{"code":"71111","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":99.93,"maximum":249.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":99.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":101.93,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":100.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":102.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":249.52,"additional_payer_notes":"APC"}]}]},{"description":"Ct thorax w/o dye","code_information":[{"code":"71250","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":99.93,"maximum":249.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":99.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":101.93,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":100.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":102.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":249.52,"additional_payer_notes":"APC"}]}]},{"description":"Ct thorax lung cancer scr c-","code_information":[{"code":"71271","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":99.93,"maximum":249.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":99.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":101.93,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":100.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":102.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":249.52,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam neck spine 4/5vws","code_information":[{"code":"72050","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":99.93,"maximum":249.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":99.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":101.93,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":100.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":102.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":249.52,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam neck spine 6/>vws","code_information":[{"code":"72052","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":99.93,"maximum":249.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":99.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":101.93,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":100.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":102.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":249.52,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam thorac spine 2vws","code_information":[{"code":"72070","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":99.93,"maximum":249.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":99.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":101.93,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":100.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":102.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":249.52,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam thorac spine 3vws","code_information":[{"code":"72072","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":99.93,"maximum":249.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":99.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":101.93,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":100.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":102.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":249.52,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam thorac spine4/>vw","code_information":[{"code":"72074","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":99.93,"maximum":249.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":99.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":101.93,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":100.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":102.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":249.52,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam entire spi 2/3 vw","code_information":[{"code":"72082","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":99.93,"maximum":249.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":99.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":101.93,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":100.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":102.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":249.52,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam entire spi 4/5 vw","code_information":[{"code":"72083","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":99.93,"maximum":249.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":99.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":101.93,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":100.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":102.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":249.52,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam entire spi 6/> vw","code_information":[{"code":"72084","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":99.93,"maximum":249.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":99.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":101.93,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":100.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":102.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":249.52,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam l-s spine 2/3 vws","code_information":[{"code":"72100","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":99.93,"maximum":249.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":99.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":101.93,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":100.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":102.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":249.52,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam l-2 spine 4/>vws","code_information":[{"code":"72110","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":99.93,"maximum":249.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":99.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":101.93,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":100.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":102.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":249.52,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam l-s spine bending","code_information":[{"code":"72114","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":99.93,"maximum":249.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":99.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":101.93,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":100.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":102.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":249.52,"additional_payer_notes":"APC"}]}]},{"description":"X-ray bend only l-s spine","code_information":[{"code":"72120","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":99.93,"maximum":249.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":99.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":101.93,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":100.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":102.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":249.52,"additional_payer_notes":"APC"}]}]},{"description":"Ct neck spine w/o dye","code_information":[{"code":"72125","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":99.93,"maximum":249.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":99.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":101.93,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":100.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":102.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":249.52,"additional_payer_notes":"APC"}]}]},{"description":"Ct chest spine w/o dye","code_information":[{"code":"72128","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":99.93,"maximum":249.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":99.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":101.93,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":100.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":102.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":249.52,"additional_payer_notes":"APC"}]}]},{"description":"Ct lumbar spine w/o dye","code_information":[{"code":"72131","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":99.93,"maximum":249.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":99.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":101.93,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":100.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":102.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":249.52,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam of pelvis","code_information":[{"code":"72170","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":99.93,"maximum":249.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":99.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":101.93,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":100.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":102.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":249.52,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam of pelvis","code_information":[{"code":"72190","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":99.93,"maximum":249.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":99.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":101.93,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":100.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":102.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":249.52,"additional_payer_notes":"APC"}]}]},{"description":"Ct pelvis w/o dye","code_information":[{"code":"72192","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":99.93,"maximum":249.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":99.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":101.93,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":100.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":102.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":249.52,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam si joints","code_information":[{"code":"72200","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":99.93,"maximum":249.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":99.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":101.93,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":100.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":102.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":249.52,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam si joints 3/> vws","code_information":[{"code":"72202","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":99.93,"maximum":249.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":99.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":101.93,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":100.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":102.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":249.52,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam of shoulder blade","code_information":[{"code":"73010","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":99.93,"maximum":249.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":99.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":101.93,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":100.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":102.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":249.52,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam of arm infant","code_information":[{"code":"73092","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":99.93,"maximum":249.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":99.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":101.93,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":100.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":102.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":249.52,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam of hand","code_information":[{"code":"73120","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":99.93,"maximum":249.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":99.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":101.93,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":100.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":102.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":249.52,"additional_payer_notes":"APC"}]}]},{"description":"Ct upper extremity w/o dye","code_information":[{"code":"73200","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":99.93,"maximum":249.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":99.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":101.93,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":100.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":102.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":249.52,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam hip uni 4/> views","code_information":[{"code":"73503","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":99.93,"maximum":249.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":99.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":101.93,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":100.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":102.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":249.52,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam hips bi 2 views","code_information":[{"code":"73521","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":99.93,"maximum":249.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":99.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":101.93,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":100.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":102.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":249.52,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam hips bi 3-4 views","code_information":[{"code":"73522","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":99.93,"maximum":249.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":99.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":101.93,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":100.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":102.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":249.52,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam hips bi 5/> views","code_information":[{"code":"73523","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":99.93,"maximum":249.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":99.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":101.93,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":100.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":102.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":249.52,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam knee 4 or more","code_information":[{"code":"73564","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":99.93,"maximum":249.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":99.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":101.93,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":100.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":102.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":249.52,"additional_payer_notes":"APC"}]}]},{"description":"Ct lower extremity w/o dye","code_information":[{"code":"73700","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":99.93,"maximum":249.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":99.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":101.93,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":100.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":102.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":249.52,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam abdomen 2 views","code_information":[{"code":"74019","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":99.93,"maximum":249.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":99.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":101.93,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":100.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":102.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":249.52,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam abdomen 3+ views","code_information":[{"code":"74021","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":99.93,"maximum":249.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":99.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":101.93,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":100.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":102.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":249.52,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam series abdomen","code_information":[{"code":"74022","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":99.93,"maximum":249.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":99.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":101.93,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":100.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":102.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":249.52,"additional_payer_notes":"APC"}]}]},{"description":"Ct abdomen w/o dye","code_information":[{"code":"74150","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":99.93,"maximum":249.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":99.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":101.93,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":100.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":102.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":249.52,"additional_payer_notes":"APC"}]}]},{"description":"Ct colonography dx","code_information":[{"code":"74261","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":99.93,"maximum":249.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":99.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":101.93,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":100.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":102.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":249.52,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam of penis","code_information":[{"code":"74445","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":99.93,"maximum":249.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":99.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":101.93,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":100.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":102.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":249.52,"additional_payer_notes":"APC"}]}]},{"description":"Nonvascular shunt x-ray","code_information":[{"code":"75809","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":99.93,"maximum":249.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":99.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":101.93,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":100.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":102.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":249.52,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam of body section","code_information":[{"code":"76100","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":99.93,"maximum":249.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":99.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":101.93,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":100.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":102.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":249.52,"additional_payer_notes":"APC"}]}]},{"description":"Cine/video x-rays","code_information":[{"code":"76120","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":99.93,"maximum":249.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":99.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":101.93,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":100.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":102.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":249.52,"additional_payer_notes":"APC"}]}]},{"description":"Echo exam of head","code_information":[{"code":"76506","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":99.93,"maximum":249.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":99.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":101.93,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":100.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":102.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":249.52,"additional_payer_notes":"APC"}]}]},{"description":"Ophth us quant a only","code_information":[{"code":"76511","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":99.93,"maximum":249.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":99.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":101.93,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":100.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":102.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":249.52,"additional_payer_notes":"APC"}]}]},{"description":"Ophth us b w/non-quant a","code_information":[{"code":"76512","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":99.93,"maximum":249.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":99.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":101.93,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":100.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":102.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":249.52,"additional_payer_notes":"APC"}]}]},{"description":"Echo exam of eye water bath","code_information":[{"code":"76513","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":99.93,"maximum":249.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":99.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":101.93,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":100.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":102.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":249.52,"additional_payer_notes":"APC"}]}]},{"description":"Echo exam of eye","code_information":[{"code":"76516","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":99.93,"maximum":249.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":99.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":101.93,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":100.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":102.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":249.52,"additional_payer_notes":"APC"}]}]},{"description":"Echo exam of eye","code_information":[{"code":"76519","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":99.93,"maximum":249.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":99.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":101.93,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":100.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":102.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":249.52,"additional_payer_notes":"APC"}]}]},{"description":"Us exam of head and neck","code_information":[{"code":"76536","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":99.93,"maximum":249.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":99.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":101.93,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":100.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":102.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":249.52,"additional_payer_notes":"APC"}]}]},{"description":"Us exam chest","code_information":[{"code":"76604","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":99.93,"maximum":249.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":99.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":101.93,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":100.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":102.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":249.52,"additional_payer_notes":"APC"}]}]},{"description":"Ultrasound breast complete","code_information":[{"code":"76641","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":99.93,"maximum":249.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":99.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":101.93,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":100.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":102.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":249.52,"additional_payer_notes":"APC"}]}]},{"description":"Us exam abdom complete","code_information":[{"code":"76700","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":99.93,"maximum":249.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":99.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":101.93,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":100.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":102.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":249.52,"additional_payer_notes":"APC"}]}]},{"description":"Echo exam of abdomen","code_information":[{"code":"76705","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":99.93,"maximum":249.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":99.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":101.93,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":100.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":102.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":249.52,"additional_payer_notes":"APC"}]}]},{"description":"Us abdl aorta screen aaa","code_information":[{"code":"76706","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":99.93,"maximum":249.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":99.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":101.93,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":100.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":102.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":249.52,"additional_payer_notes":"APC"}]}]},{"description":"Us exam abdo back wall comp","code_information":[{"code":"76770","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":99.93,"maximum":249.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":99.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":101.93,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":100.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":102.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":249.52,"additional_payer_notes":"APC"}]}]},{"description":"Us exam abdo back wall lim","code_information":[{"code":"76775","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":99.93,"maximum":249.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":99.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":101.93,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":100.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":102.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":249.52,"additional_payer_notes":"APC"}]}]},{"description":"Us exam k transpl w/doppler","code_information":[{"code":"76776","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":99.93,"maximum":249.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":99.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":101.93,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":100.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":102.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":249.52,"additional_payer_notes":"APC"}]}]},{"description":"Us exam spinal canal","code_information":[{"code":"76800","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":99.93,"maximum":249.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":99.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":101.93,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":100.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":102.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":249.52,"additional_payer_notes":"APC"}]}]},{"description":"Ob us < 14 wks single fetus","code_information":[{"code":"76801","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":99.93,"maximum":249.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":99.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":101.93,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":100.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":102.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":249.52,"additional_payer_notes":"APC"}]}]},{"description":"Ob us >/= 14 wks sngl fetus","code_information":[{"code":"76805","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":99.93,"maximum":249.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":99.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":101.93,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":100.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":102.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":249.52,"additional_payer_notes":"APC"}]}]},{"description":"Ob us nuchal meas 1 gest","code_information":[{"code":"76813","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":99.93,"maximum":249.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":99.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":101.93,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":100.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":102.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":249.52,"additional_payer_notes":"APC"}]}]},{"description":"Ob us limited fetus(s)","code_information":[{"code":"76815","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":99.93,"maximum":249.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":99.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":101.93,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":100.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":102.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":249.52,"additional_payer_notes":"APC"}]}]},{"description":"Ob us follow-up per fetus","code_information":[{"code":"76816","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":99.93,"maximum":249.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":99.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":101.93,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":100.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":102.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":249.52,"additional_payer_notes":"APC"}]}]},{"description":"Transvaginal us obstetric","code_information":[{"code":"76817","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":99.93,"maximum":249.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":99.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":101.93,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":100.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":102.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":249.52,"additional_payer_notes":"APC"}]}]},{"description":"Fetal biophys profile w/nst","code_information":[{"code":"76818","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":99.93,"maximum":249.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":99.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":101.93,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":100.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":102.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":249.52,"additional_payer_notes":"APC"}]}]},{"description":"Fetal biophys profil w/o nst","code_information":[{"code":"76819","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":99.93,"maximum":249.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":99.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":101.93,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":100.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":102.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":249.52,"additional_payer_notes":"APC"}]}]},{"description":"Umbilical artery echo","code_information":[{"code":"76820","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":99.93,"maximum":249.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":99.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":101.93,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":100.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":102.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":249.52,"additional_payer_notes":"APC"}]}]},{"description":"Middle cerebral artery echo","code_information":[{"code":"76821","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":99.93,"maximum":249.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":99.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":101.93,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":100.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":102.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":249.52,"additional_payer_notes":"APC"}]}]},{"description":"Echo exam of fetal heart","code_information":[{"code":"76827","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":99.93,"maximum":249.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":99.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":101.93,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":100.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":102.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":249.52,"additional_payer_notes":"APC"}]}]},{"description":"Echo exam of fetal heart","code_information":[{"code":"76828","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":99.93,"maximum":249.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":99.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":101.93,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":100.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":102.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":249.52,"additional_payer_notes":"APC"}]}]},{"description":"Transvaginal us non-ob","code_information":[{"code":"76830","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":99.93,"maximum":249.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":99.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":101.93,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":100.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":102.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":249.52,"additional_payer_notes":"APC"}]}]},{"description":"Us exam pelvic complete","code_information":[{"code":"76856","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":99.93,"maximum":249.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":99.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":101.93,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":100.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":102.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":249.52,"additional_payer_notes":"APC"}]}]},{"description":"Us exam pelvic limited","code_information":[{"code":"76857","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":99.93,"maximum":249.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":99.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":101.93,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":100.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":102.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":249.52,"additional_payer_notes":"APC"}]}]},{"description":"Us exam scrotum","code_information":[{"code":"76870","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":99.93,"maximum":249.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":99.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":101.93,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":100.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":102.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":249.52,"additional_payer_notes":"APC"}]}]},{"description":"Us transrectal","code_information":[{"code":"76872","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":99.93,"maximum":249.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":99.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":101.93,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":100.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":102.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":249.52,"additional_payer_notes":"APC"}]}]},{"description":"Echograp trans r pros study","code_information":[{"code":"76873","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":99.93,"maximum":249.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":99.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":101.93,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":100.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":102.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":249.52,"additional_payer_notes":"APC"}]}]},{"description":"Us xtr non-vasc complete","code_information":[{"code":"76881","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":99.93,"maximum":249.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":99.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":101.93,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":100.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":102.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":249.52,"additional_payer_notes":"APC"}]}]},{"description":"Us xtr non-vasc lmtd","code_information":[{"code":"76882","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":99.93,"maximum":249.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":99.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":101.93,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":100.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":102.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":249.52,"additional_payer_notes":"APC"}]}]},{"description":"Us nrv&acc strux 1xtr compre","code_information":[{"code":"76883","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":99.93,"maximum":249.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":99.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":101.93,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":100.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":102.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":249.52,"additional_payer_notes":"APC"}]}]},{"description":"Us bone density measure","code_information":[{"code":"76977","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":99.93,"maximum":249.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":99.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":101.93,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":100.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":102.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":249.52,"additional_payer_notes":"APC"}]}]},{"description":"Use parenchyma","code_information":[{"code":"76981","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":99.93,"maximum":249.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":99.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":101.93,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":100.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":102.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":249.52,"additional_payer_notes":"APC"}]}]},{"description":"Use 1st target lesion","code_information":[{"code":"76982","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":99.93,"maximum":249.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":99.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":101.93,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":100.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":102.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":249.52,"additional_payer_notes":"APC"}]}]},{"description":"X-Rays for Bone Age","code_information":[{"code":"77072","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":99.93,"maximum":249.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":99.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":101.93,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":100.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":102.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":249.52,"additional_payer_notes":"APC"}]}]},{"description":"X-rays bone length studies","code_information":[{"code":"77073","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":99.93,"maximum":249.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":99.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":101.93,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":100.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":102.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":249.52,"additional_payer_notes":"APC"}]}]},{"description":"X-rays bone survey limited","code_information":[{"code":"77074","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":99.93,"maximum":249.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":99.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":101.93,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":100.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":102.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":249.52,"additional_payer_notes":"APC"}]}]},{"description":"X-rays bone survey complete","code_information":[{"code":"77075","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":99.93,"maximum":249.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":99.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":101.93,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":100.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":102.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":249.52,"additional_payer_notes":"APC"}]}]},{"description":"X-rays bone survey infant","code_information":[{"code":"77076","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":99.93,"maximum":249.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":99.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":101.93,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":100.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":102.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":249.52,"additional_payer_notes":"APC"}]}]},{"description":"Joint survey single view","code_information":[{"code":"77077","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":99.93,"maximum":249.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":99.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":101.93,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":100.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":102.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":249.52,"additional_payer_notes":"APC"}]}]},{"description":"Dxa bone density axial","code_information":[{"code":"77080","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":99.93,"maximum":249.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":99.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":101.93,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":100.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":102.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":249.52,"additional_payer_notes":"APC"}]}]},{"description":"Dxa bone density study","code_information":[{"code":"77085","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":99.93,"maximum":249.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":99.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":101.93,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":100.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":102.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":249.52,"additional_payer_notes":"APC"}]}]},{"description":"Extracranial uni/ltd study","code_information":[{"code":"93882","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":99.93,"maximum":249.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":99.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":101.93,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":100.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":102.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":249.52,"additional_payer_notes":"APC"}]}]},{"description":"Intracranial limited study","code_information":[{"code":"93888","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":99.93,"maximum":249.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":99.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":101.93,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":100.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":102.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":249.52,"additional_payer_notes":"APC"}]}]},{"description":"Tcd emboli detect w/o inj","code_information":[{"code":"93892","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":99.93,"maximum":249.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":99.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":101.93,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":100.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":102.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":249.52,"additional_payer_notes":"APC"}]}]},{"description":"Tcd emboli detect w/inj","code_information":[{"code":"93893","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":99.93,"maximum":249.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":99.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":101.93,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":100.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":102.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":249.52,"additional_payer_notes":"APC"}]}]},{"description":"Lower extremity study","code_information":[{"code":"93926","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":99.93,"maximum":249.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":99.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":101.93,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":100.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":102.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":249.52,"additional_payer_notes":"APC"}]}]},{"description":"Upper extremity study","code_information":[{"code":"93931","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":99.93,"maximum":249.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":99.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":101.93,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":100.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":102.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":249.52,"additional_payer_notes":"APC"}]}]},{"description":"Extremity study","code_information":[{"code":"93971","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":99.93,"maximum":249.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":99.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":101.93,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":100.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":102.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":249.52,"additional_payer_notes":"APC"}]}]},{"description":"Vascular study","code_information":[{"code":"93976","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":99.93,"maximum":249.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":99.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":101.93,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":100.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":102.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":249.52,"additional_payer_notes":"APC"}]}]},{"description":"Vascular study","code_information":[{"code":"93979","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":99.93,"maximum":249.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":99.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":101.93,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":100.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":102.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":249.52,"additional_payer_notes":"APC"}]}]},{"description":"Penile vascular study","code_information":[{"code":"93980","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":99.93,"maximum":249.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":99.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":101.93,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":100.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":102.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":249.52,"additional_payer_notes":"APC"}]}]},{"description":"Penile vascular study","code_information":[{"code":"93981","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":99.93,"maximum":249.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":99.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":101.93,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":100.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":102.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":249.52,"additional_payer_notes":"APC"}]}]},{"description":"Dup-scan hemo compl uni std","code_information":[{"code":"93986","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":99.93,"maximum":249.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":99.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":101.93,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":100.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":102.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":249.52,"additional_payer_notes":"APC"}]}]},{"description":"Doppler flow testing","code_information":[{"code":"93990","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":99.93,"maximum":249.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":99.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":101.93,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":100.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":102.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":249.52,"additional_payer_notes":"APC"}]}]},{"description":"Dental tomographic survey","code_information":[{"code":"D0322","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":99.93,"maximum":249.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":99.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":101.93,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":100.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":102.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":249.52,"additional_payer_notes":"APC"}]}]},{"description":"Cone beam ct capt & interp","code_information":[{"code":"D0364","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":99.93,"maximum":249.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":99.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":101.93,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":100.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":102.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":249.52,"additional_payer_notes":"APC"}]}]},{"description":"Cone beam ct interprete man","code_information":[{"code":"D0365","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":99.93,"maximum":249.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":99.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":101.93,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":100.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":102.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":249.52,"additional_payer_notes":"APC"}]}]},{"description":"Cone beam ct interprete max","code_information":[{"code":"D0366","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":99.93,"maximum":249.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":99.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":101.93,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":100.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":102.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":249.52,"additional_payer_notes":"APC"}]}]},{"description":"Cone beam ct interp both jaw","code_information":[{"code":"D0367","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":99.93,"maximum":249.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":99.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":101.93,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":100.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":102.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":249.52,"additional_payer_notes":"APC"}]}]},{"description":"Cone beam ct interprete TMJ","code_information":[{"code":"D0368","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":99.93,"maximum":249.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":99.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":101.93,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":100.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":102.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":249.52,"additional_payer_notes":"APC"}]}]},{"description":"Max MRI capture & interprete","code_information":[{"code":"D0369","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":99.93,"maximum":249.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":99.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":101.93,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":100.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":102.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":249.52,"additional_payer_notes":"APC"}]}]},{"description":"Max ultrasound capt & interp","code_information":[{"code":"D0370","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":99.93,"maximum":249.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":99.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":101.93,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":100.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":102.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":249.52,"additional_payer_notes":"APC"}]}]},{"description":"Cone beam ct capture limited","code_information":[{"code":"D0380","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":99.93,"maximum":249.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":99.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":101.93,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":100.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":102.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":249.52,"additional_payer_notes":"APC"}]}]},{"description":"Cone beam ct capt mandible","code_information":[{"code":"D0381","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":99.93,"maximum":249.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":99.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":101.93,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":100.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":102.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":249.52,"additional_payer_notes":"APC"}]}]},{"description":"Cone beam ct capt maxilla","code_information":[{"code":"D0382","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":99.93,"maximum":249.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":99.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":101.93,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":100.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":102.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":249.52,"additional_payer_notes":"APC"}]}]},{"description":"Cone beam ct both jaws","code_information":[{"code":"D0383","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":99.93,"maximum":249.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":99.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":101.93,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":100.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":102.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":249.52,"additional_payer_notes":"APC"}]}]},{"description":"Cone beam ct capture TMJ","code_information":[{"code":"D0384","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":99.93,"maximum":249.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":99.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":101.93,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":100.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":102.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":249.52,"additional_payer_notes":"APC"}]}]},{"description":"Max MRI image capture","code_information":[{"code":"D0385","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":99.93,"maximum":249.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":99.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":101.93,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":100.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":102.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":249.52,"additional_payer_notes":"APC"}]}]},{"description":"Max ultrasound image capture","code_information":[{"code":"D0386","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":99.93,"maximum":249.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":99.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":101.93,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":100.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":102.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":249.52,"additional_payer_notes":"APC"}]}]},{"description":"Single energy x-ray study","code_information":[{"code":"G0130","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":99.93,"maximum":249.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":99.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":101.93,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":100.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":102.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":249.52,"additional_payer_notes":"APC"}]}]},{"description":"B1 str & fx rsk assessment","code_information":[{"code":"0556T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":228.06,"maximum":569.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":228.06,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":232.62,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":230.34,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":234.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":569.47,"additional_payer_notes":"APC"}]}]},{"description":"Mrs disc pain acquisj data","code_information":[{"code":"0609T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":228.06,"maximum":569.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":228.06,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":232.62,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":230.34,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":234.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":569.47,"additional_payer_notes":"APC"}]}]},{"description":"Mrs disc pain alg alys data","code_information":[{"code":"0611T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":228.06,"maximum":569.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":228.06,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":232.62,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":230.34,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":234.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":569.47,"additional_payer_notes":"APC"}]}]},{"description":"Ct breast w/3d bi c-","code_information":[{"code":"0636T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":228.06,"maximum":569.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":228.06,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":232.62,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":230.34,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":234.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":569.47,"additional_payer_notes":"APC"}]}]},{"description":"B1 str & fx rsk vrt fx assmt","code_information":[{"code":"0743T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":228.06,"maximum":569.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":228.06,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":232.62,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":230.34,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":234.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":569.47,"additional_payer_notes":"APC"}]}]},{"description":"Quan mri alys brn w/o dx mri","code_information":[{"code":"0865T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":228.06,"maximum":569.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":228.06,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":232.62,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":230.34,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":234.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":569.47,"additional_payer_notes":"APC"}]}]},{"description":"Quan mri alys brn w/dx mri","code_information":[{"code":"0866T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":228.06,"maximum":569.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":228.06,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":232.62,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":230.34,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":234.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":569.47,"additional_payer_notes":"APC"}]}]},{"description":"3d cntr simula trgt lvr les","code_information":[{"code":"0944T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":228.06,"maximum":569.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":228.06,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":232.62,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":230.34,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":234.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":569.47,"additional_payer_notes":"APC"}]}]},{"description":"N-invas assmt car rsk w/o ct","code_information":[{"code":"0992T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":228.06,"maximum":569.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":228.06,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":232.62,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":230.34,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":234.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":569.47,"additional_payer_notes":"APC"}]}]},{"description":"N-invas assmt car rsk w/ct","code_information":[{"code":"0993T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":228.06,"maximum":569.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":228.06,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":232.62,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":230.34,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":234.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":569.47,"additional_payer_notes":"APC"}]}]},{"description":"Fluoro exam of g/colon tube","code_information":[{"code":"49465","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":228.06,"maximum":569.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":228.06,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":232.62,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":230.34,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":234.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":569.47,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam of tear duct","code_information":[{"code":"70170","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":228.06,"maximum":569.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":228.06,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":232.62,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":230.34,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":234.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":569.47,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam of teeth","code_information":[{"code":"70310","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":228.06,"maximum":569.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":228.06,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":232.62,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":230.34,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":234.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":569.47,"additional_payer_notes":"APC"}]}]},{"description":"Full mouth x-ray of teeth","code_information":[{"code":"70320","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":228.06,"maximum":569.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":228.06,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":232.62,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":230.34,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":234.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":569.47,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam of jaw joint","code_information":[{"code":"70332","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":228.06,"maximum":569.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":228.06,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":232.62,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":230.34,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":234.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":569.47,"additional_payer_notes":"APC"}]}]},{"description":"Magnetic image jaw joint","code_information":[{"code":"70336","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":228.06,"maximum":569.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":228.06,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":232.62,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":230.34,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":234.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":569.47,"additional_payer_notes":"APC"}]}]},{"description":"Speech evaluation complex","code_information":[{"code":"70371","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":228.06,"maximum":569.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":228.06,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":232.62,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":230.34,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":234.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":569.47,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam of salivary duct","code_information":[{"code":"70390","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":228.06,"maximum":569.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":228.06,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":232.62,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":230.34,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":234.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":569.47,"additional_payer_notes":"APC"}]}]},{"description":"Mri orbit/face/neck w/o dye","code_information":[{"code":"70540","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":228.06,"maximum":569.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":228.06,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":232.62,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":230.34,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":234.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":569.47,"additional_payer_notes":"APC"}]}]},{"description":"Mr Angiography Head W/O Dye","code_information":[{"code":"70544","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":228.06,"maximum":569.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":228.06,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":232.62,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":230.34,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":234.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":569.47,"additional_payer_notes":"APC"}]}]},{"description":"Mr Angiography Neck W/O Dye","code_information":[{"code":"70547","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":228.06,"maximum":569.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":228.06,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":232.62,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":230.34,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":234.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":569.47,"additional_payer_notes":"APC"}]}]},{"description":"Mri brain stem w/o dye","code_information":[{"code":"70551","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":228.06,"maximum":569.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":228.06,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":232.62,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":230.34,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":234.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":569.47,"additional_payer_notes":"APC"}]}]},{"description":"Fmri brain by tech","code_information":[{"code":"70554","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":228.06,"maximum":569.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":228.06,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":232.62,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":230.34,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":234.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":569.47,"additional_payer_notes":"APC"}]}]},{"description":"Fmri brain by phys/psych","code_information":[{"code":"70555","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":228.06,"maximum":569.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":228.06,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":232.62,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":230.34,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":234.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":569.47,"additional_payer_notes":"APC"}]}]},{"description":"Mri chest w/o dye","code_information":[{"code":"71550","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":228.06,"maximum":569.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":228.06,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":232.62,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":230.34,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":234.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":569.47,"additional_payer_notes":"APC"}]}]},{"description":"Mri neck spine w/o dye","code_information":[{"code":"72141","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":228.06,"maximum":569.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":228.06,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":232.62,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":230.34,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":234.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":569.47,"additional_payer_notes":"APC"}]}]},{"description":"Mri chest spine w/o dye","code_information":[{"code":"72146","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":228.06,"maximum":569.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":228.06,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":232.62,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":230.34,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":234.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":569.47,"additional_payer_notes":"APC"}]}]},{"description":"Mri lumbar spine w/o dye","code_information":[{"code":"72148","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":228.06,"maximum":569.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":228.06,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":232.62,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":230.34,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":234.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":569.47,"additional_payer_notes":"APC"}]}]},{"description":"Mri Pelvis W/O Dye","code_information":[{"code":"72195","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":228.06,"maximum":569.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":228.06,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":232.62,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":230.34,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":234.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":569.47,"additional_payer_notes":"APC"}]}]},{"description":"Mri Upper Extremity W/O Dye","code_information":[{"code":"73218","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":228.06,"maximum":569.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":228.06,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":232.62,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":230.34,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":234.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":569.47,"additional_payer_notes":"APC"}]}]},{"description":"Mri joint upr extrem w/o dye","code_information":[{"code":"73221","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":228.06,"maximum":569.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":228.06,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":232.62,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":230.34,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":234.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":569.47,"additional_payer_notes":"APC"}]}]},{"description":"Mri Lower Extremity W/O Dye","code_information":[{"code":"73718","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":228.06,"maximum":569.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":228.06,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":232.62,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":230.34,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":234.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":569.47,"additional_payer_notes":"APC"}]}]},{"description":"Mri jnt of lwr extre w/o dye","code_information":[{"code":"73721","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":228.06,"maximum":569.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":228.06,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":232.62,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":230.34,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":234.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":569.47,"additional_payer_notes":"APC"}]}]},{"description":"Ct abd & pelvis w/o contrast","code_information":[{"code":"74176","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":228.06,"maximum":569.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":228.06,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":232.62,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":230.34,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":234.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":569.47,"additional_payer_notes":"APC"}]}]},{"description":"Mri abdomen w/o dye","code_information":[{"code":"74181","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":228.06,"maximum":569.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":228.06,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":232.62,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":230.34,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":234.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":569.47,"additional_payer_notes":"APC"}]}]},{"description":"Ct colonography screening","code_information":[{"code":"74263","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":228.06,"maximum":569.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":228.06,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":232.62,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":230.34,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":234.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":569.47,"additional_payer_notes":"APC"}]}]},{"description":"X-ray male genital tract","code_information":[{"code":"74440","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":228.06,"maximum":569.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":228.06,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":232.62,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":230.34,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":234.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":569.47,"additional_payer_notes":"APC"}]}]},{"description":"X-ray urethra/bladder","code_information":[{"code":"74450","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":228.06,"maximum":569.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":228.06,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":232.62,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":230.34,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":234.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":569.47,"additional_payer_notes":"APC"}]}]},{"description":"X-ray urethra/bladder","code_information":[{"code":"74455","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":228.06,"maximum":569.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":228.06,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":232.62,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":230.34,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":234.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":569.47,"additional_payer_notes":"APC"}]}]},{"description":"Mri fetal sngl/1st gestation","code_information":[{"code":"74712","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":228.06,"maximum":569.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":228.06,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":232.62,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":230.34,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":234.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":569.47,"additional_payer_notes":"APC"}]}]},{"description":"X-ray female genital tract","code_information":[{"code":"74740","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":228.06,"maximum":569.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":228.06,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":232.62,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":230.34,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":234.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":569.47,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam of perineum","code_information":[{"code":"74775","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":228.06,"maximum":569.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":228.06,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":232.62,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":230.34,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":234.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":569.47,"additional_payer_notes":"APC"}]}]},{"description":"Cardiac mri for morph","code_information":[{"code":"75557","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":228.06,"maximum":569.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":228.06,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":232.62,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":230.34,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":234.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":569.47,"additional_payer_notes":"APC"}]}]},{"description":"Fluoroscope examination","code_information":[{"code":"76000","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":228.06,"maximum":569.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":228.06,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":232.62,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":230.34,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":234.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":569.47,"additional_payer_notes":"APC"}]}]},{"description":"Mr sfty med physics xm cstmz","code_information":[{"code":"76017","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":228.06,"maximum":569.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":228.06,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":232.62,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":230.34,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":234.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":569.47,"additional_payer_notes":"APC"}]}]},{"description":"Mr elastography","code_information":[{"code":"76391","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":228.06,"maximum":569.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":228.06,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":232.62,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":230.34,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":234.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":569.47,"additional_payer_notes":"APC"}]}]},{"description":"Ob us detailed sngl fetus","code_information":[{"code":"76811","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":228.06,"maximum":569.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":228.06,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":232.62,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":230.34,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":234.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":569.47,"additional_payer_notes":"APC"}]}]},{"description":"Echo exam of fetal heart","code_information":[{"code":"76826","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":228.06,"maximum":569.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":228.06,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":232.62,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":230.34,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":234.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":569.47,"additional_payer_notes":"APC"}]}]},{"description":"Echo exam uterus","code_information":[{"code":"76831","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":228.06,"maximum":569.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":228.06,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":232.62,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":230.34,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":234.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":569.47,"additional_payer_notes":"APC"}]}]},{"description":"GI endoscopic ultrasound","code_information":[{"code":"76975","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":228.06,"maximum":569.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":228.06,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":232.62,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":230.34,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":234.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":569.47,"additional_payer_notes":"APC"}]}]},{"description":"Mri breast c- unilateral","code_information":[{"code":"77046","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":228.06,"maximum":569.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":228.06,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":232.62,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":230.34,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":234.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":569.47,"additional_payer_notes":"APC"}]}]},{"description":"Mri breast c- bilateral","code_information":[{"code":"77047","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":228.06,"maximum":569.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":228.06,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":232.62,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":230.34,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":234.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":569.47,"additional_payer_notes":"APC"}]}]},{"description":"X-Ray of Mammary Duct","code_information":[{"code":"77053","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":228.06,"maximum":569.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":228.06,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":232.62,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":230.34,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":234.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":569.47,"additional_payer_notes":"APC"}]}]},{"description":"X-ray of mammary ducts","code_information":[{"code":"77054","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":228.06,"maximum":569.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":228.06,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":232.62,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":230.34,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":234.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":569.47,"additional_payer_notes":"APC"}]}]},{"description":"Magnetic image bone marrow","code_information":[{"code":"77084","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":228.06,"maximum":569.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":228.06,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":232.62,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":230.34,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":234.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":569.47,"additional_payer_notes":"APC"}]}]},{"description":"Tte w/o doppler complete","code_information":[{"code":"93307","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":228.06,"maximum":569.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":228.06,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":232.62,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":230.34,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":234.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":569.47,"additional_payer_notes":"APC"}]}]},{"description":"Tte f-up or lmtd","code_information":[{"code":"93308","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":228.06,"maximum":569.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":228.06,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":232.62,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":230.34,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":234.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":569.47,"additional_payer_notes":"APC"}]}]},{"description":"Extracranial bilat study","code_information":[{"code":"93880","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":228.06,"maximum":569.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":228.06,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":232.62,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":230.34,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":234.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":569.47,"additional_payer_notes":"APC"}]}]},{"description":"Intracranial complete study","code_information":[{"code":"93886","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":228.06,"maximum":569.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":228.06,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":232.62,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":230.34,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":234.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":569.47,"additional_payer_notes":"APC"}]}]},{"description":"Lower extremity study","code_information":[{"code":"93925","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":228.06,"maximum":569.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":228.06,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":232.62,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":230.34,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":234.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":569.47,"additional_payer_notes":"APC"}]}]},{"description":"Upper extremity study","code_information":[{"code":"93930","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":228.06,"maximum":569.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":228.06,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":232.62,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":230.34,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":234.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":569.47,"additional_payer_notes":"APC"}]}]},{"description":"Extremity study","code_information":[{"code":"93970","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":228.06,"maximum":569.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":228.06,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":232.62,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":230.34,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":234.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":569.47,"additional_payer_notes":"APC"}]}]},{"description":"Vascular study","code_information":[{"code":"93975","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":228.06,"maximum":569.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":228.06,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":232.62,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":230.34,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":234.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":569.47,"additional_payer_notes":"APC"}]}]},{"description":"Vascular study","code_information":[{"code":"93978","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":228.06,"maximum":569.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":228.06,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":232.62,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":230.34,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":234.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":569.47,"additional_payer_notes":"APC"}]}]},{"description":"Dup-scan hemo compl bi std","code_information":[{"code":"93985","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":228.06,"maximum":569.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":228.06,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":232.62,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":230.34,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":234.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":569.47,"additional_payer_notes":"APC"}]}]},{"description":"Mra w/o cont, abd","code_information":[{"code":"C8901","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":228.06,"maximum":569.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":228.06,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":232.62,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":230.34,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":234.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":569.47,"additional_payer_notes":"APC"}]}]},{"description":"MRA w/o cont, chest","code_information":[{"code":"C8910","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":228.06,"maximum":569.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":228.06,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":232.62,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":230.34,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":234.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":569.47,"additional_payer_notes":"APC"}]}]},{"description":"Mra w/o cont, lwr ext","code_information":[{"code":"C8913","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":228.06,"maximum":569.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":228.06,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":232.62,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":230.34,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":234.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":569.47,"additional_payer_notes":"APC"}]}]},{"description":"MRA w/o cont, pelvis","code_information":[{"code":"C8919","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":228.06,"maximum":569.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":228.06,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":232.62,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":230.34,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":234.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":569.47,"additional_payer_notes":"APC"}]}]},{"description":"MRA, w/o dye, spinal canal","code_information":[{"code":"C8932","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":228.06,"maximum":569.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":228.06,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":232.62,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":230.34,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":234.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":569.47,"additional_payer_notes":"APC"}]}]},{"description":"MRA, w/o dye, upper extr","code_information":[{"code":"C8935","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":228.06,"maximum":569.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":228.06,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":232.62,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":230.34,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":234.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":569.47,"additional_payer_notes":"APC"}]}]},{"description":"Intraor complete film series","code_information":[{"code":"D0210","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":228.06,"maximum":569.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":228.06,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":232.62,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":230.34,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":234.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":569.47,"additional_payer_notes":"APC"}]}]},{"description":"Bitewings - three images","code_information":[{"code":"D0273","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":228.06,"maximum":569.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":228.06,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":232.62,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":230.34,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":234.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":569.47,"additional_payer_notes":"APC"}]}]},{"description":"Bitewings four images","code_information":[{"code":"D0274","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":228.06,"maximum":569.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":228.06,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":232.62,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":230.34,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":234.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":569.47,"additional_payer_notes":"APC"}]}]},{"description":"Vert bitewings 7 to 8 images","code_information":[{"code":"D0277","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":228.06,"maximum":569.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":228.06,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":232.62,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":230.34,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":234.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":569.47,"additional_payer_notes":"APC"}]}]},{"description":"Dental saliography","code_information":[{"code":"D0310","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":228.06,"maximum":569.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":228.06,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":232.62,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":230.34,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":234.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":569.47,"additional_payer_notes":"APC"}]}]},{"description":"Dental tmj arthrogram incl i","code_information":[{"code":"D0320","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":228.06,"maximum":569.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":228.06,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":232.62,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":230.34,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":234.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":569.47,"additional_payer_notes":"APC"}]}]},{"description":"Panoramic image","code_information":[{"code":"D0330","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":228.06,"maximum":569.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":228.06,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":232.62,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":230.34,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":234.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":569.47,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam of middle ear","code_information":[{"code":"70134","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":522.28,"maximum":1304.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":522.28,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":532.72,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":527.5,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":537.94,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1304.12,"additional_payer_notes":"APC"}]}]},{"description":"Mri brain w/o dye","code_information":[{"code":"70557","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":522.28,"maximum":1304.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":522.28,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":532.72,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":527.5,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":537.94,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1304.12,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam of peritoneum","code_information":[{"code":"74190","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":522.28,"maximum":1304.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":522.28,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":532.72,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":527.5,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":537.94,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1304.12,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam of kidney lesion","code_information":[{"code":"74470","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":522.28,"maximum":1304.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":522.28,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":532.72,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":527.5,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":537.94,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1304.12,"additional_payer_notes":"APC"}]}]},{"description":"Cardiac mri w/stress img","code_information":[{"code":"75559","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":522.28,"maximum":1304.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":522.28,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":532.72,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":527.5,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":537.94,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1304.12,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam of fistula","code_information":[{"code":"76080","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":522.28,"maximum":1304.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":522.28,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":532.72,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":527.5,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":537.94,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1304.12,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam breast specimen","code_information":[{"code":"76098","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":522.28,"maximum":1304.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":522.28,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":532.72,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":527.5,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":537.94,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1304.12,"additional_payer_notes":"APC"}]}]},{"description":"Echo exam of fetal heart","code_information":[{"code":"76825","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":522.28,"maximum":1304.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":522.28,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":532.72,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":527.5,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":537.94,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1304.12,"additional_payer_notes":"APC"}]}]},{"description":"Echo transthoracic","code_information":[{"code":"93303","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":522.28,"maximum":1304.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":522.28,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":532.72,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":527.5,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":537.94,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1304.12,"additional_payer_notes":"APC"}]}]},{"description":"Echo transthoracic","code_information":[{"code":"93304","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":522.28,"maximum":1304.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":522.28,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":532.72,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":527.5,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":537.94,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1304.12,"additional_payer_notes":"APC"}]}]},{"description":"Tte w/doppler complete","code_information":[{"code":"93306","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":522.28,"maximum":1304.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":522.28,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":532.72,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":527.5,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":537.94,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1304.12,"additional_payer_notes":"APC"}]}]},{"description":"Echo transesophageal","code_information":[{"code":"93312","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":522.28,"maximum":1304.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":522.28,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":532.72,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":527.5,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":537.94,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1304.12,"additional_payer_notes":"APC"}]}]},{"description":"Echo transesophageal","code_information":[{"code":"93313","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":522.28,"maximum":1304.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":522.28,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":532.72,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":527.5,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":537.94,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1304.12,"additional_payer_notes":"APC"}]}]},{"description":"Echo transesophageal","code_information":[{"code":"93315","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":522.28,"maximum":1304.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":522.28,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":532.72,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":527.5,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":537.94,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1304.12,"additional_payer_notes":"APC"}]}]},{"description":"Echo transesophageal","code_information":[{"code":"93316","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":522.28,"maximum":1304.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":522.28,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":532.72,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":527.5,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":537.94,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1304.12,"additional_payer_notes":"APC"}]}]},{"description":"Echo Transesophageal Intraop","code_information":[{"code":"93318","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":522.28,"maximum":1304.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":522.28,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":532.72,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":527.5,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":537.94,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1304.12,"additional_payer_notes":"APC"}]}]},{"description":"Stress tte only","code_information":[{"code":"93350","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":522.28,"maximum":1304.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":522.28,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":532.72,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":527.5,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":537.94,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1304.12,"additional_payer_notes":"APC"}]}]},{"description":"Stress tte complete","code_information":[{"code":"93351","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":522.28,"maximum":1304.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":522.28,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":532.72,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":527.5,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":537.94,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1304.12,"additional_payer_notes":"APC"}]}]},{"description":"Cardiac MRI seg dys strain","code_information":[{"code":"C9762","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":522.28,"maximum":1304.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":522.28,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":532.72,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":527.5,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":537.94,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1304.12,"additional_payer_notes":"APC"}]}]},{"description":"Cardiac MRI seg dys stress","code_information":[{"code":"C9763","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":522.28,"maximum":1304.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":522.28,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":532.72,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":527.5,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":537.94,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1304.12,"additional_payer_notes":"APC"}]}]},{"description":"Ct breast w/3d uni c+","code_information":[{"code":"0634T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":167.65,"maximum":418.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":167.65,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":171.01,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":169.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":172.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":418.63,"additional_payer_notes":"APC"}]}]},{"description":"Ct breast w/3d uni c-/c+","code_information":[{"code":"0635T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":167.65,"maximum":418.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":167.65,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":171.01,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":169.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":172.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":418.63,"additional_payer_notes":"APC"}]}]},{"description":"Ct head/brain w/dye","code_information":[{"code":"70460","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":167.65,"maximum":418.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":167.65,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":171.01,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":169.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":172.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":418.63,"additional_payer_notes":"APC"}]}]},{"description":"Ct head/brain w/o & w/dye","code_information":[{"code":"70470","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":167.65,"maximum":418.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":167.65,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":171.01,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":169.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":172.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":418.63,"additional_payer_notes":"APC"}]}]},{"description":"Ct cere prfu aly c+wo ct/cta","code_information":[{"code":"70473","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":167.65,"maximum":418.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":167.65,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":171.01,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":169.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":172.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":418.63,"additional_payer_notes":"APC"}]}]},{"description":"Ct orbit/ear/fossa w/dye","code_information":[{"code":"70481","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":167.65,"maximum":418.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":167.65,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":171.01,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":169.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":172.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":418.63,"additional_payer_notes":"APC"}]}]},{"description":"Ct orbit/ear/fossa w/o&w/dye","code_information":[{"code":"70482","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":167.65,"maximum":418.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":167.65,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":171.01,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":169.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":172.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":418.63,"additional_payer_notes":"APC"}]}]},{"description":"Ct maxillofacial w/dye","code_information":[{"code":"70487","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":167.65,"maximum":418.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":167.65,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":171.01,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":169.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":172.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":418.63,"additional_payer_notes":"APC"}]}]},{"description":"Ct maxillofacial w/o & w/dye","code_information":[{"code":"70488","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":167.65,"maximum":418.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":167.65,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":171.01,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":169.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":172.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":418.63,"additional_payer_notes":"APC"}]}]},{"description":"Ct soft tissue neck w/dye","code_information":[{"code":"70491","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":167.65,"maximum":418.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":167.65,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":171.01,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":169.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":172.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":418.63,"additional_payer_notes":"APC"}]}]},{"description":"Ct sft tsue nck w/o & w/dye","code_information":[{"code":"70492","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":167.65,"maximum":418.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":167.65,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":171.01,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":169.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":172.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":418.63,"additional_payer_notes":"APC"}]}]},{"description":"Ct angiography head","code_information":[{"code":"70496","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":167.65,"maximum":418.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":167.65,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":171.01,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":169.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":172.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":418.63,"additional_payer_notes":"APC"}]}]},{"description":"Ct angiography neck","code_information":[{"code":"70498","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":167.65,"maximum":418.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":167.65,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":171.01,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":169.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":172.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":418.63,"additional_payer_notes":"APC"}]}]},{"description":"Mri brain w/dye","code_information":[{"code":"70558","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":167.65,"maximum":418.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":167.65,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":171.01,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":169.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":172.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":418.63,"additional_payer_notes":"APC"}]}]},{"description":"Mri brain w/o & w/dye","code_information":[{"code":"70559","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":167.65,"maximum":418.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":167.65,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":171.01,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":169.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":172.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":418.63,"additional_payer_notes":"APC"}]}]},{"description":"Ct thorax w/dye","code_information":[{"code":"71260","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":167.65,"maximum":418.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":167.65,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":171.01,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":169.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":172.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":418.63,"additional_payer_notes":"APC"}]}]},{"description":"Ct thorax w/o & w/dye","code_information":[{"code":"71270","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":167.65,"maximum":418.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":167.65,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":171.01,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":169.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":172.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":418.63,"additional_payer_notes":"APC"}]}]},{"description":"Ct angiography chest","code_information":[{"code":"71275","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":167.65,"maximum":418.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":167.65,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":171.01,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":169.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":172.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":418.63,"additional_payer_notes":"APC"}]}]},{"description":"Ct neck spine w/o & w/dye","code_information":[{"code":"72127","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":167.65,"maximum":418.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":167.65,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":171.01,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":169.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":172.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":418.63,"additional_payer_notes":"APC"}]}]},{"description":"Ct chest spine w/dye","code_information":[{"code":"72129","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":167.65,"maximum":418.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":167.65,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":171.01,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":169.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":172.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":418.63,"additional_payer_notes":"APC"}]}]},{"description":"Ct chest spine w/o & w/dye","code_information":[{"code":"72130","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":167.65,"maximum":418.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":167.65,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":171.01,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":169.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":172.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":418.63,"additional_payer_notes":"APC"}]}]},{"description":"Ct lumbar spine w/o & w/dye","code_information":[{"code":"72133","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":167.65,"maximum":418.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":167.65,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":171.01,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":169.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":172.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":418.63,"additional_payer_notes":"APC"}]}]},{"description":"Ct angiograph pelv w/o&w/dye","code_information":[{"code":"72191","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":167.65,"maximum":418.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":167.65,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":171.01,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":169.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":172.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":418.63,"additional_payer_notes":"APC"}]}]},{"description":"Ct pelvis w/dye","code_information":[{"code":"72193","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":167.65,"maximum":418.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":167.65,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":171.01,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":169.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":172.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":418.63,"additional_payer_notes":"APC"}]}]},{"description":"Ct pelvis w/o & w/dye","code_information":[{"code":"72194","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":167.65,"maximum":418.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":167.65,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":171.01,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":169.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":172.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":418.63,"additional_payer_notes":"APC"}]}]},{"description":"Ct uppr extremity w/o&w/dye","code_information":[{"code":"73202","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":167.65,"maximum":418.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":167.65,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":171.01,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":169.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":172.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":418.63,"additional_payer_notes":"APC"}]}]},{"description":"Ct angio upr extrm w/o&w/dye","code_information":[{"code":"73206","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":167.65,"maximum":418.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":167.65,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":171.01,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":169.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":172.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":418.63,"additional_payer_notes":"APC"}]}]},{"description":"Ct lower extremity w/dye","code_information":[{"code":"73701","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":167.65,"maximum":418.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":167.65,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":171.01,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":169.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":172.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":418.63,"additional_payer_notes":"APC"}]}]},{"description":"Ct lwr extremity w/o&w/dye","code_information":[{"code":"73702","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":167.65,"maximum":418.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":167.65,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":171.01,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":169.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":172.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":418.63,"additional_payer_notes":"APC"}]}]},{"description":"Ct angio lwr extr w/o&w/dye","code_information":[{"code":"73706","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":167.65,"maximum":418.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":167.65,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":171.01,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":169.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":172.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":418.63,"additional_payer_notes":"APC"}]}]},{"description":"Ct abdomen w/dye","code_information":[{"code":"74160","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":167.65,"maximum":418.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":167.65,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":171.01,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":169.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":172.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":418.63,"additional_payer_notes":"APC"}]}]},{"description":"Ct abdomen w/o & w/dye","code_information":[{"code":"74170","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":167.65,"maximum":418.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":167.65,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":171.01,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":169.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":172.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":418.63,"additional_payer_notes":"APC"}]}]},{"description":"Ct angio abdom w/o & w/dye","code_information":[{"code":"74175","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":167.65,"maximum":418.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":167.65,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":171.01,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":169.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":172.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":418.63,"additional_payer_notes":"APC"}]}]},{"description":"Contrst x-ray exam of throat","code_information":[{"code":"74210","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":167.65,"maximum":418.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":167.65,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":171.01,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":169.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":172.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":418.63,"additional_payer_notes":"APC"}]}]},{"description":"Contrast x-ray esophagus","code_information":[{"code":"74220","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":167.65,"maximum":418.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":167.65,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":171.01,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":169.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":172.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":418.63,"additional_payer_notes":"APC"}]}]},{"description":"X-ray xm esophagus 2cntrst","code_information":[{"code":"74221","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":167.65,"maximum":418.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":167.65,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":171.01,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":169.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":172.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":418.63,"additional_payer_notes":"APC"}]}]},{"description":"Cine/vid x-ray throat/esoph","code_information":[{"code":"74230","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":167.65,"maximum":418.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":167.65,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":171.01,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":169.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":172.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":418.63,"additional_payer_notes":"APC"}]}]},{"description":"X-ray upper gi delay w/o kub","code_information":[{"code":"74240","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":167.65,"maximum":418.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":167.65,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":171.01,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":169.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":172.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":418.63,"additional_payer_notes":"APC"}]}]},{"description":"Contrst x-ray uppr gi tract","code_information":[{"code":"74246","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":167.65,"maximum":418.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":167.65,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":171.01,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":169.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":172.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":418.63,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam of small bowel","code_information":[{"code":"74250","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":167.65,"maximum":418.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":167.65,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":171.01,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":169.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":172.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":418.63,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam of small bowel","code_information":[{"code":"74251","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":167.65,"maximum":418.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":167.65,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":171.01,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":169.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":172.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":418.63,"additional_payer_notes":"APC"}]}]},{"description":"Ct colonography dx w/dye","code_information":[{"code":"74262","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":167.65,"maximum":418.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":167.65,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":171.01,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":169.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":172.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":418.63,"additional_payer_notes":"APC"}]}]},{"description":"Contrast x-ray exam of colon","code_information":[{"code":"74270","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":167.65,"maximum":418.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":167.65,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":171.01,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":169.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":172.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":418.63,"additional_payer_notes":"APC"}]}]},{"description":"Contrast x-ray exam of colon","code_information":[{"code":"74280","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":167.65,"maximum":418.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":167.65,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":171.01,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":169.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":172.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":418.63,"additional_payer_notes":"APC"}]}]},{"description":"Contrast x-ray exam of colon","code_information":[{"code":"74283","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":167.65,"maximum":418.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":167.65,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":171.01,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":169.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":172.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":418.63,"additional_payer_notes":"APC"}]}]},{"description":"Contrast x-ray gallbladder","code_information":[{"code":"74290","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":167.65,"maximum":418.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":167.65,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":171.01,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":169.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":172.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":418.63,"additional_payer_notes":"APC"}]}]},{"description":"Contrst x-ray urinary tract","code_information":[{"code":"74400","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":167.65,"maximum":418.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":167.65,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":171.01,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":169.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":172.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":418.63,"additional_payer_notes":"APC"}]}]},{"description":"Contrst x-ray urinary tract","code_information":[{"code":"74410","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":167.65,"maximum":418.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":167.65,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":171.01,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":169.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":172.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":418.63,"additional_payer_notes":"APC"}]}]},{"description":"Contrst x-ray urinary tract","code_information":[{"code":"74415","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":167.65,"maximum":418.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":167.65,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":171.01,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":169.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":172.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":418.63,"additional_payer_notes":"APC"}]}]},{"description":"Ct Angio Abdominal Arteries","code_information":[{"code":"75635","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":167.65,"maximum":418.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":167.65,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":171.01,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":169.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":172.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":418.63,"additional_payer_notes":"APC"}]}]},{"description":"Mri w/cont, breast,  uni","code_information":[{"code":"C8903","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":167.65,"maximum":418.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":167.65,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":171.01,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":169.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":172.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":418.63,"additional_payer_notes":"APC"}]}]},{"description":"Ct breast w/3d bi c+","code_information":[{"code":"0637T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":333.46,"maximum":832.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":333.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":340.13,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":336.8,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":343.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":832.65,"additional_payer_notes":"APC"}]}]},{"description":"Ct breast w/3d bi c-/c+","code_information":[{"code":"0638T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":333.46,"maximum":832.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":333.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":340.13,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":336.8,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":343.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":832.65,"additional_payer_notes":"APC"}]}]},{"description":"Contrast x-ray of brain","code_information":[{"code":"70010","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":333.46,"maximum":832.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":333.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":340.13,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":336.8,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":343.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":832.65,"additional_payer_notes":"APC"}]}]},{"description":"Cta h&n c+ w/noncontrast img","code_information":[{"code":"70471","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":333.46,"maximum":832.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":333.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":340.13,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":336.8,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":343.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":832.65,"additional_payer_notes":"APC"}]}]},{"description":"Mri Orbit/Face/Neck W/Dye","code_information":[{"code":"70542","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":333.46,"maximum":832.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":333.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":340.13,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":336.8,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":343.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":832.65,"additional_payer_notes":"APC"}]}]},{"description":"Mri orbt/fac/nck w/o &w/dye","code_information":[{"code":"70543","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":333.46,"maximum":832.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":333.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":340.13,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":336.8,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":343.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":832.65,"additional_payer_notes":"APC"}]}]},{"description":"Mr Angiography Head W/Dye","code_information":[{"code":"70545","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":333.46,"maximum":832.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":333.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":340.13,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":336.8,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":343.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":832.65,"additional_payer_notes":"APC"}]}]},{"description":"Mr angiograph head w/o&w/dye","code_information":[{"code":"70546","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":333.46,"maximum":832.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":333.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":340.13,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":336.8,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":343.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":832.65,"additional_payer_notes":"APC"}]}]},{"description":"Mr Angiography Neck W/Dye","code_information":[{"code":"70548","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":333.46,"maximum":832.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":333.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":340.13,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":336.8,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":343.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":832.65,"additional_payer_notes":"APC"}]}]},{"description":"Mr angiograph neck w/o&w/dye","code_information":[{"code":"70549","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":333.46,"maximum":832.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":333.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":340.13,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":336.8,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":343.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":832.65,"additional_payer_notes":"APC"}]}]},{"description":"Mri brain stem w/dye","code_information":[{"code":"70552","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":333.46,"maximum":832.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":333.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":340.13,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":336.8,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":343.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":832.65,"additional_payer_notes":"APC"}]}]},{"description":"Mri brain stem w/o & w/dye","code_information":[{"code":"70553","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":333.46,"maximum":832.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":333.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":340.13,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":336.8,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":343.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":832.65,"additional_payer_notes":"APC"}]}]},{"description":"Mri chest w/o & w/dye","code_information":[{"code":"71552","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":333.46,"maximum":832.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":333.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":340.13,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":336.8,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":343.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":832.65,"additional_payer_notes":"APC"}]}]},{"description":"Ct neck spine w/dye","code_information":[{"code":"72126","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":333.46,"maximum":832.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":333.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":340.13,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":336.8,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":343.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":832.65,"additional_payer_notes":"APC"}]}]},{"description":"Ct lumbar spine w/dye","code_information":[{"code":"72132","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":333.46,"maximum":832.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":333.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":340.13,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":336.8,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":343.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":832.65,"additional_payer_notes":"APC"}]}]},{"description":"Mri neck spine w/dye","code_information":[{"code":"72142","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":333.46,"maximum":832.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":333.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":340.13,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":336.8,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":343.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":832.65,"additional_payer_notes":"APC"}]}]},{"description":"Mri chest spine w/dye","code_information":[{"code":"72147","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":333.46,"maximum":832.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":333.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":340.13,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":336.8,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":343.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":832.65,"additional_payer_notes":"APC"}]}]},{"description":"Mri lumbar spine w/dye","code_information":[{"code":"72149","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":333.46,"maximum":832.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":333.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":340.13,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":336.8,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":343.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":832.65,"additional_payer_notes":"APC"}]}]},{"description":"Mri neck spine w/o & w/dye","code_information":[{"code":"72156","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":333.46,"maximum":832.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":333.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":340.13,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":336.8,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":343.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":832.65,"additional_payer_notes":"APC"}]}]},{"description":"Mri chest spine w/o & w/dye","code_information":[{"code":"72157","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":333.46,"maximum":832.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":333.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":340.13,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":336.8,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":343.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":832.65,"additional_payer_notes":"APC"}]}]},{"description":"Mri lumbar spine w/o & w/dye","code_information":[{"code":"72158","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":333.46,"maximum":832.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":333.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":340.13,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":336.8,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":343.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":832.65,"additional_payer_notes":"APC"}]}]},{"description":"Mri pelvis w/dye","code_information":[{"code":"72196","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":333.46,"maximum":832.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":333.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":340.13,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":336.8,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":343.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":832.65,"additional_payer_notes":"APC"}]}]},{"description":"Mri pelvis w/o & w/dye","code_information":[{"code":"72197","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":333.46,"maximum":832.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":333.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":340.13,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":336.8,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":343.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":832.65,"additional_payer_notes":"APC"}]}]},{"description":"Contrast x-ray of shoulder","code_information":[{"code":"73040","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":333.46,"maximum":832.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":333.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":340.13,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":336.8,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":343.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":832.65,"additional_payer_notes":"APC"}]}]},{"description":"Contrast x-ray of elbow","code_information":[{"code":"73085","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":333.46,"maximum":832.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":333.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":340.13,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":336.8,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":343.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":832.65,"additional_payer_notes":"APC"}]}]},{"description":"Contrast x-ray of wrist","code_information":[{"code":"73115","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":333.46,"maximum":832.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":333.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":340.13,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":336.8,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":343.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":832.65,"additional_payer_notes":"APC"}]}]},{"description":"Ct upper extremity w/dye","code_information":[{"code":"73201","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":333.46,"maximum":832.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":333.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":340.13,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":336.8,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":343.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":832.65,"additional_payer_notes":"APC"}]}]},{"description":"Mri Upper Extremity W/Dye","code_information":[{"code":"73219","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":333.46,"maximum":832.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":333.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":340.13,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":336.8,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":343.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":832.65,"additional_payer_notes":"APC"}]}]},{"description":"Mri uppr extremity w/o&w/dye","code_information":[{"code":"73220","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":333.46,"maximum":832.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":333.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":340.13,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":336.8,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":343.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":832.65,"additional_payer_notes":"APC"}]}]},{"description":"Mri joint upr extr w/o&w/dye","code_information":[{"code":"73223","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":333.46,"maximum":832.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":333.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":340.13,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":336.8,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":343.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":832.65,"additional_payer_notes":"APC"}]}]},{"description":"Contrast x-ray of hip","code_information":[{"code":"73525","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":333.46,"maximum":832.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":333.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":340.13,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":336.8,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":343.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":832.65,"additional_payer_notes":"APC"}]}]},{"description":"Contrast x-ray of knee joint","code_information":[{"code":"73580","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":333.46,"maximum":832.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":333.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":340.13,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":336.8,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":343.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":832.65,"additional_payer_notes":"APC"}]}]},{"description":"Contrast x-ray of ankle","code_information":[{"code":"73615","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":333.46,"maximum":832.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":333.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":340.13,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":336.8,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":343.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":832.65,"additional_payer_notes":"APC"}]}]},{"description":"Mri Lower Extremity W/Dye","code_information":[{"code":"73719","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":333.46,"maximum":832.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":333.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":340.13,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":336.8,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":343.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":832.65,"additional_payer_notes":"APC"}]}]},{"description":"Mri lwr extremity w/o&w/dye","code_information":[{"code":"73720","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":333.46,"maximum":832.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":333.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":340.13,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":336.8,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":343.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":832.65,"additional_payer_notes":"APC"}]}]},{"description":"Mri joint lwr extr w/o&w/dye","code_information":[{"code":"73723","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":333.46,"maximum":832.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":333.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":340.13,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":336.8,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":343.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":832.65,"additional_payer_notes":"APC"}]}]},{"description":"Ct angio abd&pelv w/o&w/dye","code_information":[{"code":"74174","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":333.46,"maximum":832.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":333.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":340.13,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":336.8,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":343.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":832.65,"additional_payer_notes":"APC"}]}]},{"description":"Ct abd & pelv w/contrast","code_information":[{"code":"74177","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":333.46,"maximum":832.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":333.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":340.13,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":336.8,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":343.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":832.65,"additional_payer_notes":"APC"}]}]},{"description":"Ct abd & pelv 1/> regns","code_information":[{"code":"74178","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":333.46,"maximum":832.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":333.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":340.13,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":336.8,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":343.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":832.65,"additional_payer_notes":"APC"}]}]},{"description":"Mri Abdomen W/Dye","code_information":[{"code":"74182","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":333.46,"maximum":832.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":333.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":340.13,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":336.8,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":343.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":832.65,"additional_payer_notes":"APC"}]}]},{"description":"Mri abdomen w/o & w/dye","code_information":[{"code":"74183","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":333.46,"maximum":832.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":333.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":340.13,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":336.8,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":343.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":832.65,"additional_payer_notes":"APC"}]}]},{"description":"Contrst x-ray urinary tract","code_information":[{"code":"74420","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":333.46,"maximum":832.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":333.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":340.13,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":336.8,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":343.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":832.65,"additional_payer_notes":"APC"}]}]},{"description":"Contrst x-ray urinary tract","code_information":[{"code":"74425","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":333.46,"maximum":832.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":333.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":340.13,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":336.8,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":343.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":832.65,"additional_payer_notes":"APC"}]}]},{"description":"Contrast x-ray bladder","code_information":[{"code":"74430","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":333.46,"maximum":832.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":333.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":340.13,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":336.8,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":343.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":832.65,"additional_payer_notes":"APC"}]}]},{"description":"Cardiac mri for morph w/dye","code_information":[{"code":"75561","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":333.46,"maximum":832.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":333.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":340.13,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":336.8,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":343.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":832.65,"additional_payer_notes":"APC"}]}]},{"description":"Ct hrt w/3d image","code_information":[{"code":"75572","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":333.46,"maximum":832.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":333.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":340.13,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":336.8,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":343.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":832.65,"additional_payer_notes":"APC"}]}]},{"description":"Ct hrt w/3d image congen","code_information":[{"code":"75573","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":333.46,"maximum":832.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":333.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":340.13,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":336.8,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":343.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":832.65,"additional_payer_notes":"APC"}]}]},{"description":"Ct angio hrt w/3d image","code_information":[{"code":"75574","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":333.46,"maximum":832.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":333.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":340.13,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":336.8,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":343.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":832.65,"additional_payer_notes":"APC"}]}]},{"description":"Us trgt dyn mbubb 1st les","code_information":[{"code":"76978","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":333.46,"maximum":832.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":333.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":340.13,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":336.8,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":343.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":832.65,"additional_payer_notes":"APC"}]}]},{"description":"Mra w/cont, abd","code_information":[{"code":"C8900","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":333.46,"maximum":832.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":333.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":340.13,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":336.8,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":343.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":832.65,"additional_payer_notes":"APC"}]}]},{"description":"Mra w/o fol w/cont, abd","code_information":[{"code":"C8902","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":333.46,"maximum":832.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":333.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":340.13,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":336.8,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":343.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":832.65,"additional_payer_notes":"APC"}]}]},{"description":"Mri w/o fol w/cont, brst, un","code_information":[{"code":"C8905","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":333.46,"maximum":832.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":333.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":340.13,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":336.8,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":343.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":832.65,"additional_payer_notes":"APC"}]}]},{"description":"Mri w/cont, breast,  bi","code_information":[{"code":"C8906","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":333.46,"maximum":832.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":333.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":340.13,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":336.8,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":343.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":832.65,"additional_payer_notes":"APC"}]}]},{"description":"Mri w/o fol w/cont, breast,","code_information":[{"code":"C8908","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":333.46,"maximum":832.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":333.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":340.13,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":336.8,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":343.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":832.65,"additional_payer_notes":"APC"}]}]},{"description":"MRA w/cont, chest","code_information":[{"code":"C8909","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":333.46,"maximum":832.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":333.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":340.13,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":336.8,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":343.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":832.65,"additional_payer_notes":"APC"}]}]},{"description":"MRA w/o fol w/cont, chest","code_information":[{"code":"C8911","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":333.46,"maximum":832.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":333.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":340.13,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":336.8,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":343.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":832.65,"additional_payer_notes":"APC"}]}]},{"description":"Mra w/cont, lwr ext","code_information":[{"code":"C8912","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":333.46,"maximum":832.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":333.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":340.13,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":336.8,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":343.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":832.65,"additional_payer_notes":"APC"}]}]},{"description":"Mra w/o fol w/cont, lwr ext","code_information":[{"code":"C8914","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":333.46,"maximum":832.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":333.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":340.13,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":336.8,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":343.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":832.65,"additional_payer_notes":"APC"}]}]},{"description":"MRA w/cont, pelvis","code_information":[{"code":"C8918","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":333.46,"maximum":832.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":333.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":340.13,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":336.8,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":343.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":832.65,"additional_payer_notes":"APC"}]}]},{"description":"Mra w/o fol w/cont, pelvis","code_information":[{"code":"C8920","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":333.46,"maximum":832.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":333.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":340.13,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":336.8,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":343.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":832.65,"additional_payer_notes":"APC"}]}]},{"description":"2d tte w or w/o fol w/con,fu","code_information":[{"code":"C8924","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":333.46,"maximum":832.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":333.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":340.13,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":336.8,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":343.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":832.65,"additional_payer_notes":"APC"}]}]},{"description":"MRA, w/dye, spinal canal","code_information":[{"code":"C8931","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":333.46,"maximum":832.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":333.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":340.13,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":336.8,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":343.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":832.65,"additional_payer_notes":"APC"}]}]},{"description":"MRA, w/o&w/dye, spinal canal","code_information":[{"code":"C8933","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":333.46,"maximum":832.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":333.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":340.13,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":336.8,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":343.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":832.65,"additional_payer_notes":"APC"}]}]},{"description":"MRA, w/dye, upper extremity","code_information":[{"code":"C8934","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":333.46,"maximum":832.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":333.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":340.13,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":336.8,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":343.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":832.65,"additional_payer_notes":"APC"}]}]},{"description":"MRA, w/o&w/dye, upper extr","code_information":[{"code":"C8936","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":333.46,"maximum":832.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":333.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":340.13,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":336.8,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":343.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":832.65,"additional_payer_notes":"APC"}]}]},{"description":"Non-ophthalmic FVA","code_information":[{"code":"C9733","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":333.46,"maximum":832.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":333.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":340.13,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":336.8,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":343.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":832.65,"additional_payer_notes":"APC"}]}]},{"description":"Myelography lumbar injection","code_information":[{"code":"62302","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":749.29,"maximum":1870.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":749.29,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":764.28,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":756.78,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":771.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1870.98,"additional_payer_notes":"APC"}]}]},{"description":"Myelography lumbar injection","code_information":[{"code":"62303","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":749.29,"maximum":1870.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":749.29,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":764.28,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":756.78,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":771.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1870.98,"additional_payer_notes":"APC"}]}]},{"description":"Myelography lumbar injection","code_information":[{"code":"62304","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":749.29,"maximum":1870.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":749.29,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":764.28,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":756.78,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":771.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1870.98,"additional_payer_notes":"APC"}]}]},{"description":"Myelography lumbar injection","code_information":[{"code":"62305","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":749.29,"maximum":1870.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":749.29,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":764.28,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":756.78,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":771.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1870.98,"additional_payer_notes":"APC"}]}]},{"description":"Contrast x-ray of brain","code_information":[{"code":"70015","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":749.29,"maximum":1870.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":749.29,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":764.28,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":756.78,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":771.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1870.98,"additional_payer_notes":"APC"}]}]},{"description":"Mri Chest W/Dye","code_information":[{"code":"71551","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":749.29,"maximum":1870.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":749.29,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":764.28,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":756.78,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":771.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1870.98,"additional_payer_notes":"APC"}]}]},{"description":"Myelography neck spine","code_information":[{"code":"72240","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":749.29,"maximum":1870.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":749.29,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":764.28,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":756.78,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":771.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1870.98,"additional_payer_notes":"APC"}]}]},{"description":"Myelography thoracic spine","code_information":[{"code":"72255","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":749.29,"maximum":1870.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":749.29,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":764.28,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":756.78,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":771.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1870.98,"additional_payer_notes":"APC"}]}]},{"description":"Myelography l-s spine","code_information":[{"code":"72265","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":749.29,"maximum":1870.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":749.29,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":764.28,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":756.78,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":771.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1870.98,"additional_payer_notes":"APC"}]}]},{"description":"Myelogphy 2/> spine regions","code_information":[{"code":"72270","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":749.29,"maximum":1870.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":749.29,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":764.28,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":756.78,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":771.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1870.98,"additional_payer_notes":"APC"}]}]},{"description":"Mri joint upr extrem w/dye","code_information":[{"code":"73222","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":749.29,"maximum":1870.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":749.29,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":764.28,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":756.78,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":771.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1870.98,"additional_payer_notes":"APC"}]}]},{"description":"Mri Joint Of Lwr Extr W/Dye","code_information":[{"code":"73722","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":749.29,"maximum":1870.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":749.29,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":764.28,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":756.78,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":771.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1870.98,"additional_payer_notes":"APC"}]}]},{"description":"Card mri w/stress img & dye","code_information":[{"code":"75563","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":749.29,"maximum":1870.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":749.29,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":764.28,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":756.78,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":771.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1870.98,"additional_payer_notes":"APC"}]}]},{"description":"Tte w or w/o fol w/cont, com","code_information":[{"code":"C8921","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":749.29,"maximum":1870.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":749.29,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":764.28,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":756.78,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":771.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1870.98,"additional_payer_notes":"APC"}]}]},{"description":"Tte w or w/o fol w/cont, f/u","code_information":[{"code":"C8922","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":749.29,"maximum":1870.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":749.29,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":764.28,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":756.78,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":771.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1870.98,"additional_payer_notes":"APC"}]}]},{"description":"2d tte w or w/o fol w/con,co","code_information":[{"code":"C8923","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":749.29,"maximum":1870.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":749.29,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":764.28,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":756.78,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":771.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1870.98,"additional_payer_notes":"APC"}]}]},{"description":"2d tee w or w/o fol w/con,in","code_information":[{"code":"C8925","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":749.29,"maximum":1870.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":749.29,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":764.28,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":756.78,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":771.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1870.98,"additional_payer_notes":"APC"}]}]},{"description":"Tee w or w/o fol w/cont,cong","code_information":[{"code":"C8926","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":749.29,"maximum":1870.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":749.29,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":764.28,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":756.78,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":771.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1870.98,"additional_payer_notes":"APC"}]}]},{"description":"TEE w or w/o fol w/cont, mon","code_information":[{"code":"C8927","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":749.29,"maximum":1870.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":749.29,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":764.28,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":756.78,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":771.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1870.98,"additional_payer_notes":"APC"}]}]},{"description":"Tte w or w/o fol w/con,stres","code_information":[{"code":"C8928","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":749.29,"maximum":1870.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":749.29,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":764.28,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":756.78,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":771.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1870.98,"additional_payer_notes":"APC"}]}]},{"description":"TTE w or wo fol wcon,Doppler","code_information":[{"code":"C8929","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":749.29,"maximum":1870.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":749.29,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":764.28,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":756.78,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":771.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1870.98,"additional_payer_notes":"APC"}]}]},{"description":"TTE w or w/o contr, cont ECG","code_information":[{"code":"C8930","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":749.29,"maximum":1870.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":749.29,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":764.28,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":756.78,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":771.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1870.98,"additional_payer_notes":"APC"}]}]},{"description":"Ra tracer id of sentinl node","code_information":[{"code":"38792","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":382.11,"maximum":954.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":382.11,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":389.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":385.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":393.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":954.13,"additional_payer_notes":"APC"}]}]},{"description":"Thyroid uptake measurement","code_information":[{"code":"78012","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":382.11,"maximum":954.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":382.11,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":389.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":385.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":393.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":954.13,"additional_payer_notes":"APC"}]}]},{"description":"Thyroid imaging w/blood flow","code_information":[{"code":"78013","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":382.11,"maximum":954.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":382.11,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":389.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":385.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":393.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":954.13,"additional_payer_notes":"APC"}]}]},{"description":"Thyroid imaging w/blood flow","code_information":[{"code":"78014","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":382.11,"maximum":954.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":382.11,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":389.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":385.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":393.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":954.13,"additional_payer_notes":"APC"}]}]},{"description":"Thyroid met imaging","code_information":[{"code":"78015","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":382.11,"maximum":954.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":382.11,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":389.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":385.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":393.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":954.13,"additional_payer_notes":"APC"}]}]},{"description":"Thyroid met imaging/studies","code_information":[{"code":"78016","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":382.11,"maximum":954.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":382.11,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":389.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":385.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":393.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":954.13,"additional_payer_notes":"APC"}]}]},{"description":"Parathyroid planar imaging","code_information":[{"code":"78070","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":382.11,"maximum":954.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":382.11,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":389.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":385.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":393.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":954.13,"additional_payer_notes":"APC"}]}]},{"description":"Parathyrd planar w/wo subtrj","code_information":[{"code":"78071","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":382.11,"maximum":954.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":382.11,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":389.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":385.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":393.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":954.13,"additional_payer_notes":"APC"}]}]},{"description":"Endocrine nuclear procedure","code_information":[{"code":"78099","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":382.11,"maximum":954.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":382.11,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":389.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":385.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":393.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":954.13,"additional_payer_notes":"APC"}]}]},{"description":"Bone marrow imaging ltd","code_information":[{"code":"78102","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":382.11,"maximum":954.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":382.11,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":389.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":385.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":393.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":954.13,"additional_payer_notes":"APC"}]}]},{"description":"Bone marrow imaging mult","code_information":[{"code":"78103","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":382.11,"maximum":954.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":382.11,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":389.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":385.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":393.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":954.13,"additional_payer_notes":"APC"}]}]},{"description":"Bone marrow imaging body","code_information":[{"code":"78104","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":382.11,"maximum":954.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":382.11,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":389.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":385.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":393.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":954.13,"additional_payer_notes":"APC"}]}]},{"description":"Red cell mass single","code_information":[{"code":"78120","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":382.11,"maximum":954.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":382.11,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":389.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":385.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":393.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":954.13,"additional_payer_notes":"APC"}]}]},{"description":"Red cell survival study","code_information":[{"code":"78130","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":382.11,"maximum":954.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":382.11,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":389.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":385.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":393.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":954.13,"additional_payer_notes":"APC"}]}]},{"description":"Red cell sequestration","code_information":[{"code":"78140","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":382.11,"maximum":954.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":382.11,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":389.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":385.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":393.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":954.13,"additional_payer_notes":"APC"}]}]},{"description":"Spleen imaging","code_information":[{"code":"78185","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":382.11,"maximum":954.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":382.11,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":389.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":385.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":393.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":954.13,"additional_payer_notes":"APC"}]}]},{"description":"Platelet survival","code_information":[{"code":"78191","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":382.11,"maximum":954.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":382.11,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":389.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":385.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":393.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":954.13,"additional_payer_notes":"APC"}]}]},{"description":"Blood/lymph nuclear exam","code_information":[{"code":"78199","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":382.11,"maximum":954.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":382.11,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":389.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":385.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":393.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":954.13,"additional_payer_notes":"APC"}]}]},{"description":"Liver and spleen imaging","code_information":[{"code":"78215","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":382.11,"maximum":954.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":382.11,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":389.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":385.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":393.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":954.13,"additional_payer_notes":"APC"}]}]},{"description":"Liver & spleen image/flow","code_information":[{"code":"78216","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":382.11,"maximum":954.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":382.11,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":389.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":385.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":393.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":954.13,"additional_payer_notes":"APC"}]}]},{"description":"Hepatobiliary system imaging","code_information":[{"code":"78226","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":382.11,"maximum":954.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":382.11,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":389.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":385.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":393.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":954.13,"additional_payer_notes":"APC"}]}]},{"description":"Salivary gland imaging","code_information":[{"code":"78230","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":382.11,"maximum":954.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":382.11,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":389.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":385.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":393.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":954.13,"additional_payer_notes":"APC"}]}]},{"description":"Serial salivary imaging","code_information":[{"code":"78231","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":382.11,"maximum":954.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":382.11,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":389.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":385.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":393.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":954.13,"additional_payer_notes":"APC"}]}]},{"description":"Salivary gland function exam","code_information":[{"code":"78232","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":382.11,"maximum":954.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":382.11,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":389.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":385.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":393.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":954.13,"additional_payer_notes":"APC"}]}]},{"description":"Esophageal motility study","code_information":[{"code":"78258","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":382.11,"maximum":954.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":382.11,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":389.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":385.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":393.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":954.13,"additional_payer_notes":"APC"}]}]},{"description":"Gastric mucosa imaging","code_information":[{"code":"78261","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":382.11,"maximum":954.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":382.11,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":389.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":385.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":393.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":954.13,"additional_payer_notes":"APC"}]}]},{"description":"Gastroesophageal reflux exam","code_information":[{"code":"78262","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":382.11,"maximum":954.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":382.11,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":389.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":385.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":393.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":954.13,"additional_payer_notes":"APC"}]}]},{"description":"Gastric emptying imag study","code_information":[{"code":"78264","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":382.11,"maximum":954.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":382.11,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":389.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":385.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":393.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":954.13,"additional_payer_notes":"APC"}]}]},{"description":"Gastric emptying imag study","code_information":[{"code":"78265","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":382.11,"maximum":954.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":382.11,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":389.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":385.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":393.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":954.13,"additional_payer_notes":"APC"}]}]},{"description":"Acute GI blood loss imaging","code_information":[{"code":"78278","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":382.11,"maximum":954.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":382.11,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":389.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":385.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":393.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":954.13,"additional_payer_notes":"APC"}]}]},{"description":"GI protein loss exam","code_information":[{"code":"78282","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":382.11,"maximum":954.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":382.11,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":389.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":385.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":393.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":954.13,"additional_payer_notes":"APC"}]}]},{"description":"Meckels divert exam","code_information":[{"code":"78290","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":382.11,"maximum":954.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":382.11,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":389.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":385.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":393.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":954.13,"additional_payer_notes":"APC"}]}]},{"description":"Leveen/shunt patency exam","code_information":[{"code":"78291","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":382.11,"maximum":954.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":382.11,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":389.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":385.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":393.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":954.13,"additional_payer_notes":"APC"}]}]},{"description":"GI nuclear procedure","code_information":[{"code":"78299","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":382.11,"maximum":954.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":382.11,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":389.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":385.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":393.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":954.13,"additional_payer_notes":"APC"}]}]},{"description":"Bone imaging limited area","code_information":[{"code":"78300","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":382.11,"maximum":954.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":382.11,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":389.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":385.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":393.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":954.13,"additional_payer_notes":"APC"}]}]},{"description":"Bone imaging multiple areas","code_information":[{"code":"78305","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":382.11,"maximum":954.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":382.11,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":389.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":385.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":393.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":954.13,"additional_payer_notes":"APC"}]}]},{"description":"Bone imaging whole body","code_information":[{"code":"78306","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":382.11,"maximum":954.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":382.11,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":389.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":385.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":393.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":954.13,"additional_payer_notes":"APC"}]}]},{"description":"Bone imaging 3 phase","code_information":[{"code":"78315","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":382.11,"maximum":954.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":382.11,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":389.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":385.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":393.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":954.13,"additional_payer_notes":"APC"}]}]},{"description":"Musculoskeletal nuclear exam","code_information":[{"code":"78399","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":382.11,"maximum":954.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":382.11,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":389.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":385.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":393.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":954.13,"additional_payer_notes":"APC"}]}]},{"description":"Cardiac shunt imaging","code_information":[{"code":"78428","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":382.11,"maximum":954.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":382.11,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":389.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":385.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":393.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":954.13,"additional_payer_notes":"APC"}]}]},{"description":"Vascular flow imaging","code_information":[{"code":"78445","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":382.11,"maximum":954.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":382.11,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":389.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":385.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":393.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":954.13,"additional_payer_notes":"APC"}]}]},{"description":"Ven thrombosis images bilat","code_information":[{"code":"78458","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":382.11,"maximum":954.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":382.11,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":389.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":385.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":393.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":954.13,"additional_payer_notes":"APC"}]}]},{"description":"Heart infarct image","code_information":[{"code":"78466","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":382.11,"maximum":954.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":382.11,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":389.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":385.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":393.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":954.13,"additional_payer_notes":"APC"}]}]},{"description":"Gated heart planar single","code_information":[{"code":"78472","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":382.11,"maximum":954.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":382.11,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":389.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":385.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":393.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":954.13,"additional_payer_notes":"APC"}]}]},{"description":"Gated heart multiple","code_information":[{"code":"78473","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":382.11,"maximum":954.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":382.11,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":389.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":385.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":393.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":954.13,"additional_payer_notes":"APC"}]}]},{"description":"Heart image spect","code_information":[{"code":"78494","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":382.11,"maximum":954.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":382.11,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":389.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":385.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":393.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":954.13,"additional_payer_notes":"APC"}]}]},{"description":"Cardiovascular nuclear exam","code_information":[{"code":"78499","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":382.11,"maximum":954.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":382.11,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":389.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":385.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":393.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":954.13,"additional_payer_notes":"APC"}]}]},{"description":"Lung ventilation imaging","code_information":[{"code":"78579","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":382.11,"maximum":954.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":382.11,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":389.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":385.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":393.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":954.13,"additional_payer_notes":"APC"}]}]},{"description":"Lung perfusion imaging","code_information":[{"code":"78580","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":382.11,"maximum":954.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":382.11,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":389.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":385.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":393.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":954.13,"additional_payer_notes":"APC"}]}]},{"description":"Lung perfusion differential","code_information":[{"code":"78597","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":382.11,"maximum":954.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":382.11,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":389.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":385.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":393.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":954.13,"additional_payer_notes":"APC"}]}]},{"description":"Respiratory nuclear exam","code_information":[{"code":"78599","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":382.11,"maximum":954.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":382.11,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":389.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":385.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":393.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":954.13,"additional_payer_notes":"APC"}]}]},{"description":"Brain image < 4 views","code_information":[{"code":"78600","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":382.11,"maximum":954.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":382.11,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":389.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":385.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":393.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":954.13,"additional_payer_notes":"APC"}]}]},{"description":"Brain image w/flow < 4 views","code_information":[{"code":"78601","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":382.11,"maximum":954.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":382.11,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":389.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":385.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":393.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":954.13,"additional_payer_notes":"APC"}]}]},{"description":"Nuclear exam of tear flow","code_information":[{"code":"78660","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":382.11,"maximum":954.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":382.11,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":389.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":385.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":393.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":954.13,"additional_payer_notes":"APC"}]}]},{"description":"Nervous system nuclear exam","code_information":[{"code":"78699","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":382.11,"maximum":954.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":382.11,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":389.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":385.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":393.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":954.13,"additional_payer_notes":"APC"}]}]},{"description":"Kidney imaging morphol","code_information":[{"code":"78700","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":382.11,"maximum":954.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":382.11,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":389.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":385.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":393.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":954.13,"additional_payer_notes":"APC"}]}]},{"description":"Kidney imaging with flow","code_information":[{"code":"78701","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":382.11,"maximum":954.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":382.11,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":389.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":385.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":393.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":954.13,"additional_payer_notes":"APC"}]}]},{"description":"Kidney function study","code_information":[{"code":"78725","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":382.11,"maximum":954.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":382.11,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":389.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":385.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":393.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":954.13,"additional_payer_notes":"APC"}]}]},{"description":"Ureteral reflux study","code_information":[{"code":"78740","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":382.11,"maximum":954.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":382.11,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":389.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":385.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":393.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":954.13,"additional_payer_notes":"APC"}]}]},{"description":"Testicular imaging w/flow","code_information":[{"code":"78761","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":382.11,"maximum":954.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":382.11,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":389.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":385.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":393.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":954.13,"additional_payer_notes":"APC"}]}]},{"description":"Genitourinary nuclear exam","code_information":[{"code":"78799","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":382.11,"maximum":954.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":382.11,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":389.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":385.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":393.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":954.13,"additional_payer_notes":"APC"}]}]},{"description":"Tumor imaging limited area","code_information":[{"code":"78800","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":382.11,"maximum":954.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":382.11,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":389.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":385.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":393.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":954.13,"additional_payer_notes":"APC"}]}]},{"description":"Tumor imaging mult areas","code_information":[{"code":"78801","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":382.11,"maximum":954.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":382.11,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":389.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":385.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":393.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":954.13,"additional_payer_notes":"APC"}]}]},{"description":"Iv inj ra drug dx study","code_information":[{"code":"78808","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":382.11,"maximum":954.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":382.11,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":389.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":385.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":393.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":954.13,"additional_payer_notes":"APC"}]}]},{"description":"Nuclear diagnostic exam","code_information":[{"code":"78999","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":382.11,"maximum":954.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":382.11,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":389.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":385.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":393.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":954.13,"additional_payer_notes":"APC"}]}]},{"description":"PET not otherwise specified","code_information":[{"code":"G0235","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":382.11,"maximum":954.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":382.11,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":389.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":385.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":393.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":954.13,"additional_payer_notes":"APC"}]}]},{"description":"Thyroid met imaging body","code_information":[{"code":"78018","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":518.98,"maximum":1295.90,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":518.98,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":529.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":524.17,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":534.55,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1295.9,"additional_payer_notes":"APC"}]}]},{"description":"Parathyrd planar w/spect&ct","code_information":[{"code":"78072","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":518.98,"maximum":1295.90,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":518.98,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":529.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":524.17,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":534.55,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1295.9,"additional_payer_notes":"APC"}]}]},{"description":"Red cell mass multiple","code_information":[{"code":"78121","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":518.98,"maximum":1295.90,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":518.98,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":529.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":524.17,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":534.55,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1295.9,"additional_payer_notes":"APC"}]}]},{"description":"Blood volume","code_information":[{"code":"78122","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":518.98,"maximum":1295.90,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":518.98,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":529.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":524.17,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":534.55,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1295.9,"additional_payer_notes":"APC"}]}]},{"description":"Lymph system imaging","code_information":[{"code":"78195","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":518.98,"maximum":1295.90,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":518.98,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":529.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":524.17,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":534.55,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1295.9,"additional_payer_notes":"APC"}]}]},{"description":"Liver imaging","code_information":[{"code":"78201","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":518.98,"maximum":1295.90,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":518.98,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":529.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":524.17,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":534.55,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1295.9,"additional_payer_notes":"APC"}]}]},{"description":"Liver imaging with flow","code_information":[{"code":"78202","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":518.98,"maximum":1295.90,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":518.98,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":529.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":524.17,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":534.55,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1295.9,"additional_payer_notes":"APC"}]}]},{"description":"Hepatobil syst image w/drug","code_information":[{"code":"78227","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":518.98,"maximum":1295.90,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":518.98,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":529.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":524.17,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":534.55,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1295.9,"additional_payer_notes":"APC"}]}]},{"description":"Gastric emptying imag study","code_information":[{"code":"78266","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":518.98,"maximum":1295.90,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":518.98,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":529.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":524.17,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":534.55,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1295.9,"additional_payer_notes":"APC"}]}]},{"description":"Non-imaging heart function","code_information":[{"code":"78414","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":518.98,"maximum":1295.90,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":518.98,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":529.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":524.17,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":534.55,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1295.9,"additional_payer_notes":"APC"}]}]},{"description":"Venous thrombosis imaging","code_information":[{"code":"78457","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":518.98,"maximum":1295.90,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":518.98,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":529.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":524.17,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":534.55,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1295.9,"additional_payer_notes":"APC"}]}]},{"description":"Heart infarct image (ef)","code_information":[{"code":"78468","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":518.98,"maximum":1295.90,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":518.98,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":529.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":524.17,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":534.55,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1295.9,"additional_payer_notes":"APC"}]}]},{"description":"Heart infarct image (3D)","code_information":[{"code":"78469","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":518.98,"maximum":1295.90,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":518.98,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":529.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":524.17,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":534.55,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1295.9,"additional_payer_notes":"APC"}]}]},{"description":"Heart first pass single","code_information":[{"code":"78481","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":518.98,"maximum":1295.90,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":518.98,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":529.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":524.17,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":534.55,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1295.9,"additional_payer_notes":"APC"}]}]},{"description":"Heart first pass multiple","code_information":[{"code":"78483","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":518.98,"maximum":1295.90,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":518.98,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":529.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":524.17,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":534.55,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1295.9,"additional_payer_notes":"APC"}]}]},{"description":"Lung ventilat&perfus imaging","code_information":[{"code":"78582","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":518.98,"maximum":1295.90,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":518.98,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":529.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":524.17,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":534.55,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1295.9,"additional_payer_notes":"APC"}]}]},{"description":"Lung perf&ventilat diferentl","code_information":[{"code":"78598","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":518.98,"maximum":1295.90,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":518.98,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":529.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":524.17,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":534.55,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1295.9,"additional_payer_notes":"APC"}]}]},{"description":"Brain image 4+ views","code_information":[{"code":"78605","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":518.98,"maximum":1295.90,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":518.98,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":529.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":524.17,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":534.55,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1295.9,"additional_payer_notes":"APC"}]}]},{"description":"Brain image w/flow 4 + views","code_information":[{"code":"78606","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":518.98,"maximum":1295.90,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":518.98,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":529.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":524.17,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":534.55,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1295.9,"additional_payer_notes":"APC"}]}]},{"description":"Brain flow imaging only","code_information":[{"code":"78610","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":518.98,"maximum":1295.90,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":518.98,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":529.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":524.17,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":534.55,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1295.9,"additional_payer_notes":"APC"}]}]},{"description":"Cerebrospinal fluid scan","code_information":[{"code":"78630","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":518.98,"maximum":1295.90,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":518.98,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":529.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":524.17,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":534.55,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1295.9,"additional_payer_notes":"APC"}]}]},{"description":"CSF ventriculography","code_information":[{"code":"78635","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":518.98,"maximum":1295.90,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":518.98,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":529.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":524.17,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":534.55,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1295.9,"additional_payer_notes":"APC"}]}]},{"description":"CSF shunt evaluation","code_information":[{"code":"78645","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":518.98,"maximum":1295.90,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":518.98,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":529.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":524.17,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":534.55,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1295.9,"additional_payer_notes":"APC"}]}]},{"description":"K flow/funct image w/o drug","code_information":[{"code":"78707","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":518.98,"maximum":1295.90,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":518.98,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":529.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":524.17,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":534.55,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1295.9,"additional_payer_notes":"APC"}]}]},{"description":"K flow/funct image w/drug","code_information":[{"code":"78708","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":518.98,"maximum":1295.90,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":518.98,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":529.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":524.17,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":534.55,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1295.9,"additional_payer_notes":"APC"}]}]},{"description":"K flow/funct image multiple","code_information":[{"code":"78709","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":518.98,"maximum":1295.90,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":518.98,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":529.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":524.17,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":534.55,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1295.9,"additional_payer_notes":"APC"}]}]},{"description":"Tumor imaging whole body","code_information":[{"code":"78802","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":518.98,"maximum":1295.90,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":518.98,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":529.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":524.17,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":534.55,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1295.9,"additional_payer_notes":"APC"}]}]},{"description":"Tumor imaging (3D)","code_information":[{"code":"78803","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":518.98,"maximum":1295.90,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":518.98,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":529.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":524.17,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":534.55,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1295.9,"additional_payer_notes":"APC"}]}]},{"description":"Tumor imaging whole body","code_information":[{"code":"78804","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":518.98,"maximum":1295.90,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":518.98,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":529.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":524.17,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":534.55,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1295.9,"additional_payer_notes":"APC"}]}]},{"description":"Heart symp image plnr","code_information":[{"code":"0331T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1237.46,"maximum":3089.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1237.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1262.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1249.83,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1274.58,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3089.93,"additional_payer_notes":"APC"}]}]},{"description":"Heart symp image plnr spect","code_information":[{"code":"0332T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1237.46,"maximum":3089.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1237.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1262.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1249.83,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1274.58,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3089.93,"additional_payer_notes":"APC"}]}]},{"description":"Adrenal cortex & medulla img","code_information":[{"code":"78075","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1237.46,"maximum":3089.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1237.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1262.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1249.83,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1274.58,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3089.93,"additional_payer_notes":"APC"}]}]},{"description":"Plasma volume single","code_information":[{"code":"78110","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1237.46,"maximum":3089.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1237.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1262.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1249.83,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1274.58,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3089.93,"additional_payer_notes":"APC"}]}]},{"description":"Plasma volume multiple","code_information":[{"code":"78111","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1237.46,"maximum":3089.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1237.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1262.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1249.83,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1274.58,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3089.93,"additional_payer_notes":"APC"}]}]},{"description":"Ht muscle image spect sing","code_information":[{"code":"78451","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1237.46,"maximum":3089.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1237.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1262.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1249.83,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1274.58,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3089.93,"additional_payer_notes":"APC"}]}]},{"description":"Ht muscle image spect mult","code_information":[{"code":"78452","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1237.46,"maximum":3089.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1237.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1262.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1249.83,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1274.58,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3089.93,"additional_payer_notes":"APC"}]}]},{"description":"Ht muscle image planar sing","code_information":[{"code":"78453","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1237.46,"maximum":3089.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1237.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1262.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1249.83,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1274.58,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3089.93,"additional_payer_notes":"APC"}]}]},{"description":"Ht musc image planar mult","code_information":[{"code":"78454","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1237.46,"maximum":3089.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1237.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1262.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1249.83,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1274.58,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3089.93,"additional_payer_notes":"APC"}]}]},{"description":"Acute venous thrombus image","code_information":[{"code":"78456","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1237.46,"maximum":3089.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1237.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1262.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1249.83,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1274.58,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3089.93,"additional_payer_notes":"APC"}]}]},{"description":"Heart muscle imaging (PET)","code_information":[{"code":"78459","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1237.46,"maximum":3089.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1237.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1262.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1249.83,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1274.58,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3089.93,"additional_payer_notes":"APC"}]}]},{"description":"CSF leakage imaging","code_information":[{"code":"78650","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1237.46,"maximum":3089.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1237.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1262.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1249.83,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1274.58,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3089.93,"additional_payer_notes":"APC"}]}]},{"description":"Pet image ltd area","code_information":[{"code":"78811","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1237.46,"maximum":3089.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1237.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1262.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1249.83,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1274.58,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3089.93,"additional_payer_notes":"APC"}]}]},{"description":"Rp loclzj tum spect w/ct 1","code_information":[{"code":"78830","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1237.46,"maximum":3089.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1237.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1262.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1249.83,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1274.58,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3089.93,"additional_payer_notes":"APC"}]}]},{"description":"Rp loclzj tum spect 2 areas","code_information":[{"code":"78831","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1237.46,"maximum":3089.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1237.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1262.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1249.83,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1274.58,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3089.93,"additional_payer_notes":"APC"}]}]},{"description":"Myocrd img pet 1 std w/ct","code_information":[{"code":"78429","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1366.78,"maximum":3412.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1366.78,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1394.11,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1380.45,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1407.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3412.85,"additional_payer_notes":"APC"}]}]},{"description":"Myocrd img pet rst/strs w/ct","code_information":[{"code":"78430","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1366.78,"maximum":3412.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1366.78,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1394.11,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1380.45,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1407.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3412.85,"additional_payer_notes":"APC"}]}]},{"description":"Heart image (pet) single","code_information":[{"code":"78491","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1366.78,"maximum":3412.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1366.78,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1394.11,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1380.45,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1407.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3412.85,"additional_payer_notes":"APC"}]}]},{"description":"Heart image (pet) multiple","code_information":[{"code":"78492","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1366.78,"maximum":3412.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1366.78,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1394.11,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1380.45,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1407.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3412.85,"additional_payer_notes":"APC"}]}]},{"description":"Brain imaging (PET)","code_information":[{"code":"78608","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1366.78,"maximum":3412.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1366.78,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1394.11,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1380.45,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1407.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3412.85,"additional_payer_notes":"APC"}]}]},{"description":"Pet image skull-thigh","code_information":[{"code":"78812","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1366.78,"maximum":3412.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1366.78,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1394.11,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1380.45,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1407.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3412.85,"additional_payer_notes":"APC"}]}]},{"description":"Pet image full body","code_information":[{"code":"78813","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1366.78,"maximum":3412.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1366.78,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1394.11,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1380.45,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1407.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3412.85,"additional_payer_notes":"APC"}]}]},{"description":"Pet image w/ct lmtd","code_information":[{"code":"78814","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1366.78,"maximum":3412.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1366.78,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1394.11,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1380.45,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1407.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3412.85,"additional_payer_notes":"APC"}]}]},{"description":"Pet image w/ct skull-thigh","code_information":[{"code":"78815","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1366.78,"maximum":3412.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1366.78,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1394.11,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1380.45,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1407.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3412.85,"additional_payer_notes":"APC"}]}]},{"description":"Pet image w/ct full body","code_information":[{"code":"78816","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1366.78,"maximum":3412.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1366.78,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1394.11,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1380.45,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1407.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3412.85,"additional_payer_notes":"APC"}]}]},{"description":"Rp loclzj tum spect w/ct 2","code_information":[{"code":"78832","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1366.78,"maximum":3412.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1366.78,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1394.11,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1380.45,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1407.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3412.85,"additional_payer_notes":"APC"}]}]},{"description":"Ins mark thor for rt perq","code_information":[{"code":"32553","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1322.98,"maximum":3303.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1322.98,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1349.44,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1336.21,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1362.67,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3303.49,"additional_payer_notes":"APC"}]}]},{"description":"Ins mark abd/pel for rt perq","code_information":[{"code":"49411","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1322.98,"maximum":3303.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1322.98,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1349.44,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1336.21,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1362.67,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3303.49,"additional_payer_notes":"APC"}]}]},{"description":"Place rt device/marker pros","code_information":[{"code":"55876","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1322.98,"maximum":3303.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1322.98,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1349.44,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1336.21,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1362.67,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3303.49,"additional_payer_notes":"APC"}]}]},{"description":"3-d radiotherapy plan","code_information":[{"code":"77295","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1322.98,"maximum":3303.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1322.98,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1349.44,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1336.21,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1362.67,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3303.49,"additional_payer_notes":"APC"}]}]},{"description":"Radiotherapy dose plan imrt","code_information":[{"code":"77301","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1322.98,"maximum":3303.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1322.98,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1349.44,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1336.21,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1362.67,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3303.49,"additional_payer_notes":"APC"}]}]},{"description":"Place device/marker, non pro","code_information":[{"code":"C9728","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1322.98,"maximum":3303.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1322.98,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1349.44,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1336.21,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1362.67,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3303.49,"additional_payer_notes":"APC"}]}]},{"description":"Radiation treatment delivery","code_information":[{"code":"77412","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":528.13,"maximum":1318.75,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":528.13,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":538.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":533.41,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":543.98,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1318.75,"additional_payer_notes":"APC"}]}]},{"description":"Neutron beam tx complex","code_information":[{"code":"77423","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":528.13,"maximum":1318.75,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":528.13,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":538.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":533.41,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":543.98,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1318.75,"additional_payer_notes":"APC"}]}]},{"description":"Special radiation treatment","code_information":[{"code":"77470","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":528.13,"maximum":1318.75,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":528.13,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":538.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":533.41,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":543.98,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1318.75,"additional_payer_notes":"APC"}]}]},{"description":"Proton trmt simple w/o comp","code_information":[{"code":"77520","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":528.13,"maximum":1318.75,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":528.13,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":538.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":533.41,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":543.98,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1318.75,"additional_payer_notes":"APC"}]}]},{"description":"Hyperthermia treatment","code_information":[{"code":"77610","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":528.13,"maximum":1318.75,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":528.13,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":538.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":533.41,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":543.98,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1318.75,"additional_payer_notes":"APC"}]}]},{"description":"Hyperthermia treatment","code_information":[{"code":"77615","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":528.13,"maximum":1318.75,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":528.13,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":538.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":533.41,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":543.98,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1318.75,"additional_payer_notes":"APC"}]}]},{"description":"Hyperthermia treatment","code_information":[{"code":"77620","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":528.13,"maximum":1318.75,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":528.13,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":538.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":533.41,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":543.98,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1318.75,"additional_payer_notes":"APC"}]}]},{"description":"Apply intrcav radiat simple","code_information":[{"code":"77761","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":528.13,"maximum":1318.75,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":528.13,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":538.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":533.41,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":543.98,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1318.75,"additional_payer_notes":"APC"}]}]},{"description":"Apply intrcav radiat interm","code_information":[{"code":"77762","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":528.13,"maximum":1318.75,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":528.13,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":538.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":533.41,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":543.98,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1318.75,"additional_payer_notes":"APC"}]}]},{"description":"Path clin consltj sf 5-20","code_information":[{"code":"80503","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":49.81,"maximum":124.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":49.81,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":50.81,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":50.31,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":51.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":124.37,"additional_payer_notes":"APC"}]}]},{"description":"Phys blood bank serv authrj","code_information":[{"code":"86079","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":49.81,"maximum":124.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":49.81,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":50.81,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":50.31,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":51.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":124.37,"additional_payer_notes":"APC"}]}]},{"description":"RBC antibody screen","code_information":[{"code":"86850","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":49.81,"maximum":124.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":49.81,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":50.81,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":50.31,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":51.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":124.37,"additional_payer_notes":"APC"}]}]},{"description":"Cytopath cell enhance tech","code_information":[{"code":"88112","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":49.81,"maximum":124.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":49.81,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":50.81,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":50.31,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":51.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":124.37,"additional_payer_notes":"APC"}]}]},{"description":"Forensic cytopathology","code_information":[{"code":"88125","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":49.81,"maximum":124.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":49.81,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":50.81,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":50.31,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":51.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":124.37,"additional_payer_notes":"APC"}]}]},{"description":"Cytopath smear other source","code_information":[{"code":"88162","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":49.81,"maximum":124.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":49.81,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":50.81,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":50.31,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":51.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":124.37,"additional_payer_notes":"APC"}]}]},{"description":"Cytopath eval fna report","code_information":[{"code":"88173","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":49.81,"maximum":124.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":49.81,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":50.81,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":50.31,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":51.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":124.37,"additional_payer_notes":"APC"}]}]},{"description":"Cell marker study","code_information":[{"code":"88182","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":49.81,"maximum":124.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":49.81,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":50.81,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":50.31,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":51.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":124.37,"additional_payer_notes":"APC"}]}]},{"description":"Cytopathology procedure","code_information":[{"code":"88199","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":49.81,"maximum":124.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":49.81,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":50.81,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":50.31,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":51.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":124.37,"additional_payer_notes":"APC"}]}]},{"description":"Cytogenetic study","code_information":[{"code":"88299","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":49.81,"maximum":124.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":49.81,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":50.81,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":50.31,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":51.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":124.37,"additional_payer_notes":"APC"}]}]},{"description":"Tissue exam by pathologist","code_information":[{"code":"88304","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":49.81,"maximum":124.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":49.81,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":50.81,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":50.31,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":51.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":124.37,"additional_payer_notes":"APC"}]}]},{"description":"Tissue exam by pathologist","code_information":[{"code":"88305","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":49.81,"maximum":124.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":49.81,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":50.81,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":50.31,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":51.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":124.37,"additional_payer_notes":"APC"}]}]},{"description":"Special stains group 1","code_information":[{"code":"88312","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":49.81,"maximum":124.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":49.81,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":50.81,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":50.31,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":51.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":124.37,"additional_payer_notes":"APC"}]}]},{"description":"Microslide consultation","code_information":[{"code":"88323","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":49.81,"maximum":124.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":49.81,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":50.81,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":50.31,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":51.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":124.37,"additional_payer_notes":"APC"}]}]},{"description":"Analysis nerve","code_information":[{"code":"88356","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":49.81,"maximum":124.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":49.81,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":50.81,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":50.31,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":51.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":124.37,"additional_payer_notes":"APC"}]}]},{"description":"Surgical pathology procedure","code_information":[{"code":"88399","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":49.81,"maximum":124.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":49.81,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":50.81,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":50.31,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":51.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":124.37,"additional_payer_notes":"APC"}]}]},{"description":"Collect sweat for test","code_information":[{"code":"89230","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":49.81,"maximum":124.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":49.81,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":50.81,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":50.31,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":51.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":124.37,"additional_payer_notes":"APC"}]}]},{"description":"Pathology lab procedure","code_information":[{"code":"89240","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":49.81,"maximum":124.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":49.81,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":50.81,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":50.31,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":51.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":124.37,"additional_payer_notes":"APC"}]}]},{"description":"Prepare embryo for transfer","code_information":[{"code":"89255","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":49.81,"maximum":124.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":49.81,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":50.81,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":50.31,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":51.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":124.37,"additional_payer_notes":"APC"}]}]},{"description":"Sperm identification","code_information":[{"code":"89257","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":49.81,"maximum":124.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":49.81,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":50.81,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":50.31,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":51.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":124.37,"additional_payer_notes":"APC"}]}]},{"description":"Sperm isolation simple","code_information":[{"code":"89260","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":49.81,"maximum":124.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":49.81,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":50.81,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":50.31,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":51.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":124.37,"additional_payer_notes":"APC"}]}]},{"description":"Sperm isolation complex","code_information":[{"code":"89261","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":49.81,"maximum":124.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":49.81,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":50.81,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":50.31,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":51.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":124.37,"additional_payer_notes":"APC"}]}]},{"description":"Identify sperm tissue","code_information":[{"code":"89264","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":49.81,"maximum":124.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":49.81,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":50.81,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":50.31,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":51.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":124.37,"additional_payer_notes":"APC"}]}]},{"description":"Cryopreserve testicular tiss","code_information":[{"code":"89335","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":49.81,"maximum":124.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":49.81,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":50.81,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":50.31,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":51.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":124.37,"additional_payer_notes":"APC"}]}]},{"description":"Thawing cryopresrved sperm","code_information":[{"code":"89353","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":49.81,"maximum":124.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":49.81,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":50.81,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":50.31,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":51.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":124.37,"additional_payer_notes":"APC"}]}]},{"description":"Unlisted reprod med lab proc","code_information":[{"code":"89398","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":49.81,"maximum":124.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":49.81,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":50.81,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":50.31,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":51.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":124.37,"additional_payer_notes":"APC"}]}]},{"description":"Path clin consltj mod 21-40","code_information":[{"code":"80504","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":162.84,"maximum":406.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":162.84,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":166.1,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":164.47,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":167.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":406.62,"additional_payer_notes":"APC"}]}]},{"description":"Path clin consltj high 41-60","code_information":[{"code":"80505","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":162.84,"maximum":406.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":162.84,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":166.1,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":164.47,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":167.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":406.62,"additional_payer_notes":"APC"}]}]},{"description":"Phys blood bank serv reactj","code_information":[{"code":"86078","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":162.84,"maximum":406.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":162.84,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":166.1,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":164.47,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":167.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":406.62,"additional_payer_notes":"APC"}]}]},{"description":"RBC antibody elution","code_information":[{"code":"86860","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":162.84,"maximum":406.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":162.84,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":166.1,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":164.47,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":167.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":406.62,"additional_payer_notes":"APC"}]}]},{"description":"Coombs test indirect qual","code_information":[{"code":"86885","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":162.84,"maximum":406.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":162.84,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":166.1,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":164.47,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":167.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":406.62,"additional_payer_notes":"APC"}]}]},{"description":"Coombs test indirect titer","code_information":[{"code":"86886","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":162.84,"maximum":406.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":162.84,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":166.1,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":164.47,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":167.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":406.62,"additional_payer_notes":"APC"}]}]},{"description":"Autologous blood process","code_information":[{"code":"86890","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":162.84,"maximum":406.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":162.84,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":166.1,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":164.47,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":167.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":406.62,"additional_payer_notes":"APC"}]}]},{"description":"Compatibility test spin","code_information":[{"code":"86920","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":162.84,"maximum":406.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":162.84,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":166.1,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":164.47,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":167.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":406.62,"additional_payer_notes":"APC"}]}]},{"description":"Compatibility test incubate","code_information":[{"code":"86921","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":162.84,"maximum":406.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":162.84,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":166.1,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":164.47,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":167.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":406.62,"additional_payer_notes":"APC"}]}]},{"description":"Compatibility test antiglob","code_information":[{"code":"86922","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":162.84,"maximum":406.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":162.84,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":166.1,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":164.47,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":167.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":406.62,"additional_payer_notes":"APC"}]}]},{"description":"Compatibility test electric","code_information":[{"code":"86923","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":162.84,"maximum":406.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":162.84,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":166.1,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":164.47,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":167.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":406.62,"additional_payer_notes":"APC"}]}]},{"description":"Plasma fresh frozen","code_information":[{"code":"86927","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":162.84,"maximum":406.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":162.84,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":166.1,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":164.47,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":167.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":406.62,"additional_payer_notes":"APC"}]}]},{"description":"Frozen blood prep","code_information":[{"code":"86930","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":162.84,"maximum":406.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":162.84,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":166.1,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":164.47,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":167.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":406.62,"additional_payer_notes":"APC"}]}]},{"description":"Frozen blood thaw","code_information":[{"code":"86931","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":162.84,"maximum":406.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":162.84,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":166.1,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":164.47,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":167.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":406.62,"additional_payer_notes":"APC"}]}]},{"description":"Leukacyte transfusion","code_information":[{"code":"86950","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":162.84,"maximum":406.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":162.84,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":166.1,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":164.47,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":167.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":406.62,"additional_payer_notes":"APC"}]}]},{"description":"Vol reduction of blood/prod","code_information":[{"code":"86960","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":162.84,"maximum":406.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":162.84,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":166.1,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":164.47,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":167.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":406.62,"additional_payer_notes":"APC"}]}]},{"description":"Pooling blood platelets","code_information":[{"code":"86965","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":162.84,"maximum":406.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":162.84,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":166.1,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":164.47,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":167.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":406.62,"additional_payer_notes":"APC"}]}]},{"description":"Rbc pretx incubatj w/enzymes","code_information":[{"code":"86971","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":162.84,"maximum":406.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":162.84,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":166.1,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":164.47,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":167.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":406.62,"additional_payer_notes":"APC"}]}]},{"description":"Rbc pretx incubatj w/density","code_information":[{"code":"86972","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":162.84,"maximum":406.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":162.84,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":166.1,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":164.47,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":167.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":406.62,"additional_payer_notes":"APC"}]}]},{"description":"Rbc serum pretx incubj/inhib","code_information":[{"code":"86977","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":162.84,"maximum":406.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":162.84,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":166.1,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":164.47,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":167.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":406.62,"additional_payer_notes":"APC"}]}]},{"description":"Split blood or products","code_information":[{"code":"86985","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":162.84,"maximum":406.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":162.84,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":166.1,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":164.47,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":167.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":406.62,"additional_payer_notes":"APC"}]}]},{"description":"Cytp urne 3-5 probes ea spec","code_information":[{"code":"88120","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":162.84,"maximum":406.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":162.84,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":166.1,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":164.47,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":167.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":406.62,"additional_payer_notes":"APC"}]}]},{"description":"Cytp urine 3-5 probes cmptr","code_information":[{"code":"88121","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":162.84,"maximum":406.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":162.84,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":166.1,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":164.47,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":167.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":406.62,"additional_payer_notes":"APC"}]}]},{"description":"Cytp dx eval fna 1st ea site","code_information":[{"code":"88172","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":162.84,"maximum":406.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":162.84,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":166.1,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":164.47,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":167.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":406.62,"additional_payer_notes":"APC"}]}]},{"description":"Comprehensive review of data","code_information":[{"code":"88325","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":162.84,"maximum":406.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":162.84,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":166.1,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":164.47,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":167.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":406.62,"additional_payer_notes":"APC"}]}]},{"description":"Path consult intraop 1 bloc","code_information":[{"code":"88331","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":162.84,"maximum":406.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":162.84,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":166.1,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":164.47,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":167.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":406.62,"additional_payer_notes":"APC"}]}]},{"description":"Immunohisto antb 1st stain","code_information":[{"code":"88342","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":162.84,"maximum":406.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":162.84,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":166.1,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":164.47,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":167.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":406.62,"additional_payer_notes":"APC"}]}]},{"description":"Immunofluor antb 1st stain","code_information":[{"code":"88346","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":162.84,"maximum":406.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":162.84,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":166.1,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":164.47,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":167.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":406.62,"additional_payer_notes":"APC"}]}]},{"description":"Analysis skeletal muscle","code_information":[{"code":"88355","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":162.84,"maximum":406.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":162.84,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":166.1,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":164.47,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":167.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":406.62,"additional_payer_notes":"APC"}]}]},{"description":"Analysis tumor","code_information":[{"code":"88358","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":162.84,"maximum":406.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":162.84,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":166.1,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":164.47,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":167.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":406.62,"additional_payer_notes":"APC"}]}]},{"description":"Tumor immunohistochem/manual","code_information":[{"code":"88360","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":162.84,"maximum":406.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":162.84,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":166.1,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":164.47,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":167.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":406.62,"additional_payer_notes":"APC"}]}]},{"description":"Insitu hybridization (fish)","code_information":[{"code":"88365","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":162.84,"maximum":406.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":162.84,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":166.1,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":164.47,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":167.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":406.62,"additional_payer_notes":"APC"}]}]},{"description":"Insitu hybridization (fish)","code_information":[{"code":"88366","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":162.84,"maximum":406.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":162.84,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":166.1,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":164.47,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":167.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":406.62,"additional_payer_notes":"APC"}]}]},{"description":"M/phmtrc alys ishquant/semiq","code_information":[{"code":"88374","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":162.84,"maximum":406.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":162.84,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":166.1,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":164.47,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":167.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":406.62,"additional_payer_notes":"APC"}]}]},{"description":"M/phmtrc alys ishquant/semiq","code_information":[{"code":"88377","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":162.84,"maximum":406.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":162.84,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":166.1,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":164.47,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":167.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":406.62,"additional_payer_notes":"APC"}]}]},{"description":"Chct for mal hyperthermia","code_information":[{"code":"89049","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":162.84,"maximum":406.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":162.84,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":166.1,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":164.47,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":167.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":406.62,"additional_payer_notes":"APC"}]}]},{"description":"Sputum specimen collection","code_information":[{"code":"89220","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":162.84,"maximum":406.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":162.84,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":166.1,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":164.47,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":167.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":406.62,"additional_payer_notes":"APC"}]}]},{"description":"Cultr oocyte/embryo <4 days","code_information":[{"code":"89250","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":162.84,"maximum":406.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":162.84,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":166.1,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":164.47,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":167.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":406.62,"additional_payer_notes":"APC"}]}]},{"description":"Cultr oocyte/embryo <4 days","code_information":[{"code":"89251","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":162.84,"maximum":406.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":162.84,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":166.1,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":164.47,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":167.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":406.62,"additional_payer_notes":"APC"}]}]},{"description":"Embryo hatching","code_information":[{"code":"89253","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":162.84,"maximum":406.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":162.84,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":166.1,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":164.47,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":167.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":406.62,"additional_payer_notes":"APC"}]}]},{"description":"Oocyte identification","code_information":[{"code":"89254","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":162.84,"maximum":406.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":162.84,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":166.1,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":164.47,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":167.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":406.62,"additional_payer_notes":"APC"}]}]},{"description":"Cryopreservation sperm","code_information":[{"code":"89259","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":162.84,"maximum":406.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":162.84,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":166.1,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":164.47,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":167.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":406.62,"additional_payer_notes":"APC"}]}]},{"description":"Insemination of oocytes","code_information":[{"code":"89268","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":162.84,"maximum":406.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":162.84,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":166.1,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":164.47,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":167.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":406.62,"additional_payer_notes":"APC"}]}]},{"description":"Assist oocyte fertilization","code_information":[{"code":"89281","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":162.84,"maximum":406.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":162.84,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":166.1,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":164.47,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":167.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":406.62,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy oocyte polar body","code_information":[{"code":"89290","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":162.84,"maximum":406.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":162.84,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":166.1,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":164.47,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":167.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":406.62,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy oocyte polar body","code_information":[{"code":"89291","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":162.84,"maximum":406.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":162.84,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":166.1,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":164.47,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":167.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":406.62,"additional_payer_notes":"APC"}]}]},{"description":"Cryopreservation oocyte(s)","code_information":[{"code":"89337","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":162.84,"maximum":406.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":162.84,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":166.1,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":164.47,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":167.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":406.62,"additional_payer_notes":"APC"}]}]},{"description":"Storage/year embryo(s)","code_information":[{"code":"89342","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":162.84,"maximum":406.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":162.84,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":166.1,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":164.47,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":167.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":406.62,"additional_payer_notes":"APC"}]}]},{"description":"Storage/year sperm/semen","code_information":[{"code":"89343","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":162.84,"maximum":406.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":162.84,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":166.1,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":164.47,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":167.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":406.62,"additional_payer_notes":"APC"}]}]},{"description":"Storage/year reprod tissue","code_information":[{"code":"89344","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":162.84,"maximum":406.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":162.84,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":166.1,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":164.47,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":167.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":406.62,"additional_payer_notes":"APC"}]}]},{"description":"Storage/year oocyte(s)","code_information":[{"code":"89346","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":162.84,"maximum":406.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":162.84,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":166.1,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":164.47,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":167.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":406.62,"additional_payer_notes":"APC"}]}]},{"description":"Thawing cryopresrved embryo","code_information":[{"code":"89352","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":162.84,"maximum":406.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":162.84,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":166.1,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":164.47,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":167.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":406.62,"additional_payer_notes":"APC"}]}]},{"description":"Thaw cryoprsvrd reprod tiss","code_information":[{"code":"89354","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":162.84,"maximum":406.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":162.84,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":166.1,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":164.47,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":167.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":406.62,"additional_payer_notes":"APC"}]}]},{"description":"Thawing cryopresrved oocyte","code_information":[{"code":"89356","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":162.84,"maximum":406.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":162.84,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":166.1,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":164.47,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":167.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":406.62,"additional_payer_notes":"APC"}]}]},{"description":"RBC antibody identification","code_information":[{"code":"86870","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":342.61,"maximum":855.50,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":342.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":349.46,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":346.04,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":352.89,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":855.5,"additional_payer_notes":"APC"}]}]},{"description":"Blood type antigen donor ea","code_information":[{"code":"86902","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":342.61,"maximum":855.50,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":342.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":349.46,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":346.04,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":352.89,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":855.5,"additional_payer_notes":"APC"}]}]},{"description":"Blood typing rbc antigens","code_information":[{"code":"86905","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":342.61,"maximum":855.50,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":342.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":349.46,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":346.04,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":352.89,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":855.5,"additional_payer_notes":"APC"}]}]},{"description":"Flowcytometry/ tc 1 marker","code_information":[{"code":"88184","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":342.61,"maximum":855.50,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":342.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":349.46,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":346.04,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":352.89,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":855.5,"additional_payer_notes":"APC"}]}]},{"description":"Tissue exam by pathologist","code_information":[{"code":"88307","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":342.61,"maximum":855.50,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":342.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":349.46,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":346.04,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":352.89,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":855.5,"additional_payer_notes":"APC"}]}]},{"description":"Immunohisto antibody slide","code_information":[{"code":"88344","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":342.61,"maximum":855.50,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":342.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":349.46,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":346.04,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":352.89,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":855.5,"additional_payer_notes":"APC"}]}]},{"description":"Tumor immunohistochem/comput","code_information":[{"code":"88361","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":342.61,"maximum":855.50,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":342.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":349.46,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":346.04,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":352.89,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":855.5,"additional_payer_notes":"APC"}]}]},{"description":"Insitu hybridization auto","code_information":[{"code":"88367","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":342.61,"maximum":855.50,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":342.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":349.46,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":346.04,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":352.89,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":855.5,"additional_payer_notes":"APC"}]}]},{"description":"Insitu hybridization manual","code_information":[{"code":"88368","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":342.61,"maximum":855.50,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":342.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":349.46,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":346.04,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":352.89,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":855.5,"additional_payer_notes":"APC"}]}]},{"description":"Prostate biopsy, any mthd","code_information":[{"code":"G0416","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":342.61,"maximum":855.50,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":342.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":349.46,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":346.04,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":352.89,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":855.5,"additional_payer_notes":"APC"}]}]},{"description":"Immunotherapy one injection","code_information":[{"code":"95115","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":44.76,"maximum":111.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":44.76,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":45.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":45.2,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":46.1,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":111.76,"additional_payer_notes":"APC"}]}]},{"description":"Immunotherapy injections","code_information":[{"code":"95117","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":44.76,"maximum":111.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":44.76,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":45.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":45.2,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":46.1,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":111.76,"additional_payer_notes":"APC"}]}]},{"description":"Antigen therapy services","code_information":[{"code":"95144","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":44.76,"maximum":111.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":44.76,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":45.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":45.2,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":46.1,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":111.76,"additional_payer_notes":"APC"}]}]},{"description":"Antigen therapy services","code_information":[{"code":"95145","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":44.76,"maximum":111.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":44.76,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":45.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":45.2,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":46.1,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":111.76,"additional_payer_notes":"APC"}]}]},{"description":"Antigen therapy services","code_information":[{"code":"95146","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":44.76,"maximum":111.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":44.76,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":45.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":45.2,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":46.1,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":111.76,"additional_payer_notes":"APC"}]}]},{"description":"Antigen therapy services","code_information":[{"code":"95165","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":44.76,"maximum":111.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":44.76,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":45.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":45.2,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":46.1,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":111.76,"additional_payer_notes":"APC"}]}]},{"description":"Antigen therapy services","code_information":[{"code":"95170","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":44.76,"maximum":111.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":44.76,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":45.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":45.2,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":46.1,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":111.76,"additional_payer_notes":"APC"}]}]},{"description":"Hydrate iv infusion add-on","code_information":[{"code":"96361","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":44.76,"maximum":111.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":44.76,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":45.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":45.2,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":46.1,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":111.76,"additional_payer_notes":"APC"}]}]},{"description":"Ther/proph/diag iv inf addon","code_information":[{"code":"96366","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":44.76,"maximum":111.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":44.76,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":45.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":45.2,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":46.1,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":111.76,"additional_payer_notes":"APC"}]}]},{"description":"Sc ther infusion addl hr","code_information":[{"code":"96370","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":44.76,"maximum":111.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":44.76,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":45.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":45.2,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":46.1,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":111.76,"additional_payer_notes":"APC"}]}]},{"description":"Tx/pro/dx inj new drug addon","code_information":[{"code":"96375","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":44.76,"maximum":111.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":44.76,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":45.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":45.2,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":46.1,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":111.76,"additional_payer_notes":"APC"}]}]},{"description":"Applicaton on-body injector","code_information":[{"code":"96377","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":44.76,"maximum":111.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":44.76,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":45.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":45.2,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":46.1,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":111.76,"additional_payer_notes":"APC"}]}]},{"description":"Ther/prop/diag inj/inf proc","code_information":[{"code":"96379","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":44.76,"maximum":111.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":44.76,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":45.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":45.2,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":46.1,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":111.76,"additional_payer_notes":"APC"}]}]},{"description":"Chemo ia infuse each addl hr","code_information":[{"code":"96423","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":44.76,"maximum":111.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":44.76,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":45.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":45.2,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":46.1,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":111.76,"additional_payer_notes":"APC"}]}]},{"description":"Chemotherapy unspecified","code_information":[{"code":"96549","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":44.76,"maximum":111.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":44.76,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":45.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":45.2,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":46.1,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":111.76,"additional_payer_notes":"APC"}]}]},{"description":"Admin influenza virus vac","code_information":[{"code":"G0008","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":44.76,"maximum":111.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":44.76,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":45.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":45.2,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":46.1,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":111.76,"additional_payer_notes":"APC"}]}]},{"description":"Admin pneumococcal vaccine","code_information":[{"code":"G0009","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":44.76,"maximum":111.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":44.76,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":45.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":45.2,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":46.1,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":111.76,"additional_payer_notes":"APC"}]}]},{"description":"Admin hepatitis b vaccine","code_information":[{"code":"G0010","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":44.76,"maximum":111.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":44.76,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":45.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":45.2,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":46.1,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":111.76,"additional_payer_notes":"APC"}]}]},{"description":"Immunization admin","code_information":[{"code":"90471","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":68.82,"maximum":171.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":68.82,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":70.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":69.51,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":70.88,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":171.84,"additional_payer_notes":"APC"}]}]},{"description":"Immune admin oral/nasal","code_information":[{"code":"90473","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":68.82,"maximum":171.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":68.82,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":70.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":69.51,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":70.88,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":171.84,"additional_payer_notes":"APC"}]}]},{"description":"Antigen therapy services","code_information":[{"code":"95147","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":68.82,"maximum":171.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":68.82,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":70.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":69.51,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":70.88,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":171.84,"additional_payer_notes":"APC"}]}]},{"description":"Antigen therapy services","code_information":[{"code":"95148","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":68.82,"maximum":171.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":68.82,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":70.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":69.51,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":70.88,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":171.84,"additional_payer_notes":"APC"}]}]},{"description":"Antigen therapy services","code_information":[{"code":"95149","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":68.82,"maximum":171.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":68.82,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":70.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":69.51,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":70.88,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":171.84,"additional_payer_notes":"APC"}]}]},{"description":"Tx/proph/dg addl seq iv inf","code_information":[{"code":"96367","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":68.82,"maximum":171.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":68.82,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":70.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":69.51,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":70.88,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":171.84,"additional_payer_notes":"APC"}]}]},{"description":"Sc ther infusion reset pump","code_information":[{"code":"96371","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":68.82,"maximum":171.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":68.82,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":70.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":69.51,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":70.88,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":171.84,"additional_payer_notes":"APC"}]}]},{"description":"Ther/proph/diag inj sc/im","code_information":[{"code":"96372","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":68.82,"maximum":171.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":68.82,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":70.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":69.51,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":70.88,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":171.84,"additional_payer_notes":"APC"}]}]},{"description":"Chemo anti-neopl sq/im","code_information":[{"code":"96401","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":68.82,"maximum":171.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":68.82,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":70.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":69.51,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":70.88,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":171.84,"additional_payer_notes":"APC"}]}]},{"description":"Chemo hormon antineopl sq/im","code_information":[{"code":"96402","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":68.82,"maximum":171.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":68.82,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":70.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":69.51,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":70.88,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":171.84,"additional_payer_notes":"APC"}]}]},{"description":"Chemo intralesional up to 7","code_information":[{"code":"96405","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":68.82,"maximum":171.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":68.82,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":70.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":69.51,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":70.88,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":171.84,"additional_payer_notes":"APC"}]}]},{"description":"Chemo iv push addl drug","code_information":[{"code":"96411","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":68.82,"maximum":171.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":68.82,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":70.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":69.51,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":70.88,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":171.84,"additional_payer_notes":"APC"}]}]},{"description":"Chemo iv infusion addl hr","code_information":[{"code":"96415","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":68.82,"maximum":171.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":68.82,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":70.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":69.51,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":70.88,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":171.84,"additional_payer_notes":"APC"}]}]},{"description":"Chemo iv infus each addl seq","code_information":[{"code":"96417","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":68.82,"maximum":171.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":68.82,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":70.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":69.51,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":70.88,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":171.84,"additional_payer_notes":"APC"}]}]},{"description":"Injection of hiv prep drug","code_information":[{"code":"G0012","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":68.82,"maximum":171.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":68.82,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":70.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":69.51,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":70.88,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":171.84,"additional_payer_notes":"APC"}]}]},{"description":"Inj w/fluor eval cv device","code_information":[{"code":"36598","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":203.31,"maximum":507.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":203.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":207.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":205.34,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":209.41,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":507.66,"additional_payer_notes":"APC"}]}]},{"description":"Hydration iv infusion init","code_information":[{"code":"96360","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":203.31,"maximum":507.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":203.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":207.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":205.34,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":209.41,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":507.66,"additional_payer_notes":"APC"}]}]},{"description":"Ther/proph/diag iv inf init","code_information":[{"code":"96365","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":203.31,"maximum":507.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":203.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":207.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":205.34,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":209.41,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":507.66,"additional_payer_notes":"APC"}]}]},{"description":"Sc ther infusion up to 1 hr","code_information":[{"code":"96369","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":203.31,"maximum":507.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":203.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":207.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":205.34,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":209.41,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":507.66,"additional_payer_notes":"APC"}]}]},{"description":"Ther/proph/diag inj ia","code_information":[{"code":"96373","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":203.31,"maximum":507.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":203.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":207.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":205.34,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":209.41,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":507.66,"additional_payer_notes":"APC"}]}]},{"description":"Ther/proph/diag inj iv push","code_information":[{"code":"96374","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":203.31,"maximum":507.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":203.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":207.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":205.34,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":209.41,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":507.66,"additional_payer_notes":"APC"}]}]},{"description":"Chemo intralesional over 7","code_information":[{"code":"96406","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":203.31,"maximum":507.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":203.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":207.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":205.34,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":209.41,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":507.66,"additional_payer_notes":"APC"}]}]},{"description":"Refill/maint portable pump","code_information":[{"code":"96521","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":203.31,"maximum":507.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":203.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":207.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":205.34,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":209.41,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":507.66,"additional_payer_notes":"APC"}]}]},{"description":"Refill/maint pump/resvr syst","code_information":[{"code":"96522","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":203.31,"maximum":507.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":203.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":207.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":205.34,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":209.41,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":507.66,"additional_payer_notes":"APC"}]}]},{"description":"Prolonged iv inf, req pump","code_information":[{"code":"C8957","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":203.31,"maximum":507.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":203.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":207.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":205.34,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":209.41,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":507.66,"additional_payer_notes":"APC"}]}]},{"description":"Declot vascular device","code_information":[{"code":"36593","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":315.71,"maximum":788.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":315.71,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":322.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":318.87,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":325.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":788.34,"additional_payer_notes":"APC"}]}]},{"description":"Thrombolytic therapy stroke","code_information":[{"code":"37195","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":315.71,"maximum":788.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":315.71,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":322.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":318.87,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":325.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":788.34,"additional_payer_notes":"APC"}]}]},{"description":"Car-t admn autologous","code_information":[{"code":"38228","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":315.71,"maximum":788.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":315.71,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":322.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":318.87,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":325.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":788.34,"additional_payer_notes":"APC"}]}]},{"description":"Injection eye drug","code_information":[{"code":"67028","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":315.71,"maximum":788.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":315.71,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":322.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":318.87,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":325.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":788.34,"additional_payer_notes":"APC"}]}]},{"description":"Sprchoroidal spc njx rx agt","code_information":[{"code":"67516","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":315.71,"maximum":788.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":315.71,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":322.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":318.87,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":325.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":788.34,"additional_payer_notes":"APC"}]}]},{"description":"Spin/brain pump refil & main","code_information":[{"code":"95990","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":315.71,"maximum":788.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":315.71,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":322.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":318.87,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":325.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":788.34,"additional_payer_notes":"APC"}]}]},{"description":"Chemo iv push sngl drug","code_information":[{"code":"96409","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":315.71,"maximum":788.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":315.71,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":322.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":318.87,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":325.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":788.34,"additional_payer_notes":"APC"}]}]},{"description":"Chemo iv infusion 1 hr","code_information":[{"code":"96413","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":315.71,"maximum":788.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":315.71,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":322.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":318.87,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":325.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":788.34,"additional_payer_notes":"APC"}]}]},{"description":"Chemo prolong infuse w/pump","code_information":[{"code":"96416","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":315.71,"maximum":788.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":315.71,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":322.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":318.87,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":325.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":788.34,"additional_payer_notes":"APC"}]}]},{"description":"Chemo ia push tecnique","code_information":[{"code":"96420","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":315.71,"maximum":788.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":315.71,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":322.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":318.87,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":325.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":788.34,"additional_payer_notes":"APC"}]}]},{"description":"Chemo ia infusion up to 1 hr","code_information":[{"code":"96422","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":315.71,"maximum":788.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":315.71,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":322.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":318.87,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":325.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":788.34,"additional_payer_notes":"APC"}]}]},{"description":"Chemotherapy infusion method","code_information":[{"code":"96425","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":315.71,"maximum":788.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":315.71,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":322.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":318.87,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":325.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":788.34,"additional_payer_notes":"APC"}]}]},{"description":"Chemotherapy intracavitary","code_information":[{"code":"96440","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":315.71,"maximum":788.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":315.71,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":322.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":318.87,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":325.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":788.34,"additional_payer_notes":"APC"}]}]},{"description":"Chemotx admn prtl cavity","code_information":[{"code":"96446","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":315.71,"maximum":788.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":315.71,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":322.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":318.87,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":325.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":788.34,"additional_payer_notes":"APC"}]}]},{"description":"Chemotherapy into cns","code_information":[{"code":"96450","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":315.71,"maximum":788.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":315.71,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":322.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":318.87,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":325.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":788.34,"additional_payer_notes":"APC"}]}]},{"description":"Chemotherapy injection","code_information":[{"code":"96542","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":315.71,"maximum":788.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":315.71,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":322.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":318.87,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":325.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":788.34,"additional_payer_notes":"APC"}]}]},{"description":"Chemo extend iv infus w/pump","code_information":[{"code":"G0498","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":315.71,"maximum":788.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":315.71,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":322.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":318.87,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":325.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":788.34,"additional_payer_notes":"APC"}]}]},{"description":"Compre audiometry evaluation","code_information":[{"code":"0212T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":122.99,"maximum":307.10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":122.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":125.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":124.22,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":126.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":307.1,"additional_payer_notes":"APC"}]}]},{"description":"Tempr","code_information":[{"code":"0278T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":122.99,"maximum":307.10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":122.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":125.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":124.22,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":126.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":307.1,"additional_payer_notes":"APC"}]}]},{"description":"Visual ep test for glaucoma","code_information":[{"code":"0464T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":122.99,"maximum":307.10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":122.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":125.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":124.22,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":126.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":307.1,"additional_payer_notes":"APC"}]}]},{"description":"Colonic lavage 35+l water","code_information":[{"code":"0736T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":122.99,"maximum":307.10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":122.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":125.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":124.22,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":126.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":307.1,"additional_payer_notes":"APC"}]}]},{"description":"Smmg cncrnt appl imu snr","code_information":[{"code":"0778T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":122.99,"maximum":307.10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":122.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":125.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":124.22,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":126.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":307.1,"additional_payer_notes":"APC"}]}]},{"description":"Tc auriculr neurostimulation","code_information":[{"code":"0783T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":122.99,"maximum":307.10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":122.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":125.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":124.22,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":126.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":307.1,"additional_payer_notes":"APC"}]}]},{"description":"Rem mlt day uroflow dev sply","code_information":[{"code":"0812T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":122.99,"maximum":307.10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":122.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":125.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":124.22,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":126.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":307.1,"additional_payer_notes":"APC"}]}]},{"description":"Dx gastr intub w/asp specs","code_information":[{"code":"43755","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":122.99,"maximum":307.10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":122.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":125.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":124.22,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":126.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":307.1,"additional_payer_notes":"APC"}]}]},{"description":"Measure ureter pressure","code_information":[{"code":"50686","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":122.99,"maximum":307.10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":122.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":125.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":124.22,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":126.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":307.1,"additional_payer_notes":"APC"}]}]},{"description":"Insert bladder cath complex","code_information":[{"code":"51703","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":122.99,"maximum":307.10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":122.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":125.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":124.22,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":126.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":307.1,"additional_payer_notes":"APC"}]}]},{"description":"Anal/urinary muscle study","code_information":[{"code":"51784","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":122.99,"maximum":307.10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":122.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":125.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":124.22,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":126.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":307.1,"additional_payer_notes":"APC"}]}]},{"description":"Dilation of urethra","code_information":[{"code":"53660","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":122.99,"maximum":307.10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":122.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":125.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":124.22,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":126.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":307.1,"additional_payer_notes":"APC"}]}]},{"description":"Liver elastography","code_information":[{"code":"91200","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":122.99,"maximum":307.10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":122.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":125.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":124.22,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":126.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":307.1,"additional_payer_notes":"APC"}]}]},{"description":"Gastroenterology procedure","code_information":[{"code":"91299","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":122.99,"maximum":307.10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":122.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":125.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":124.22,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":126.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":307.1,"additional_payer_notes":"APC"}]}]},{"description":"Multifocal erg w/i&r","code_information":[{"code":"92274","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":122.99,"maximum":307.10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":122.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":125.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":124.22,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":126.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":307.1,"additional_payer_notes":"APC"}]}]},{"description":"Vemp test i&r cervical","code_information":[{"code":"92517","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":122.99,"maximum":307.10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":122.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":125.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":124.22,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":126.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":307.1,"additional_payer_notes":"APC"}]}]},{"description":"Vemp test i&r ocular","code_information":[{"code":"92518","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":122.99,"maximum":307.10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":122.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":125.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":124.22,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":126.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":307.1,"additional_payer_notes":"APC"}]}]},{"description":"Caloric vstblr test w/rec","code_information":[{"code":"92537","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":122.99,"maximum":307.10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":122.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":125.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":124.22,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":126.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":307.1,"additional_payer_notes":"APC"}]}]},{"description":"Optokinetic nystagmus test","code_information":[{"code":"92544","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":122.99,"maximum":307.10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":122.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":125.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":124.22,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":126.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":307.1,"additional_payer_notes":"APC"}]}]},{"description":"Sinusoidal rotational test","code_information":[{"code":"92546","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":122.99,"maximum":307.10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":122.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":125.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":124.22,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":126.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":307.1,"additional_payer_notes":"APC"}]}]},{"description":"Audiometry air & bone","code_information":[{"code":"92553","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":122.99,"maximum":307.10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":122.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":125.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":124.22,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":126.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":307.1,"additional_payer_notes":"APC"}]}]},{"description":"Comprehensive hearing test","code_information":[{"code":"92557","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":122.99,"maximum":307.10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":122.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":125.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":124.22,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":126.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":307.1,"additional_payer_notes":"APC"}]}]},{"description":"Acoustic immitance testing","code_information":[{"code":"92570","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":122.99,"maximum":307.10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":122.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":125.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":124.22,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":126.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":307.1,"additional_payer_notes":"APC"}]}]},{"description":"Staggered spondaic word test","code_information":[{"code":"92572","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":122.99,"maximum":307.10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":122.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":125.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":124.22,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":126.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":307.1,"additional_payer_notes":"APC"}]}]},{"description":"Conditioning play audiometry","code_information":[{"code":"92582","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":122.99,"maximum":307.10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":122.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":125.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":124.22,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":126.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":307.1,"additional_payer_notes":"APC"}]}]},{"description":"Electrocochleography","code_information":[{"code":"92584","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":122.99,"maximum":307.10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":122.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":125.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":124.22,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":126.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":307.1,"additional_payer_notes":"APC"}]}]},{"description":"Cochlear implt f/up exam <7","code_information":[{"code":"92601","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":122.99,"maximum":307.10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":122.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":125.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":124.22,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":126.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":307.1,"additional_payer_notes":"APC"}]}]},{"description":"Reprogram cochlear implt 7/>","code_information":[{"code":"92602","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":122.99,"maximum":307.10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":122.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":125.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":124.22,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":126.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":307.1,"additional_payer_notes":"APC"}]}]},{"description":"Cochlear implt f/up exam 7/>","code_information":[{"code":"92603","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":122.99,"maximum":307.10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":122.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":125.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":124.22,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":126.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":307.1,"additional_payer_notes":"APC"}]}]},{"description":"Reprogram cochlear implt 7/>","code_information":[{"code":"92604","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":122.99,"maximum":307.10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":122.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":125.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":124.22,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":126.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":307.1,"additional_payer_notes":"APC"}]}]},{"description":"Auditory function 60 min","code_information":[{"code":"92620","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":122.99,"maximum":307.10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":122.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":125.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":124.22,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":126.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":307.1,"additional_payer_notes":"APC"}]}]},{"description":"Dx aly aud oi snd prcsr 1st","code_information":[{"code":"92622","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":122.99,"maximum":307.10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":122.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":125.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":124.22,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":126.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":307.1,"additional_payer_notes":"APC"}]}]},{"description":"Tinnitus assessment","code_information":[{"code":"92625","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":122.99,"maximum":307.10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":122.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":125.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":124.22,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":126.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":307.1,"additional_payer_notes":"APC"}]}]},{"description":"Eval aud rehab status","code_information":[{"code":"92626","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":122.99,"maximum":307.10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":122.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":125.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":124.22,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":126.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":307.1,"additional_payer_notes":"APC"}]}]},{"description":"Aud brainstem implt programg","code_information":[{"code":"92640","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":122.99,"maximum":307.10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":122.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":125.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":124.22,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":126.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":307.1,"additional_payer_notes":"APC"}]}]},{"description":"Microvolt t-wave assess","code_information":[{"code":"93025","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":122.99,"maximum":307.10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":122.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":125.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":124.22,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":126.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":307.1,"additional_payer_notes":"APC"}]}]},{"description":"Interrog crtd sins bat ip wo","code_information":[{"code":"93145","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":122.99,"maximum":307.10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":122.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":125.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":124.22,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":126.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":307.1,"additional_payer_notes":"APC"}]}]},{"description":"Interrog crtd sins bat ip w/","code_information":[{"code":"93146","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":122.99,"maximum":307.10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":122.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":125.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":124.22,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":126.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":307.1,"additional_payer_notes":"APC"}]}]},{"description":"Bis xtracell fluid analysis","code_information":[{"code":"93702","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":122.99,"maximum":307.10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":122.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":125.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":124.22,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":126.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":307.1,"additional_payer_notes":"APC"}]}]},{"description":"Temperature gradient studies","code_information":[{"code":"93740","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":122.99,"maximum":307.10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":122.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":125.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":124.22,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":126.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":307.1,"additional_payer_notes":"APC"}]}]},{"description":"Cardiovascular procedure","code_information":[{"code":"93799","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":122.99,"maximum":307.10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":122.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":125.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":124.22,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":126.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":307.1,"additional_payer_notes":"APC"}]}]},{"description":"Spirometry up to 2 yrs old","code_information":[{"code":"94011","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":122.99,"maximum":307.10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":122.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":125.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":124.22,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":126.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":307.1,"additional_payer_notes":"APC"}]}]},{"description":"Vital capacity test","code_information":[{"code":"94150","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":122.99,"maximum":307.10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":122.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":125.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":124.22,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":126.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":307.1,"additional_payer_notes":"APC"}]}]},{"description":"Hypoxia response curve","code_information":[{"code":"94450","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":122.99,"maximum":307.10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":122.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":125.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":124.22,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":126.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":307.1,"additional_payer_notes":"APC"}]}]},{"description":"Exhaled air analysis o2","code_information":[{"code":"94680","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":122.99,"maximum":307.10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":122.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":125.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":124.22,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":126.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":307.1,"additional_payer_notes":"APC"}]}]},{"description":"Pulm funct test oscillometry","code_information":[{"code":"94728","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":122.99,"maximum":307.10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":122.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":125.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":124.22,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":126.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":307.1,"additional_payer_notes":"APC"}]}]},{"description":"Measure blood oxygen level","code_information":[{"code":"94762","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":122.99,"maximum":307.10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":122.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":125.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":124.22,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":126.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":307.1,"additional_payer_notes":"APC"}]}]},{"description":"Ped home apnea rec hk-up","code_information":[{"code":"94775","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":122.99,"maximum":307.10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":122.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":125.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":124.22,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":126.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":307.1,"additional_payer_notes":"APC"}]}]},{"description":"Ped home apnea rec downld","code_information":[{"code":"94776","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":122.99,"maximum":307.10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":122.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":125.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":124.22,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":126.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":307.1,"additional_payer_notes":"APC"}]}]},{"description":"Pulmonary service/procedure","code_information":[{"code":"94799","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":122.99,"maximum":307.10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":122.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":125.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":124.22,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":126.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":307.1,"additional_payer_notes":"APC"}]}]},{"description":"Muscle test 3 limbs","code_information":[{"code":"95863","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":122.99,"maximum":307.10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":122.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":125.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":124.22,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":126.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":307.1,"additional_payer_notes":"APC"}]}]},{"description":"Muscle test 4 limbs","code_information":[{"code":"95864","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":122.99,"maximum":307.10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":122.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":125.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":124.22,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":126.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":307.1,"additional_payer_notes":"APC"}]}]},{"description":"Muscle test hemidiaphragm","code_information":[{"code":"95866","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":122.99,"maximum":307.10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":122.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":125.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":124.22,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":126.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":307.1,"additional_payer_notes":"APC"}]}]},{"description":"Limb exercise test","code_information":[{"code":"95875","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":122.99,"maximum":307.10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":122.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":125.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":124.22,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":126.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":307.1,"additional_payer_notes":"APC"}]}]},{"description":"Autonomic nrv parasym inervj","code_information":[{"code":"95921","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":122.99,"maximum":307.10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":122.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":125.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":124.22,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":126.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":307.1,"additional_payer_notes":"APC"}]}]},{"description":"Neuromuscular junction test","code_information":[{"code":"95937","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":122.99,"maximum":307.10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":122.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":125.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":124.22,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":126.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":307.1,"additional_payer_notes":"APC"}]}]},{"description":"Neurological procedure","code_information":[{"code":"95999","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":122.99,"maximum":307.10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":122.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":125.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":124.22,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":126.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":307.1,"additional_payer_notes":"APC"}]}]},{"description":"Devel tst phys/qhp 1st hr","code_information":[{"code":"96112","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":122.99,"maximum":307.10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":122.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":125.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":124.22,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":126.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":307.1,"additional_payer_notes":"APC"}]}]},{"description":"3d anat seg imaging preop","code_information":[{"code":"C8001","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":122.99,"maximum":307.10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":122.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":125.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":124.22,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":126.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":307.1,"additional_payer_notes":"APC"}]}]},{"description":"3d bn img algor drvd fr mri","code_information":[{"code":"G0566","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":122.99,"maximum":307.10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":122.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":125.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":124.22,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":126.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":307.1,"additional_payer_notes":"APC"}]}]},{"description":"Pattern erg w/i&r","code_information":[{"code":"0509T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":206.38,"maximum":515.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":206.38,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":210.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":208.45,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":212.58,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":515.34,"additional_payer_notes":"APC"}]}]},{"description":"Ncntc r-t fluor wnd img 1st","code_information":[{"code":"0598T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":206.38,"maximum":515.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":206.38,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":210.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":208.45,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":212.58,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":515.34,"additional_payer_notes":"APC"}]}]},{"description":"N-nvs artl plaq alys quan","code_information":[{"code":"0712T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":206.38,"maximum":515.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":206.38,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":210.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":208.45,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":212.58,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":515.34,"additional_payer_notes":"APC"}]}]},{"description":"Tc mag stimj pn 1st tx 1nrv","code_information":[{"code":"0766T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":206.38,"maximum":515.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":206.38,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":210.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":208.45,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":212.58,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":515.34,"additional_payer_notes":"APC"}]}]},{"description":"Pulm tiss vntj alys prev ct","code_information":[{"code":"0807T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":206.38,"maximum":515.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":206.38,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":210.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":208.45,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":212.58,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":515.34,"additional_payer_notes":"APC"}]}]},{"description":"Pulm tiss vntj alys w/ct","code_information":[{"code":"0808T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":206.38,"maximum":515.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":206.38,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":210.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":208.45,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":212.58,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":515.34,"additional_payer_notes":"APC"}]}]},{"description":"Tx gastro intub w/asp","code_information":[{"code":"43753","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":206.38,"maximum":515.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":206.38,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":210.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":208.45,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":212.58,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":515.34,"additional_payer_notes":"APC"}]}]},{"description":"Dx gastr intub w/asp spec","code_information":[{"code":"43754","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":206.38,"maximum":515.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":206.38,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":210.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":208.45,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":212.58,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":515.34,"additional_payer_notes":"APC"}]}]},{"description":"Electro-uroflowmetry first","code_information":[{"code":"51741","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":206.38,"maximum":515.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":206.38,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":210.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":208.45,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":212.58,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":515.34,"additional_payer_notes":"APC"}]}]},{"description":"Penis study","code_information":[{"code":"54240","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":206.38,"maximum":515.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":206.38,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":210.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":208.45,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":212.58,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":515.34,"additional_payer_notes":"APC"}]}]},{"description":"Echo guide for artery repair","code_information":[{"code":"76936","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":206.38,"maximum":515.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":206.38,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":210.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":208.45,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":212.58,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":515.34,"additional_payer_notes":"APC"}]}]},{"description":"Tcranial magn stim tx plan","code_information":[{"code":"90867","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":206.38,"maximum":515.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":206.38,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":210.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":208.45,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":212.58,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":515.34,"additional_payer_notes":"APC"}]}]},{"description":"Tcranial magn stim tx deli","code_information":[{"code":"90868","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":206.38,"maximum":515.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":206.38,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":210.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":208.45,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":212.58,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":515.34,"additional_payer_notes":"APC"}]}]},{"description":"Tcran magn stim redetemine","code_information":[{"code":"90869","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":206.38,"maximum":515.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":206.38,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":210.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":208.45,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":212.58,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":515.34,"additional_payer_notes":"APC"}]}]},{"description":"Esoph imped function test","code_information":[{"code":"91037","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":206.38,"maximum":515.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":206.38,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":210.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":208.45,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":212.58,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":515.34,"additional_payer_notes":"APC"}]}]},{"description":"Breath hydrogen/methane test","code_information":[{"code":"91065","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":206.38,"maximum":515.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":206.38,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":210.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":208.45,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":212.58,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":515.34,"additional_payer_notes":"APC"}]}]},{"description":"Colon motility 6 hr study","code_information":[{"code":"91117","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":206.38,"maximum":515.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":206.38,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":210.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":208.45,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":212.58,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":515.34,"additional_payer_notes":"APC"}]}]},{"description":"Rct snsatn tone&cmplianc std","code_information":[{"code":"91124","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":206.38,"maximum":515.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":206.38,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":210.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":208.45,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":212.58,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":515.34,"additional_payer_notes":"APC"}]}]},{"description":"Electrogastrography","code_information":[{"code":"91132","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":206.38,"maximum":515.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":206.38,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":210.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":208.45,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":212.58,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":515.34,"additional_payer_notes":"APC"}]}]},{"description":"Cptrz oph img pst sg rta oct","code_information":[{"code":"92137","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":206.38,"maximum":515.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":206.38,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":210.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":208.45,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":212.58,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":515.34,"additional_payer_notes":"APC"}]}]},{"description":"Fluorescein angrph uni/bi","code_information":[{"code":"92235","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":206.38,"maximum":515.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":206.38,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":210.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":208.45,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":212.58,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":515.34,"additional_payer_notes":"APC"}]}]},{"description":"Icg angiography uni/bi","code_information":[{"code":"92240","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":206.38,"maximum":515.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":206.38,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":210.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":208.45,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":212.58,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":515.34,"additional_payer_notes":"APC"}]}]},{"description":"Fluorescein icg angiography","code_information":[{"code":"92242","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":206.38,"maximum":515.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":206.38,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":210.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":208.45,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":212.58,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":515.34,"additional_payer_notes":"APC"}]}]},{"description":"Full field erg w/i&r","code_information":[{"code":"92273","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":206.38,"maximum":515.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":206.38,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":210.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":208.45,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":212.58,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":515.34,"additional_payer_notes":"APC"}]}]},{"description":"Nasal function studies","code_information":[{"code":"92512","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":206.38,"maximum":515.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":206.38,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":210.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":208.45,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":212.58,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":515.34,"additional_payer_notes":"APC"}]}]},{"description":"Facial nerve function test","code_information":[{"code":"92516","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":206.38,"maximum":515.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":206.38,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":210.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":208.45,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":212.58,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":515.34,"additional_payer_notes":"APC"}]}]},{"description":"Vemp tst i&r cervical&ocular","code_information":[{"code":"92519","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":206.38,"maximum":515.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":206.38,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":210.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":208.45,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":212.58,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":515.34,"additional_payer_notes":"APC"}]}]},{"description":"Caloric vstblr test w/rec","code_information":[{"code":"92538","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":206.38,"maximum":515.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":206.38,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":210.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":208.45,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":212.58,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":515.34,"additional_payer_notes":"APC"}]}]},{"description":"Basic vestibular evaluation","code_information":[{"code":"92540","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":206.38,"maximum":515.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":206.38,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":210.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":208.45,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":212.58,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":515.34,"additional_payer_notes":"APC"}]}]},{"description":"Oscillating tracking test","code_information":[{"code":"92545","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":206.38,"maximum":515.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":206.38,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":210.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":208.45,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":212.58,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":515.34,"additional_payer_notes":"APC"}]}]},{"description":"Tympanometry & reflex thresh","code_information":[{"code":"92550","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":206.38,"maximum":515.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":206.38,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":210.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":208.45,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":212.58,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":515.34,"additional_payer_notes":"APC"}]}]},{"description":"Loudness balance test","code_information":[{"code":"92562","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":206.38,"maximum":515.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":206.38,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":210.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":208.45,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":212.58,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":515.34,"additional_payer_notes":"APC"}]}]},{"description":"Visual audiometry (vra)","code_information":[{"code":"92579","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":206.38,"maximum":515.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":206.38,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":210.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":208.45,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":212.58,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":515.34,"additional_payer_notes":"APC"}]}]},{"description":"Evoked auditory test limited","code_information":[{"code":"92587","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":206.38,"maximum":515.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":206.38,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":210.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":208.45,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":212.58,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":515.34,"additional_payer_notes":"APC"}]}]},{"description":"Aep hearing status deter i&r","code_information":[{"code":"92651","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":206.38,"maximum":515.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":206.38,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":210.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":208.45,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":212.58,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":515.34,"additional_payer_notes":"APC"}]}]},{"description":"Aep thrshld est mlt freq i&r","code_information":[{"code":"92652","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":206.38,"maximum":515.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":206.38,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":210.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":208.45,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":212.58,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":515.34,"additional_payer_notes":"APC"}]}]},{"description":"Aep neurodiagnostic i&r","code_information":[{"code":"92653","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":206.38,"maximum":515.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":206.38,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":210.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":208.45,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":212.58,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":515.34,"additional_payer_notes":"APC"}]}]},{"description":"Heart/lung resuscitation cpr","code_information":[{"code":"92950","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":206.38,"maximum":515.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":206.38,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":210.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":208.45,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":212.58,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":515.34,"additional_payer_notes":"APC"}]}]},{"description":"Cardiovascular stress test","code_information":[{"code":"93017","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":206.38,"maximum":515.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":206.38,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":210.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":208.45,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":212.58,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":515.34,"additional_payer_notes":"APC"}]}]},{"description":"Upr/lxtr art stdy 3+ lvls","code_information":[{"code":"93923","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":206.38,"maximum":515.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":206.38,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":210.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":208.45,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":212.58,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":515.34,"additional_payer_notes":"APC"}]}]},{"description":"Lwr xtr vasc stdy bilat","code_information":[{"code":"93924","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":206.38,"maximum":515.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":206.38,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":210.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":208.45,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":212.58,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":515.34,"additional_payer_notes":"APC"}]}]},{"description":"Breathing capacity test","code_information":[{"code":"94010","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":206.38,"maximum":515.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":206.38,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":210.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":208.45,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":212.58,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":515.34,"additional_payer_notes":"APC"}]}]},{"description":"Spirmtry w/brnchdil inf-2 yr","code_information":[{"code":"94012","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":206.38,"maximum":515.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":206.38,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":210.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":208.45,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":212.58,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":515.34,"additional_payer_notes":"APC"}]}]},{"description":"Patient recorded spirometry","code_information":[{"code":"94015","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":206.38,"maximum":515.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":206.38,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":210.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":208.45,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":212.58,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":515.34,"additional_payer_notes":"APC"}]}]},{"description":"Respiratory flow volume loop","code_information":[{"code":"94375","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":206.38,"maximum":515.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":206.38,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":210.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":208.45,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":212.58,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":515.34,"additional_payer_notes":"APC"}]}]},{"description":"Pulm function test by gas","code_information":[{"code":"94727","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":206.38,"maximum":515.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":206.38,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":210.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":208.45,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":212.58,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":515.34,"additional_payer_notes":"APC"}]}]},{"description":"Eeg cont rec w/vid eeg tech","code_information":[{"code":"95700","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":206.38,"maximum":515.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":206.38,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":210.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":208.45,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":212.58,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":515.34,"additional_payer_notes":"APC"}]}]},{"description":"Eeg w/o vid 2-12 hr unmntr","code_information":[{"code":"95705","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":206.38,"maximum":515.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":206.38,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":210.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":208.45,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":212.58,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":515.34,"additional_payer_notes":"APC"}]}]},{"description":"Eeg wo vid 2-12hr intmt mntr","code_information":[{"code":"95706","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":206.38,"maximum":515.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":206.38,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":210.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":208.45,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":212.58,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":515.34,"additional_payer_notes":"APC"}]}]},{"description":"Eeg w/o vid 2-12hr cont mntr","code_information":[{"code":"95707","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":206.38,"maximum":515.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":206.38,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":210.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":208.45,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":212.58,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":515.34,"additional_payer_notes":"APC"}]}]},{"description":"Veeg 2-12 hr unmonitored","code_information":[{"code":"95711","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":206.38,"maximum":515.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":206.38,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":210.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":208.45,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":212.58,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":515.34,"additional_payer_notes":"APC"}]}]},{"description":"Slp stdy unattended","code_information":[{"code":"95800","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":206.38,"maximum":515.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":206.38,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":210.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":208.45,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":212.58,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":515.34,"additional_payer_notes":"APC"}]}]},{"description":"Sleep study unatt&resp efft","code_information":[{"code":"95806","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":206.38,"maximum":515.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":206.38,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":210.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":208.45,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":212.58,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":515.34,"additional_payer_notes":"APC"}]}]},{"description":"Eeg 41-60 minutes","code_information":[{"code":"95812","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":206.38,"maximum":515.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":206.38,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":210.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":208.45,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":212.58,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":515.34,"additional_payer_notes":"APC"}]}]},{"description":"Eeg over 1 hour","code_information":[{"code":"95813","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":206.38,"maximum":515.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":206.38,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":210.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":208.45,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":212.58,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":515.34,"additional_payer_notes":"APC"}]}]},{"description":"Eeg awake and drowsy","code_information":[{"code":"95816","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":206.38,"maximum":515.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":206.38,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":210.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":208.45,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":212.58,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":515.34,"additional_payer_notes":"APC"}]}]},{"description":"Eeg awake and asleep","code_information":[{"code":"95819","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":206.38,"maximum":515.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":206.38,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":210.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":208.45,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":212.58,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":515.34,"additional_payer_notes":"APC"}]}]},{"description":"Eeg coma or sleep only","code_information":[{"code":"95822","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":206.38,"maximum":515.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":206.38,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":210.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":208.45,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":212.58,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":515.34,"additional_payer_notes":"APC"}]}]},{"description":"Cholinesterase challenge","code_information":[{"code":"95857","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":206.38,"maximum":515.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":206.38,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":210.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":208.45,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":212.58,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":515.34,"additional_payer_notes":"APC"}]}]},{"description":"Muscle test cran nerv unilat","code_information":[{"code":"95867","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":206.38,"maximum":515.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":206.38,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":210.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":208.45,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":212.58,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":515.34,"additional_payer_notes":"APC"}]}]},{"description":"Muscle test cran nerve bilat","code_information":[{"code":"95868","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":206.38,"maximum":515.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":206.38,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":210.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":208.45,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":212.58,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":515.34,"additional_payer_notes":"APC"}]}]},{"description":"Muscle test thor paraspinal","code_information":[{"code":"95869","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":206.38,"maximum":515.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":206.38,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":210.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":208.45,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":212.58,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":515.34,"additional_payer_notes":"APC"}]}]},{"description":"Muscle test one fiber","code_information":[{"code":"95872","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":206.38,"maximum":515.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":206.38,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":210.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":208.45,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":212.58,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":515.34,"additional_payer_notes":"APC"}]}]},{"description":"Nvr cndj tst 1-2 studies","code_information":[{"code":"95907","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":206.38,"maximum":515.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":206.38,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":210.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":208.45,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":212.58,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":515.34,"additional_payer_notes":"APC"}]}]},{"description":"Nrv cndj tst 3-4 studies","code_information":[{"code":"95908","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":206.38,"maximum":515.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":206.38,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":210.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":208.45,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":212.58,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":515.34,"additional_payer_notes":"APC"}]}]},{"description":"Nrv cndj tst 5-6 studies","code_information":[{"code":"95909","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":206.38,"maximum":515.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":206.38,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":210.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":208.45,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":212.58,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":515.34,"additional_payer_notes":"APC"}]}]},{"description":"Ans parasymp & symp w/tilt","code_information":[{"code":"95924","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":206.38,"maximum":515.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":206.38,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":210.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":208.45,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":212.58,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":515.34,"additional_payer_notes":"APC"}]}]},{"description":"Somatosensory testing","code_information":[{"code":"95925","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":206.38,"maximum":515.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":206.38,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":210.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":208.45,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":212.58,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":515.34,"additional_payer_notes":"APC"}]}]},{"description":"Somatosensory testing","code_information":[{"code":"95926","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":206.38,"maximum":515.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":206.38,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":210.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":208.45,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":212.58,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":515.34,"additional_payer_notes":"APC"}]}]},{"description":"Somatosensory testing","code_information":[{"code":"95927","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":206.38,"maximum":515.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":206.38,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":210.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":208.45,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":212.58,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":515.34,"additional_payer_notes":"APC"}]}]},{"description":"Visual evoked potential test","code_information":[{"code":"95930","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":206.38,"maximum":515.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":206.38,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":210.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":208.45,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":212.58,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":515.34,"additional_payer_notes":"APC"}]}]},{"description":"Dynamic surface emg","code_information":[{"code":"96002","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":206.38,"maximum":515.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":206.38,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":210.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":208.45,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":212.58,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":515.34,"additional_payer_notes":"APC"}]}]},{"description":"Neurobehavioral status exam","code_information":[{"code":"96116","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":206.38,"maximum":515.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":206.38,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":210.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":208.45,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":212.58,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":515.34,"additional_payer_notes":"APC"}]}]},{"description":"Psycl tst eval phys/qhp 1st","code_information":[{"code":"96130","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":206.38,"maximum":515.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":206.38,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":210.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":208.45,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":212.58,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":515.34,"additional_payer_notes":"APC"}]}]},{"description":"Pre-op service LVRS 10-15dos","code_information":[{"code":"G0303","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":206.38,"maximum":515.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":206.38,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":210.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":208.45,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":212.58,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":515.34,"additional_payer_notes":"APC"}]}]},{"description":"Home sleep test/type 2 porta","code_information":[{"code":"G0398","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":206.38,"maximum":515.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":206.38,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":210.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":208.45,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":212.58,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":515.34,"additional_payer_notes":"APC"}]}]},{"description":"Home sleep test/type 3 porta","code_information":[{"code":"G0399","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":206.38,"maximum":515.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":206.38,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":210.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":208.45,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":212.58,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":515.34,"additional_payer_notes":"APC"}]}]},{"description":"Home sleep test/type 4 porta","code_information":[{"code":"G0400","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":206.38,"maximum":515.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":206.38,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":210.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":208.45,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":212.58,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":515.34,"additional_payer_notes":"APC"}]}]},{"description":"Myocardial imaging mcg","code_information":[{"code":"0541T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":356.67,"maximum":890.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":356.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":363.81,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":360.24,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":367.37,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":890.61,"additional_payer_notes":"APC"}]}]},{"description":"Gi myoelectrical actv study","code_information":[{"code":"0779T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":356.67,"maximum":890.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":356.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":363.81,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":360.24,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":367.37,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":890.61,"additional_payer_notes":"APC"}]}]},{"description":"Hi-res gastric ep mapping","code_information":[{"code":"0868T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":356.67,"maximum":890.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":356.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":363.81,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":360.24,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":367.37,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":890.61,"additional_payer_notes":"APC"}]}]},{"description":"Med physic dos eval rad exps","code_information":[{"code":"76145","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":356.67,"maximum":890.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":356.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":363.81,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":360.24,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":367.37,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":890.61,"additional_payer_notes":"APC"}]}]},{"description":"Esophagus motility study","code_information":[{"code":"91010","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":356.67,"maximum":890.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":356.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":363.81,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":360.24,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":367.37,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":890.61,"additional_payer_notes":"APC"}]}]},{"description":"Gastric motility studies","code_information":[{"code":"91020","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":356.67,"maximum":890.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":356.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":363.81,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":360.24,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":367.37,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":890.61,"additional_payer_notes":"APC"}]}]},{"description":"Duodenal motility study","code_information":[{"code":"91022","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":356.67,"maximum":890.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":356.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":363.81,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":360.24,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":367.37,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":890.61,"additional_payer_notes":"APC"}]}]},{"description":"Acid perfusion of esophagus","code_information":[{"code":"91030","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":356.67,"maximum":890.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":356.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":363.81,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":360.24,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":367.37,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":890.61,"additional_payer_notes":"APC"}]}]},{"description":"Gastroesophageal reflux test","code_information":[{"code":"91034","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":356.67,"maximum":890.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":356.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":363.81,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":360.24,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":367.37,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":890.61,"additional_payer_notes":"APC"}]}]},{"description":"Esoph imped funct test > 1hr","code_information":[{"code":"91038","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":356.67,"maximum":890.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":356.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":363.81,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":360.24,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":367.37,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":890.61,"additional_payer_notes":"APC"}]}]},{"description":"Esoph balloon distension tst","code_information":[{"code":"91040","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":356.67,"maximum":890.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":356.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":363.81,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":360.24,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":367.37,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":890.61,"additional_payer_notes":"APC"}]}]},{"description":"Anrct mano rct snsatn&balo","code_information":[{"code":"91125","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":356.67,"maximum":890.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":356.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":363.81,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":360.24,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":367.37,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":890.61,"additional_payer_notes":"APC"}]}]},{"description":"Eye exam with photos","code_information":[{"code":"92230","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":356.67,"maximum":890.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":356.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":363.81,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":360.24,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":367.37,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":890.61,"additional_payer_notes":"APC"}]}]},{"description":"Stenger test speech","code_information":[{"code":"92577","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":356.67,"maximum":890.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":356.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":363.81,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":360.24,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":367.37,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":890.61,"additional_payer_notes":"APC"}]}]},{"description":"Evoked auditory tst complete","code_information":[{"code":"92588","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":356.67,"maximum":890.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":356.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":363.81,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":360.24,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":367.37,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":890.61,"additional_payer_notes":"APC"}]}]},{"description":"Remote 30 day ecg tech supp","code_information":[{"code":"93229","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":356.67,"maximum":890.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":356.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":363.81,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":360.24,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":367.37,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":890.61,"additional_payer_notes":"APC"}]}]},{"description":"Tilt table evaluation","code_information":[{"code":"93660","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":356.67,"maximum":890.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":356.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":363.81,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":360.24,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":367.37,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":890.61,"additional_payer_notes":"APC"}]}]},{"description":"Meas lung vol thru 2 yrs","code_information":[{"code":"94013","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":356.67,"maximum":890.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":356.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":363.81,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":360.24,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":367.37,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":890.61,"additional_payer_notes":"APC"}]}]},{"description":"Evaluation of wheezing","code_information":[{"code":"94060","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":356.67,"maximum":890.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":356.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":363.81,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":360.24,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":367.37,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":890.61,"additional_payer_notes":"APC"}]}]},{"description":"Evaluation of wheezing","code_information":[{"code":"94070","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":356.67,"maximum":890.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":356.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":363.81,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":360.24,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":367.37,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":890.61,"additional_payer_notes":"APC"}]}]},{"description":"Pulm stress test/complex","code_information":[{"code":"94621","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":356.67,"maximum":890.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":356.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":363.81,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":360.24,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":367.37,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":890.61,"additional_payer_notes":"APC"}]}]},{"description":"Exhaled air analysis o2/co2","code_information":[{"code":"94681","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":356.67,"maximum":890.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":356.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":363.81,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":360.24,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":367.37,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":890.61,"additional_payer_notes":"APC"}]}]},{"description":"Pulm funct tst plethysmograp","code_information":[{"code":"94726","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":356.67,"maximum":890.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":356.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":363.81,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":360.24,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":367.37,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":890.61,"additional_payer_notes":"APC"}]}]},{"description":"Breath recording infant","code_information":[{"code":"94772","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":356.67,"maximum":890.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":356.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":363.81,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":360.24,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":367.37,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":890.61,"additional_payer_notes":"APC"}]}]},{"description":"Bronchial allergy tests","code_information":[{"code":"95070","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":356.67,"maximum":890.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":356.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":363.81,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":360.24,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":367.37,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":890.61,"additional_payer_notes":"APC"}]}]},{"description":"Ingest challenge ini 120 min","code_information":[{"code":"95076","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":356.67,"maximum":890.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":356.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":363.81,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":360.24,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":367.37,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":890.61,"additional_payer_notes":"APC"}]}]},{"description":"Eeg wo vid ea 12-26hr unmntr","code_information":[{"code":"95708","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":356.67,"maximum":890.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":356.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":363.81,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":360.24,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":367.37,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":890.61,"additional_payer_notes":"APC"}]}]},{"description":"Eeg w/o vid ea 12-26hr intmt","code_information":[{"code":"95709","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":356.67,"maximum":890.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":356.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":363.81,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":360.24,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":367.37,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":890.61,"additional_payer_notes":"APC"}]}]},{"description":"Eeg w/o vid ea 12-26hr cont","code_information":[{"code":"95710","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":356.67,"maximum":890.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":356.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":363.81,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":360.24,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":367.37,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":890.61,"additional_payer_notes":"APC"}]}]},{"description":"Veeg 2-12 hr intmt mntr","code_information":[{"code":"95712","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":356.67,"maximum":890.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":356.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":363.81,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":360.24,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":367.37,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":890.61,"additional_payer_notes":"APC"}]}]},{"description":"Veeg 2-12 hr cont mntr","code_information":[{"code":"95713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":356.67,"maximum":890.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":356.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":363.81,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":360.24,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":367.37,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":890.61,"additional_payer_notes":"APC"}]}]},{"description":"Veeg ea 12-26 hr unmntr","code_information":[{"code":"95714","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":356.67,"maximum":890.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":356.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":363.81,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":360.24,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":367.37,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":890.61,"additional_payer_notes":"APC"}]}]},{"description":"Veeg ea 12-26hr intmt mntr","code_information":[{"code":"95715","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":356.67,"maximum":890.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":356.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":363.81,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":360.24,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":367.37,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":890.61,"additional_payer_notes":"APC"}]}]},{"description":"Sleep study attended","code_information":[{"code":"95807","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":356.67,"maximum":890.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":356.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":363.81,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":360.24,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":367.37,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":890.61,"additional_payer_notes":"APC"}]}]},{"description":"Eeg cerebral death only","code_information":[{"code":"95824","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":356.67,"maximum":890.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":356.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":363.81,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":360.24,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":367.37,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":890.61,"additional_payer_notes":"APC"}]}]},{"description":"Nrv cndj test 7-8 studies","code_information":[{"code":"95910","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":356.67,"maximum":890.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":356.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":363.81,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":360.24,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":367.37,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":890.61,"additional_payer_notes":"APC"}]}]},{"description":"Nrv cndj test 9-10 studies","code_information":[{"code":"95911","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":356.67,"maximum":890.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":356.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":363.81,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":360.24,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":367.37,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":890.61,"additional_payer_notes":"APC"}]}]},{"description":"Nrv cndj test 11-12 studies","code_information":[{"code":"95912","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":356.67,"maximum":890.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":356.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":363.81,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":360.24,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":367.37,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":890.61,"additional_payer_notes":"APC"}]}]},{"description":"Nrv cndj test 13/> studies","code_information":[{"code":"95913","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":356.67,"maximum":890.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":356.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":363.81,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":360.24,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":367.37,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":890.61,"additional_payer_notes":"APC"}]}]},{"description":"C motor evoked lwr limbs","code_information":[{"code":"95929","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":356.67,"maximum":890.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":356.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":363.81,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":360.24,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":367.37,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":890.61,"additional_payer_notes":"APC"}]}]},{"description":"EEG monitoring/giving drugs","code_information":[{"code":"95954","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":356.67,"maximum":890.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":356.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":363.81,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":360.24,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":367.37,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":890.61,"additional_payer_notes":"APC"}]}]},{"description":"Motion analysis video/3d","code_information":[{"code":"96000","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":356.67,"maximum":890.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":356.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":363.81,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":360.24,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":367.37,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":890.61,"additional_payer_notes":"APC"}]}]},{"description":"Nrpsyc tst eval phys/qhp 1st","code_information":[{"code":"96132","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":356.67,"maximum":890.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":356.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":363.81,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":360.24,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":367.37,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":890.61,"additional_payer_notes":"APC"}]}]},{"description":"Pre-op service LVRS complete","code_information":[{"code":"G0302","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":356.67,"maximum":890.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":356.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":363.81,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":360.24,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":367.37,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":890.61,"additional_payer_notes":"APC"}]}]},{"description":"Pre-op service LVRS 1-9 dos","code_information":[{"code":"G0304","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":356.67,"maximum":890.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":356.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":363.81,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":360.24,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":367.37,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":890.61,"additional_payer_notes":"APC"}]}]},{"description":"Post op service LVRS min 6","code_information":[{"code":"G0305","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":356.67,"maximum":890.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":356.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":363.81,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":360.24,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":367.37,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":890.61,"additional_payer_notes":"APC"}]}]},{"description":"Blinded conv. Tx MDD clin tr","code_information":[{"code":"G2000","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":356.67,"maximum":890.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":356.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":363.81,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":360.24,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":367.37,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":890.61,"additional_payer_notes":"APC"}]}]},{"description":"N-invas augmnt arrhyt alys","code_information":[{"code":"0897T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":820.80,"maximum":2049.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":820.8,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":837.22,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":829.01,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":845.43,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2049.55,"additional_payer_notes":"APC"}]}]},{"description":"N-invas prst8 cancer est map","code_information":[{"code":"0898T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":820.80,"maximum":2049.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":820.8,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":837.22,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":829.01,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":845.43,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2049.55,"additional_payer_notes":"APC"}]}]},{"description":"Drain bladder by trocar/cath","code_information":[{"code":"51101","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":820.80,"maximum":2049.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":820.8,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":837.22,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":829.01,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":845.43,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2049.55,"additional_payer_notes":"APC"}]}]},{"description":"N-invas est c ffr sw aly cta","code_information":[{"code":"75580","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":820.80,"maximum":2049.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":820.8,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":837.22,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":829.01,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":845.43,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2049.55,"additional_payer_notes":"APC"}]}]},{"description":"Electroconvulsive therapy","code_information":[{"code":"90870","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":820.80,"maximum":2049.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":820.8,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":837.22,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":829.01,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":845.43,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2049.55,"additional_payer_notes":"APC"}]}]},{"description":"G-esoph reflx tst w/electrod","code_information":[{"code":"91035","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":820.80,"maximum":2049.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":820.8,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":837.22,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":829.01,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":845.43,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2049.55,"additional_payer_notes":"APC"}]}]},{"description":"Percut allergy skin tests","code_information":[{"code":"95004","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":820.80,"maximum":2049.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":820.8,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":837.22,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":829.01,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":845.43,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2049.55,"additional_payer_notes":"APC"}]}]},{"description":"Allergy patch tests","code_information":[{"code":"95044","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":820.80,"maximum":2049.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":820.8,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":837.22,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":829.01,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":845.43,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2049.55,"additional_payer_notes":"APC"}]}]},{"description":"Veeg ea 12-26hr cont mntr","code_information":[{"code":"95716","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":820.80,"maximum":2049.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":820.8,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":837.22,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":829.01,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":845.43,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2049.55,"additional_payer_notes":"APC"}]}]},{"description":"Polysom <6 yrs 4/> paramtrs","code_information":[{"code":"95782","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":820.80,"maximum":2049.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":820.8,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":837.22,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":829.01,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":845.43,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2049.55,"additional_payer_notes":"APC"}]}]},{"description":"Polysom <6 yrs cpap/bilvl","code_information":[{"code":"95783","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":820.80,"maximum":2049.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":820.8,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":837.22,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":829.01,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":845.43,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2049.55,"additional_payer_notes":"APC"}]}]},{"description":"Multiple sleep latency test","code_information":[{"code":"95805","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":820.80,"maximum":2049.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":820.8,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":837.22,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":829.01,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":845.43,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2049.55,"additional_payer_notes":"APC"}]}]},{"description":"Polysom any age 1-3> param","code_information":[{"code":"95808","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":820.80,"maximum":2049.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":820.8,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":837.22,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":829.01,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":845.43,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2049.55,"additional_payer_notes":"APC"}]}]},{"description":"Polysom 6/> yrs 4/> param","code_information":[{"code":"95810","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":820.80,"maximum":2049.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":820.8,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":837.22,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":829.01,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":845.43,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2049.55,"additional_payer_notes":"APC"}]}]},{"description":"Polysom 6/>yrs cpap 4/> parm","code_information":[{"code":"95811","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":820.80,"maximum":2049.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":820.8,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":837.22,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":829.01,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":845.43,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2049.55,"additional_payer_notes":"APC"}]}]},{"description":"C motor evoked uppr limbs","code_information":[{"code":"95928","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":820.80,"maximum":2049.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":820.8,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":837.22,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":829.01,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":845.43,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2049.55,"additional_payer_notes":"APC"}]}]},{"description":"Somatosensory testing","code_information":[{"code":"95938","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":820.80,"maximum":2049.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":820.8,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":837.22,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":829.01,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":845.43,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2049.55,"additional_payer_notes":"APC"}]}]},{"description":"C motor evoked upr&lwr limbs","code_information":[{"code":"95939","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":820.80,"maximum":2049.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":820.8,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":837.22,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":829.01,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":845.43,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2049.55,"additional_payer_notes":"APC"}]}]},{"description":"EEG monitoring/function test","code_information":[{"code":"95958","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":820.80,"maximum":2049.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":820.8,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":837.22,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":829.01,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":845.43,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2049.55,"additional_payer_notes":"APC"}]}]},{"description":"Electrode stimulation brain","code_information":[{"code":"95961","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":820.80,"maximum":2049.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":820.8,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":837.22,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":829.01,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":845.43,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2049.55,"additional_payer_notes":"APC"}]}]},{"description":"Meg spontaneous","code_information":[{"code":"95965","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":820.80,"maximum":2049.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":820.8,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":837.22,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":829.01,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":845.43,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2049.55,"additional_payer_notes":"APC"}]}]},{"description":"Meg evoked single","code_information":[{"code":"95966","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":820.80,"maximum":2049.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":820.8,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":837.22,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":829.01,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":845.43,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2049.55,"additional_payer_notes":"APC"}]}]},{"description":"Motion test w/ft press meas","code_information":[{"code":"96001","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":820.80,"maximum":2049.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":820.8,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":837.22,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":829.01,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":845.43,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2049.55,"additional_payer_notes":"APC"}]}]},{"description":"Pre-plan 3d model w/ccta","code_information":[{"code":"C9793","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":820.80,"maximum":2049.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":820.8,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":837.22,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":829.01,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":845.43,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2049.55,"additional_payer_notes":"APC"}]}]},{"description":"Replacment pt electronic sys","code_information":[{"code":"G0555","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":820.80,"maximum":2049.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":820.8,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":837.22,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":829.01,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":845.43,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2049.55,"additional_payer_notes":"APC"}]}]},{"description":"BIA whole body","code_information":[{"code":"0358T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":27.65,"maximum":69.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27.65,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27.92,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28.48,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":69.03,"additional_payer_notes":"APC"}]}]},{"description":"Interrog dev eval wcs ip","code_information":[{"code":"0521T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":27.65,"maximum":69.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27.65,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27.92,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28.48,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":69.03,"additional_payer_notes":"APC"}]}]},{"description":"B1 str&fx rsk transmis data","code_information":[{"code":"0555T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":27.65,"maximum":69.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27.65,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27.92,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28.48,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":69.03,"additional_payer_notes":"APC"}]}]},{"description":"Air displacmnt plethysmograp","code_information":[{"code":"1002T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":27.65,"maximum":69.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27.65,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27.92,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28.48,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":69.03,"additional_payer_notes":"APC"}]}]},{"description":"Ndl insj w/o njx 1 or 2 musc","code_information":[{"code":"20560","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":27.65,"maximum":69.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27.65,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27.92,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28.48,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":69.03,"additional_payer_notes":"APC"}]}]},{"description":"Ndl insj w/o njx 3+ musc","code_information":[{"code":"20561","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":27.65,"maximum":69.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27.65,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27.92,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28.48,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":69.03,"additional_payer_notes":"APC"}]}]},{"description":"Us bone stimulation","code_information":[{"code":"20979","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":27.65,"maximum":69.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27.65,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27.92,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28.48,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":69.03,"additional_payer_notes":"APC"}]}]},{"description":"Mr sfty implt&/fb asmt stf 1","code_information":[{"code":"76014","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":27.65,"maximum":69.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27.65,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27.92,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28.48,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":69.03,"additional_payer_notes":"APC"}]}]},{"description":"Echo exam of eye thickness","code_information":[{"code":"76514","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":27.65,"maximum":69.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27.65,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27.92,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28.48,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":69.03,"additional_payer_notes":"APC"}]}]},{"description":"Phys blood bank serv xmatch","code_information":[{"code":"86077","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":27.65,"maximum":69.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27.65,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27.92,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28.48,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":69.03,"additional_payer_notes":"APC"}]}]},{"description":"Skin test candida","code_information":[{"code":"86485","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":27.65,"maximum":69.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27.65,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27.92,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28.48,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":69.03,"additional_payer_notes":"APC"}]}]},{"description":"Skin test nos antigen","code_information":[{"code":"86486","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":27.65,"maximum":69.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27.65,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27.92,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28.48,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":69.03,"additional_payer_notes":"APC"}]}]},{"description":"TB intradermal test","code_information":[{"code":"86580","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":27.65,"maximum":69.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27.65,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27.92,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28.48,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":69.03,"additional_payer_notes":"APC"}]}]},{"description":"Rbc serum pretx id dilution","code_information":[{"code":"86976","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":27.65,"maximum":69.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27.65,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27.92,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28.48,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":69.03,"additional_payer_notes":"APC"}]}]},{"description":"Transfusion procedure","code_information":[{"code":"86999","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":27.65,"maximum":69.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27.65,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27.92,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28.48,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":69.03,"additional_payer_notes":"APC"}]}]},{"description":"Cytopath fl nongyn filter","code_information":[{"code":"88106","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":27.65,"maximum":69.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27.65,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27.92,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28.48,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":69.03,"additional_payer_notes":"APC"}]}]},{"description":"Cytopath smear other source","code_information":[{"code":"88160","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":27.65,"maximum":69.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27.65,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27.92,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28.48,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":69.03,"additional_payer_notes":"APC"}]}]},{"description":"Cytopath smear other source","code_information":[{"code":"88161","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":27.65,"maximum":69.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27.65,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27.92,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28.48,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":69.03,"additional_payer_notes":"APC"}]}]},{"description":"Surgical path gross","code_information":[{"code":"88300","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":27.65,"maximum":69.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27.65,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27.92,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28.48,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":69.03,"additional_payer_notes":"APC"}]}]},{"description":"Xm archive tissue molec anal","code_information":[{"code":"88363","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":27.65,"maximum":69.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27.65,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27.92,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28.48,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":69.03,"additional_payer_notes":"APC"}]}]},{"description":"Eye service or procedure","code_information":[{"code":"92499","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":27.65,"maximum":69.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27.65,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27.92,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28.48,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":69.03,"additional_payer_notes":"APC"}]}]},{"description":"Ent procedure/service","code_information":[{"code":"92700","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":27.65,"maximum":69.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27.65,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27.92,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28.48,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":69.03,"additional_payer_notes":"APC"}]}]},{"description":"Art pressure waveform analys","code_information":[{"code":"93050","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":27.65,"maximum":69.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27.65,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27.92,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28.48,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":69.03,"additional_payer_notes":"APC"}]}]},{"description":"Ilr device interrogate","code_information":[{"code":"93291","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":27.65,"maximum":69.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27.65,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27.92,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28.48,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":69.03,"additional_payer_notes":"APC"}]}]},{"description":"Noninvas vasc dx study proc","code_information":[{"code":"93998","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":27.65,"maximum":69.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27.65,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27.92,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28.48,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":69.03,"additional_payer_notes":"APC"}]}]},{"description":"Perq & icut allg test venoms","code_information":[{"code":"95017","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":27.65,"maximum":69.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27.65,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27.92,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28.48,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":69.03,"additional_payer_notes":"APC"}]}]},{"description":"Icut allergy titrate-airborn","code_information":[{"code":"95027","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":27.65,"maximum":69.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27.65,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27.92,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28.48,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":69.03,"additional_payer_notes":"APC"}]}]},{"description":"Allergy immunology services","code_information":[{"code":"95199","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":27.65,"maximum":69.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27.65,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27.92,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28.48,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":69.03,"additional_payer_notes":"APC"}]}]},{"description":"Psycl/nrpsyc tst auto result","code_information":[{"code":"96146","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":27.65,"maximum":69.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27.65,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27.92,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28.48,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":69.03,"additional_payer_notes":"APC"}]}]},{"description":"Acupunct w/o stimul 15 min","code_information":[{"code":"97810","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":27.65,"maximum":69.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27.65,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27.92,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28.48,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":69.03,"additional_payer_notes":"APC"}]}]},{"description":"Acupunct w/stimul 15 min","code_information":[{"code":"97813","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":27.65,"maximum":69.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27.65,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27.92,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28.48,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":69.03,"additional_payer_notes":"APC"}]}]},{"description":"Self-meas bp pt educaj/train","code_information":[{"code":"99473","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":27.65,"maximum":69.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27.65,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27.92,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28.48,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":69.03,"additional_payer_notes":"APC"}]}]},{"description":"Glaucoma scrn hgh risk direc","code_information":[{"code":"G0117","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":27.65,"maximum":69.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27.65,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27.92,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28.48,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":69.03,"additional_payer_notes":"APC"}]}]},{"description":"Therapeutic procd strg endur","code_information":[{"code":"G0237","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":27.65,"maximum":69.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27.65,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27.92,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28.48,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":69.03,"additional_payer_notes":"APC"}]}]},{"description":"Oth resp proc, indiv","code_information":[{"code":"G0238","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":27.65,"maximum":69.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27.65,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27.92,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28.48,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":69.03,"additional_payer_notes":"APC"}]}]},{"description":"EKG tracing for initial prev","code_information":[{"code":"G0404","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":27.65,"maximum":69.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27.65,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27.92,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28.48,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":69.03,"additional_payer_notes":"APC"}]}]},{"description":"No pt prsnt train initial 30","code_information":[{"code":"G0541","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":27.65,"maximum":69.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27.65,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27.92,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28.48,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":69.03,"additional_payer_notes":"APC"}]}]},{"description":"Group train w/o patient","code_information":[{"code":"G0543","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":27.65,"maximum":69.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27.65,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27.92,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28.48,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":69.03,"additional_payer_notes":"APC"}]}]},{"description":"Alcohol/sub abuse assess","code_information":[{"code":"G2011","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":27.65,"maximum":69.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27.65,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27.92,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28.48,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":69.03,"additional_payer_notes":"APC"}]}]},{"description":"Obtaining screen pap smear","code_information":[{"code":"Q0091","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":27.65,"maximum":69.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27.65,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27.92,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28.48,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":69.03,"additional_payer_notes":"APC"}]}]},{"description":"Touch Quant Sensory Test","code_information":[{"code":"0106T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.70,"maximum":89.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.7,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.41,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.06,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":89.15,"additional_payer_notes":"APC"}]}]},{"description":"Vibrate Quant Sensory Test","code_information":[{"code":"0107T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.70,"maximum":89.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.7,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.41,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.06,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":89.15,"additional_payer_notes":"APC"}]}]},{"description":"Heat Quant Sensory Test","code_information":[{"code":"0109T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.70,"maximum":89.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.7,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.41,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.06,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":89.15,"additional_payer_notes":"APC"}]}]},{"description":"Audiometry air only","code_information":[{"code":"0208T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.70,"maximum":89.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.7,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.41,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.06,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":89.15,"additional_payer_notes":"APC"}]}]},{"description":"Audiometry air & bone","code_information":[{"code":"0209T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.70,"maximum":89.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.7,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.41,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.06,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":89.15,"additional_payer_notes":"APC"}]}]},{"description":"Speech audiometry threshold","code_information":[{"code":"0210T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.70,"maximum":89.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.7,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.41,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.06,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":89.15,"additional_payer_notes":"APC"}]}]},{"description":"Speech audiom thresh & recog","code_information":[{"code":"0211T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.70,"maximum":89.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.7,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.41,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.06,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":89.15,"additional_payer_notes":"APC"}]}]},{"description":"Tear film img uni/bi w/i&r","code_information":[{"code":"0330T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.70,"maximum":89.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.7,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.41,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.06,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":89.15,"additional_payer_notes":"APC"}]}]},{"description":"Vis field assmnt tech suppt","code_information":[{"code":"0379T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.70,"maximum":89.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.7,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.41,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.06,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":89.15,"additional_payer_notes":"APC"}]}]},{"description":"Oct mid ear i&r unilateral","code_information":[{"code":"0485T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.70,"maximum":89.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.7,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.41,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.06,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":89.15,"additional_payer_notes":"APC"}]}]},{"description":"Oct mid ear i&r bilateral","code_information":[{"code":"0486T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.70,"maximum":89.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.7,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.41,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.06,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":89.15,"additional_payer_notes":"APC"}]}]},{"description":"Ncntc nr ifr spctrsc wnd","code_information":[{"code":"0640T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.70,"maximum":89.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.7,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.41,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.06,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":89.15,"additional_payer_notes":"APC"}]}]},{"description":"Surf radj ther tx planning","code_information":[{"code":"77436","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.70,"maximum":89.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.7,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.41,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.06,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":89.15,"additional_payer_notes":"APC"}]}]},{"description":"Histoplasmosis skin test","code_information":[{"code":"86510","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.70,"maximum":89.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.7,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.41,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.06,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":89.15,"additional_payer_notes":"APC"}]}]},{"description":"Blood typing serologic rh(d)","code_information":[{"code":"86901","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.70,"maximum":89.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.7,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.41,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.06,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":89.15,"additional_payer_notes":"APC"}]}]},{"description":"Bld typing serologic rh phnt","code_information":[{"code":"86906","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.70,"maximum":89.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.7,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.41,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.06,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":89.15,"additional_payer_notes":"APC"}]}]},{"description":"Frozen blood freeze/thaw","code_information":[{"code":"86932","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.70,"maximum":89.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.7,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.41,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.06,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":89.15,"additional_payer_notes":"APC"}]}]},{"description":"Blood product/irradiation","code_information":[{"code":"86945","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.70,"maximum":89.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.7,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.41,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.06,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":89.15,"additional_payer_notes":"APC"}]}]},{"description":"Cytopath fl nongyn smears","code_information":[{"code":"88104","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.70,"maximum":89.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.7,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.41,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.06,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":89.15,"additional_payer_notes":"APC"}]}]},{"description":"Cytopath concentrate tech","code_information":[{"code":"88108","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.70,"maximum":89.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.7,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.41,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.06,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":89.15,"additional_payer_notes":"APC"}]}]},{"description":"Tissue exam by pathologist","code_information":[{"code":"88302","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.70,"maximum":89.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.7,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.41,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.06,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":89.15,"additional_payer_notes":"APC"}]}]},{"description":"Microslide consultation","code_information":[{"code":"88321","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.70,"maximum":89.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.7,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.41,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.06,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":89.15,"additional_payer_notes":"APC"}]}]},{"description":"Remote retinal imaging mgmt","code_information":[{"code":"92228","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.70,"maximum":89.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.7,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.41,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.06,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":89.15,"additional_payer_notes":"APC"}]}]},{"description":"Ophthalmoscopy/dynamometry","code_information":[{"code":"92260","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.70,"maximum":89.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.7,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.41,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.06,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":89.15,"additional_payer_notes":"APC"}]}]},{"description":"Eye photography","code_information":[{"code":"92285","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.70,"maximum":89.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.7,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.41,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.06,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":89.15,"additional_payer_notes":"APC"}]}]},{"description":"Rx corneoscleral cntact lens","code_information":[{"code":"92317","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.70,"maximum":89.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.7,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.41,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.06,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":89.15,"additional_payer_notes":"APC"}]}]},{"description":"Fit spectacles single system","code_information":[{"code":"92354","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.70,"maximum":89.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.7,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.41,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.06,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":89.15,"additional_payer_notes":"APC"}]}]},{"description":"Fit spectacles compound lens","code_information":[{"code":"92355","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.70,"maximum":89.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.7,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.41,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.06,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":89.15,"additional_payer_notes":"APC"}]}]},{"description":"Tone decay hearing test","code_information":[{"code":"92563","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.70,"maximum":89.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.7,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.41,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.06,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":89.15,"additional_payer_notes":"APC"}]}]},{"description":"Tympanometry","code_information":[{"code":"92567","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.70,"maximum":89.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.7,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.41,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.06,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":89.15,"additional_payer_notes":"APC"}]}]},{"description":"Acoustic refl threshold tst","code_information":[{"code":"92568","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.70,"maximum":89.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.7,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.41,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.06,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":89.15,"additional_payer_notes":"APC"}]}]},{"description":"Filtered speech hearing test","code_information":[{"code":"92571","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.70,"maximum":89.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.7,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.41,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.06,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":89.15,"additional_payer_notes":"APC"}]}]},{"description":"Sensorineural acuity test","code_information":[{"code":"92575","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.70,"maximum":89.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.7,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.41,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.06,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":89.15,"additional_payer_notes":"APC"}]}]},{"description":"Synthetic sentence test","code_information":[{"code":"92576","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.70,"maximum":89.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.7,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.41,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.06,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":89.15,"additional_payer_notes":"APC"}]}]},{"description":"Ear protector evaluation","code_information":[{"code":"92596","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.70,"maximum":89.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.7,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.41,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.06,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":89.15,"additional_payer_notes":"APC"}]}]},{"description":"Ext ecg>48hr<7d recording","code_information":[{"code":"93242","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.70,"maximum":89.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.7,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.41,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.06,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":89.15,"additional_payer_notes":"APC"}]}]},{"description":"Ext ecg>7d<15d recording","code_information":[{"code":"93246","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.70,"maximum":89.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.7,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.41,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.06,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":89.15,"additional_payer_notes":"APC"}]}]},{"description":"Car seat/bed test 60 min","code_information":[{"code":"94780","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.70,"maximum":89.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.7,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.41,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.06,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":89.15,"additional_payer_notes":"APC"}]}]},{"description":"Exhaled Nitric Oxide Meas","code_information":[{"code":"95012","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.70,"maximum":89.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.7,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.41,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.06,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":89.15,"additional_payer_notes":"APC"}]}]},{"description":"Perq&ic allg test drugs/biol","code_information":[{"code":"95018","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.70,"maximum":89.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.7,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.41,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.06,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":89.15,"additional_payer_notes":"APC"}]}]},{"description":"Icut allergy test-delayed","code_information":[{"code":"95028","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.70,"maximum":89.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.7,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.41,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.06,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":89.15,"additional_payer_notes":"APC"}]}]},{"description":"Nose allergy test","code_information":[{"code":"95065","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.70,"maximum":89.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.7,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.41,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.06,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":89.15,"additional_payer_notes":"APC"}]}]},{"description":"Brief emotional/behav assmt","code_information":[{"code":"96127","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.70,"maximum":89.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.7,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.41,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.06,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":89.15,"additional_payer_notes":"APC"}]}]},{"description":"Ultraviolet light therapy","code_information":[{"code":"96900","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.70,"maximum":89.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.7,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.41,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.06,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":89.15,"additional_payer_notes":"APC"}]}]},{"description":"Appl modality 1+lllt po pain","code_information":[{"code":"97037","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.70,"maximum":89.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.7,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.41,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.06,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":89.15,"additional_payer_notes":"APC"}]}]},{"description":"Glaucoma scrn hgh risk direc","code_information":[{"code":"G0118","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.70,"maximum":89.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.7,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.41,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.06,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":89.15,"additional_payer_notes":"APC"}]}]},{"description":"Oth resp proc, group","code_information":[{"code":"G0239","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.70,"maximum":89.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.7,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.41,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.06,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":89.15,"additional_payer_notes":"APC"}]}]},{"description":"Non-cov surg proc,clin trial","code_information":[{"code":"G0293","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.70,"maximum":89.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.7,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.41,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.06,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":89.15,"additional_payer_notes":"APC"}]}]},{"description":"Non-cov proc, clinical trial","code_information":[{"code":"G0294","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.70,"maximum":89.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.7,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.41,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.06,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":89.15,"additional_payer_notes":"APC"}]}]},{"description":"Cardiokymography","code_information":[{"code":"Q0035","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.70,"maximum":89.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.7,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.41,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.06,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":89.15,"additional_payer_notes":"APC"}]}]},{"description":"Cool Quant Sensory Test","code_information":[{"code":"0108T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":56.39,"maximum":140.80,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":56.39,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":57.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":56.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":58.08,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":140.8,"additional_payer_notes":"APC"}]}]},{"description":"Ins bone device for rsa","code_information":[{"code":"0347T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":56.39,"maximum":140.80,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":56.39,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":57.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":56.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":58.08,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":140.8,"additional_payer_notes":"APC"}]}]},{"description":"Mac pgmt opt dns meas hfp","code_information":[{"code":"0506T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":56.39,"maximum":140.80,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":56.39,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":57.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":56.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":58.08,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":140.8,"additional_payer_notes":"APC"}]}]},{"description":"Near ifr 2img mibmn glnd i&r","code_information":[{"code":"0507T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":56.39,"maximum":140.80,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":56.39,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":57.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":56.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":58.08,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":140.8,"additional_payer_notes":"APC"}]}]},{"description":"Evac meibomian glnd heat bi","code_information":[{"code":"0563T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":56.39,"maximum":140.80,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":56.39,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":57.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":56.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":58.08,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":140.8,"additional_payer_notes":"APC"}]}]},{"description":"Elec impd spectrsc 1+skn les","code_information":[{"code":"0658T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":56.39,"maximum":140.80,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":56.39,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":57.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":56.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":58.08,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":140.8,"additional_payer_notes":"APC"}]}]},{"description":"Car acous wavfrm rec cad rsk","code_information":[{"code":"0716T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":56.39,"maximum":140.80,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":56.39,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":57.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":56.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":58.08,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":140.8,"additional_payer_notes":"APC"}]}]},{"description":"Augmnt ai-based fcl phnt a/r","code_information":[{"code":"0731T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":56.39,"maximum":140.80,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":56.39,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":57.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":56.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":58.08,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":140.8,"additional_payer_notes":"APC"}]}]},{"description":"Rem auton alg nsln cal setup","code_information":[{"code":"0740T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":56.39,"maximum":140.80,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":56.39,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":57.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":56.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":58.08,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":140.8,"additional_payer_notes":"APC"}]}]},{"description":"Pt spec alg rx-onc tx option","code_information":[{"code":"0794T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":56.39,"maximum":140.80,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":56.39,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":57.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":56.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":58.08,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":140.8,"additional_payer_notes":"APC"}]}]},{"description":"Ecg alg 12 ld rdcd trcg only","code_information":[{"code":"0904T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":56.39,"maximum":140.80,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":56.39,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":57.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":56.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":58.08,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":140.8,"additional_payer_notes":"APC"}]}]},{"description":"Elec aly nstm sys vgs nrv wo","code_information":[{"code":"0911T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":56.39,"maximum":140.80,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":56.39,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":57.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":56.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":58.08,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":140.8,"additional_payer_notes":"APC"}]}]},{"description":"Elec aly npgs esoph sbsq w/o","code_information":[{"code":"1017T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":56.39,"maximum":140.80,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":56.39,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":57.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":56.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":58.08,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":140.8,"additional_payer_notes":"APC"}]}]},{"description":"Raman spectroscopy 1+skn les","code_information":[{"code":"1020T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":56.39,"maximum":140.80,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":56.39,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":57.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":56.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":58.08,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":140.8,"additional_payer_notes":"APC"}]}]},{"description":"Trim nail(s) any number","code_information":[{"code":"11719","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":56.39,"maximum":140.80,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":56.39,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":57.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":56.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":58.08,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":140.8,"additional_payer_notes":"APC"}]}]},{"description":"Debride nail 1-5","code_information":[{"code":"11720","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":56.39,"maximum":140.80,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":56.39,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":57.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":56.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":58.08,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":140.8,"additional_payer_notes":"APC"}]}]},{"description":"Debride nail 6 or more","code_information":[{"code":"11721","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":56.39,"maximum":140.80,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":56.39,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":57.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":56.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":58.08,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":140.8,"additional_payer_notes":"APC"}]}]},{"description":"Cryotherapy of skin","code_information":[{"code":"17340","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":56.39,"maximum":140.80,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":56.39,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":57.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":56.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":58.08,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":140.8,"additional_payer_notes":"APC"}]}]},{"description":"Application of finger splint","code_information":[{"code":"29131","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":56.39,"maximum":140.80,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":56.39,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":57.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":56.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":58.08,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":140.8,"additional_payer_notes":"APC"}]}]},{"description":"Strapping of elbow or wrist","code_information":[{"code":"29260","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":56.39,"maximum":140.80,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":56.39,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":57.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":56.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":58.08,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":140.8,"additional_payer_notes":"APC"}]}]},{"description":"Strapping of hand or finger","code_information":[{"code":"29280","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":56.39,"maximum":140.80,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":56.39,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":57.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":56.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":58.08,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":140.8,"additional_payer_notes":"APC"}]}]},{"description":"Strapping of toes","code_information":[{"code":"29550","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":56.39,"maximum":140.80,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":56.39,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":57.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":56.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":58.08,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":140.8,"additional_payer_notes":"APC"}]}]},{"description":"Urinary reflex study","code_information":[{"code":"51792","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":56.39,"maximum":140.80,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":56.39,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":57.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":56.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":58.08,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":140.8,"additional_payer_notes":"APC"}]}]},{"description":"Us urine capacity measure","code_information":[{"code":"51798","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":56.39,"maximum":140.80,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":56.39,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":57.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":56.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":58.08,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":140.8,"additional_payer_notes":"APC"}]}]},{"description":"Treat vagina infection","code_information":[{"code":"57150","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":56.39,"maximum":140.80,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":56.39,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":57.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":56.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":58.08,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":140.8,"additional_payer_notes":"APC"}]}]},{"description":"Remove impacted ear wax uni","code_information":[{"code":"69209","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":56.39,"maximum":140.80,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":56.39,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":57.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":56.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":58.08,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":140.8,"additional_payer_notes":"APC"}]}]},{"description":"Remove impacted ear wax uni","code_information":[{"code":"69210","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":56.39,"maximum":140.80,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":56.39,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":57.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":56.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":58.08,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":140.8,"additional_payer_notes":"APC"}]}]},{"description":"Mr safety implt pos&/immoblj","code_information":[{"code":"76019","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":56.39,"maximum":140.80,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":56.39,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":57.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":56.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":58.08,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":140.8,"additional_payer_notes":"APC"}]}]},{"description":"Coombs test direct","code_information":[{"code":"86880","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":56.39,"maximum":140.80,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":56.39,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":57.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":56.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":58.08,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":140.8,"additional_payer_notes":"APC"}]}]},{"description":"Blood typing patient serum","code_information":[{"code":"86904","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":56.39,"maximum":140.80,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":56.39,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":57.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":56.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":58.08,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":140.8,"additional_payer_notes":"APC"}]}]},{"description":"Rbc pretx incubatj w/chemicl","code_information":[{"code":"86970","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":56.39,"maximum":140.80,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":56.39,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":57.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":56.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":58.08,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":140.8,"additional_payer_notes":"APC"}]}]},{"description":"Rbc pretreatment serum","code_information":[{"code":"86978","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":56.39,"maximum":140.80,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":56.39,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":57.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":56.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":58.08,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":140.8,"additional_payer_notes":"APC"}]}]},{"description":"Path consult introp","code_information":[{"code":"88329","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":56.39,"maximum":140.80,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":56.39,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":57.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":56.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":58.08,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":140.8,"additional_payer_notes":"APC"}]}]},{"description":"Corneal Topography","code_information":[{"code":"92025","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":56.39,"maximum":140.80,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":56.39,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":57.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":56.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":58.08,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":140.8,"additional_payer_notes":"APC"}]}]},{"description":"Special eye evaluation","code_information":[{"code":"92060","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":56.39,"maximum":140.80,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":56.39,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":57.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":56.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":58.08,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":140.8,"additional_payer_notes":"APC"}]}]},{"description":"Orthop traing supvj phys/qhp","code_information":[{"code":"92066","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":56.39,"maximum":140.80,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":56.39,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":57.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":56.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":58.08,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":140.8,"additional_payer_notes":"APC"}]}]},{"description":"Visual field examination(s)","code_information":[{"code":"92081","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":56.39,"maximum":140.80,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":56.39,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":57.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":56.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":58.08,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":140.8,"additional_payer_notes":"APC"}]}]},{"description":"Visual field examination(s)","code_information":[{"code":"92082","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":56.39,"maximum":140.80,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":56.39,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":57.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":56.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":58.08,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":140.8,"additional_payer_notes":"APC"}]}]},{"description":"Cmptr ophth dx img ant segmt","code_information":[{"code":"92132","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":56.39,"maximum":140.80,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":56.39,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":57.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":56.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":58.08,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":140.8,"additional_payer_notes":"APC"}]}]},{"description":"Cmptr ophth img optic nerve","code_information":[{"code":"92133","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":56.39,"maximum":140.80,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":56.39,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":57.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":56.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":58.08,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":140.8,"additional_payer_notes":"APC"}]}]},{"description":"Cptr ophth dx img post segmt","code_information":[{"code":"92134","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":56.39,"maximum":140.80,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":56.39,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":57.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":56.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":58.08,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":140.8,"additional_payer_notes":"APC"}]}]},{"description":"Corneal hysteresis deter","code_information":[{"code":"92145","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":56.39,"maximum":140.80,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":56.39,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":57.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":56.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":58.08,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":140.8,"additional_payer_notes":"APC"}]}]},{"description":"Opscpy extnd rta draw uni/bi","code_information":[{"code":"92201","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":56.39,"maximum":140.80,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":56.39,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":57.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":56.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":58.08,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":140.8,"additional_payer_notes":"APC"}]}]},{"description":"Opscpy extnd on/mac draw","code_information":[{"code":"92202","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":56.39,"maximum":140.80,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":56.39,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":57.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":56.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":58.08,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":140.8,"additional_payer_notes":"APC"}]}]},{"description":"Remote dx retinal imaging","code_information":[{"code":"92227","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":56.39,"maximum":140.80,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":56.39,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":57.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":56.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":58.08,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":140.8,"additional_payer_notes":"APC"}]}]},{"description":"Img rta detc/mntr ds poc aly","code_information":[{"code":"92229","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":56.39,"maximum":140.80,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":56.39,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":57.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":56.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":58.08,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":140.8,"additional_payer_notes":"APC"}]}]},{"description":"Eye muscle evaluation","code_information":[{"code":"92265","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":56.39,"maximum":140.80,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":56.39,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":57.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":56.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":58.08,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":140.8,"additional_payer_notes":"APC"}]}]},{"description":"Color vision examination","code_information":[{"code":"92283","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":56.39,"maximum":140.80,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":56.39,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":57.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":56.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":58.08,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":140.8,"additional_payer_notes":"APC"}]}]},{"description":"Replacement of contact lens","code_information":[{"code":"92326","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":56.39,"maximum":140.80,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":56.39,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":57.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":56.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":58.08,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":140.8,"additional_payer_notes":"APC"}]}]},{"description":"Fit aphakia spectcl monofocl","code_information":[{"code":"92352","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":56.39,"maximum":140.80,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":56.39,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":57.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":56.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":58.08,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":140.8,"additional_payer_notes":"APC"}]}]},{"description":"Fit aphakia spectcl multifoc","code_information":[{"code":"92353","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":56.39,"maximum":140.80,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":56.39,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":57.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":56.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":58.08,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":140.8,"additional_payer_notes":"APC"}]}]},{"description":"Aphakia prosth service temp","code_information":[{"code":"92358","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":56.39,"maximum":140.80,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":56.39,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":57.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":56.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":58.08,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":140.8,"additional_payer_notes":"APC"}]}]},{"description":"Repair & adjust spectacles","code_information":[{"code":"92371","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":56.39,"maximum":140.80,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":56.39,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":57.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":56.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":58.08,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":140.8,"additional_payer_notes":"APC"}]}]},{"description":"Speech threshold audiometry","code_information":[{"code":"92555","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":56.39,"maximum":140.80,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":56.39,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":57.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":56.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":58.08,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":140.8,"additional_payer_notes":"APC"}]}]},{"description":"Speech audiometry complete","code_information":[{"code":"92556","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":56.39,"maximum":140.80,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":56.39,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":57.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":56.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":58.08,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":140.8,"additional_payer_notes":"APC"}]}]},{"description":"Stenger test pure tone","code_information":[{"code":"92565","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":56.39,"maximum":140.80,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":56.39,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":57.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":56.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":58.08,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":140.8,"additional_payer_notes":"APC"}]}]},{"description":"Select picture audiometry","code_information":[{"code":"92583","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":56.39,"maximum":140.80,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":56.39,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":57.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":56.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":58.08,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":140.8,"additional_payer_notes":"APC"}]}]},{"description":"Electrocardiogram tracing","code_information":[{"code":"93005","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":56.39,"maximum":140.80,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":56.39,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":57.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":56.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":58.08,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":140.8,"additional_payer_notes":"APC"}]}]},{"description":"Rhythm ecg tracing","code_information":[{"code":"93041","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":56.39,"maximum":140.80,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":56.39,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":57.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":56.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":58.08,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":140.8,"additional_payer_notes":"APC"}]}]},{"description":"Ecg monit/reprt up to 48 hrs","code_information":[{"code":"93226","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":56.39,"maximum":140.80,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":56.39,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":57.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":56.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":58.08,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":140.8,"additional_payer_notes":"APC"}]}]},{"description":"ECG/signal-averaged","code_information":[{"code":"93278","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":56.39,"maximum":140.80,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":56.39,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":57.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":56.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":58.08,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":140.8,"additional_payer_notes":"APC"}]}]},{"description":"Peripheral Vascular Rehab","code_information":[{"code":"93668","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":56.39,"maximum":140.80,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":56.39,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":57.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":56.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":58.08,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":140.8,"additional_payer_notes":"APC"}]}]},{"description":"Lung function test (MBC/MVV)","code_information":[{"code":"94200","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":56.39,"maximum":140.80,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":56.39,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":57.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":56.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":58.08,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":140.8,"additional_payer_notes":"APC"}]}]},{"description":"Exercise tst brncspsm wo ecg","code_information":[{"code":"94619","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":56.39,"maximum":140.80,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":56.39,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":57.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":56.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":58.08,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":140.8,"additional_payer_notes":"APC"}]}]},{"description":"Phy/qhp op pulm rhb w/o mntr","code_information":[{"code":"94625","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":56.39,"maximum":140.80,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":56.39,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":57.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":56.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":58.08,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":140.8,"additional_payer_notes":"APC"}]}]},{"description":"Phy/qhp op pulm rhb w/mntr","code_information":[{"code":"94626","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":56.39,"maximum":140.80,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":56.39,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":57.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":56.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":58.08,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":140.8,"additional_payer_notes":"APC"}]}]},{"description":"Exhaled air analysis","code_information":[{"code":"94690","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":56.39,"maximum":140.80,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":56.39,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":57.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":56.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":58.08,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":140.8,"additional_payer_notes":"APC"}]}]},{"description":"Icut allergy test drug/bug","code_information":[{"code":"95024","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":56.39,"maximum":140.80,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":56.39,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":57.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":56.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":58.08,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":140.8,"additional_payer_notes":"APC"}]}]},{"description":"Photo patch test","code_information":[{"code":"95052","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":56.39,"maximum":140.80,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":56.39,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":57.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":56.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":58.08,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":140.8,"additional_payer_notes":"APC"}]}]},{"description":"Cont gluc mntr pt prov eqp","code_information":[{"code":"95249","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":56.39,"maximum":140.80,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":56.39,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":57.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":56.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":58.08,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":140.8,"additional_payer_notes":"APC"}]}]},{"description":"Slp stdy unatnd w/anal","code_information":[{"code":"95801","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":56.39,"maximum":140.80,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":56.39,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":57.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":56.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":58.08,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":140.8,"additional_payer_notes":"APC"}]}]},{"description":"Actigraphy testing","code_information":[{"code":"95803","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":56.39,"maximum":140.80,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":56.39,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":57.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":56.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":58.08,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":140.8,"additional_payer_notes":"APC"}]}]},{"description":"Blink reflex test","code_information":[{"code":"95933","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":56.39,"maximum":140.80,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":56.39,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":57.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":56.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":58.08,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":140.8,"additional_payer_notes":"APC"}]}]},{"description":"Io anal gast n-stim subsq","code_information":[{"code":"95981","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":56.39,"maximum":140.80,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":56.39,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":57.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":56.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":58.08,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":140.8,"additional_payer_notes":"APC"}]}]},{"description":"Irrig drug delivery device","code_information":[{"code":"96523","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":56.39,"maximum":140.80,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":56.39,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":57.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":56.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":58.08,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":140.8,"additional_payer_notes":"APC"}]}]},{"description":"Photochemotherapy with UV-B","code_information":[{"code":"96910","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":56.39,"maximum":140.80,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":56.39,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":57.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":56.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":58.08,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":140.8,"additional_payer_notes":"APC"}]}]},{"description":"Photochemotherapy with UV-A","code_information":[{"code":"96912","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":56.39,"maximum":140.80,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":56.39,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":57.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":56.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":58.08,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":140.8,"additional_payer_notes":"APC"}]}]},{"description":"Trim nail(s)","code_information":[{"code":"G0127","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":56.39,"maximum":140.80,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":56.39,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":57.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":56.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":58.08,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":140.8,"additional_payer_notes":"APC"}]}]},{"description":"Pathogen test for platelets","code_information":[{"code":"P9100","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":56.39,"maximum":140.80,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":56.39,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":57.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":56.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":58.08,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":140.8,"additional_payer_notes":"APC"}]}]},{"description":"Nos Quant Sensory Test","code_information":[{"code":"0110T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":127.17,"maximum":317.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":127.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":129.71,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":130.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":317.55,"additional_payer_notes":"APC"}]}]},{"description":"Ocular blood flow measure","code_information":[{"code":"0198T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":127.17,"maximum":317.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":127.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":129.71,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":130.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":317.55,"additional_payer_notes":"APC"}]}]},{"description":"Clear eyelid gland w/heat","code_information":[{"code":"0207T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":127.17,"maximum":317.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":127.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":129.71,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":130.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":317.55,"additional_payer_notes":"APC"}]}]},{"description":"Antmc mdl 3d print 1st cmpnt","code_information":[{"code":"0559T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":127.17,"maximum":317.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":127.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":129.71,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":130.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":317.55,"additional_payer_notes":"APC"}]}]},{"description":"Antmc guide 3d print 1st gd","code_information":[{"code":"0561T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":127.17,"maximum":317.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":127.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":129.71,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":130.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":317.55,"additional_payer_notes":"APC"}]}]},{"description":"Eye mvmt alys w/o calbrj i&r","code_information":[{"code":"0615T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":127.17,"maximum":317.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":127.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":129.71,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":130.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":317.55,"additional_payer_notes":"APC"}]}]},{"description":"Asstv alg ecg rsk asmt cncrt","code_information":[{"code":"0764T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":127.17,"maximum":317.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":127.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":129.71,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":130.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":317.55,"additional_payer_notes":"APC"}]}]},{"description":"Asstv alg ecg rsk asmt prev","code_information":[{"code":"0765T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":127.17,"maximum":317.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":127.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":129.71,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":130.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":317.55,"additional_payer_notes":"APC"}]}]},{"description":"Instlj fecal microbiota ssp","code_information":[{"code":"0780T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":127.17,"maximum":317.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":127.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":129.71,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":130.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":317.55,"additional_payer_notes":"APC"}]}]},{"description":"N-invas assmt bld oxygnation","code_information":[{"code":"0893T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":127.17,"maximum":317.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":127.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":129.71,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":130.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":317.55,"additional_payer_notes":"APC"}]}]},{"description":"Qtc ntrvl augmnt alg aly ecg","code_information":[{"code":"0902T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":127.17,"maximum":317.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":127.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":129.71,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":130.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":317.55,"additional_payer_notes":"APC"}]}]},{"description":"Asstv alg alys acous&ecg rec","code_information":[{"code":"0962T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":127.17,"maximum":317.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":127.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":129.71,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":130.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":317.55,"additional_payer_notes":"APC"}]}]},{"description":"Elec alys s-scl eeg wo prgrm","code_information":[{"code":"1004T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":127.17,"maximum":317.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":127.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":129.71,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":130.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":317.55,"additional_payer_notes":"APC"}]}]},{"description":"Cptr oph alys monoc eye mvmt","code_information":[{"code":"1010T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":127.17,"maximum":317.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":127.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":129.71,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":130.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":317.55,"additional_payer_notes":"APC"}]}]},{"description":"Drain blood from under nail","code_information":[{"code":"11740","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":127.17,"maximum":317.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":127.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":129.71,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":130.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":317.55,"additional_payer_notes":"APC"}]}]},{"description":"Insert drug implant device","code_information":[{"code":"11981","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":127.17,"maximum":317.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":127.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":129.71,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":130.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":317.55,"additional_payer_notes":"APC"}]}]},{"description":"Apply forearm splint","code_information":[{"code":"29125","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":127.17,"maximum":317.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":127.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":129.71,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":130.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":317.55,"additional_payer_notes":"APC"}]}]},{"description":"Apply forearm splint","code_information":[{"code":"29126","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":127.17,"maximum":317.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":127.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":129.71,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":130.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":317.55,"additional_payer_notes":"APC"}]}]},{"description":"Application of finger splint","code_information":[{"code":"29130","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":127.17,"maximum":317.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":127.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":129.71,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":130.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":317.55,"additional_payer_notes":"APC"}]}]},{"description":"Strapping of shoulder","code_information":[{"code":"29240","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":127.17,"maximum":317.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":127.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":129.71,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":130.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":317.55,"additional_payer_notes":"APC"}]}]},{"description":"Strapping of hip","code_information":[{"code":"29520","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":127.17,"maximum":317.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":127.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":129.71,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":130.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":317.55,"additional_payer_notes":"APC"}]}]},{"description":"Strapping of knee","code_information":[{"code":"29530","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":127.17,"maximum":317.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":127.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":129.71,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":130.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":317.55,"additional_payer_notes":"APC"}]}]},{"description":"Remove nasal foreign body","code_information":[{"code":"30300","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":127.17,"maximum":317.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":127.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":129.71,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":130.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":317.55,"additional_payer_notes":"APC"}]}]},{"description":"Control of nosebleed","code_information":[{"code":"30901","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":127.17,"maximum":317.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":127.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":129.71,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":130.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":317.55,"additional_payer_notes":"APC"}]}]},{"description":"Control of nosebleed","code_information":[{"code":"30903","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":127.17,"maximum":317.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":127.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":129.71,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":130.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":317.55,"additional_payer_notes":"APC"}]}]},{"description":"Control of nosebleed","code_information":[{"code":"30905","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":127.17,"maximum":317.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":127.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":129.71,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":130.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":317.55,"additional_payer_notes":"APC"}]}]},{"description":"Vein access cutdown < 1 yr","code_information":[{"code":"36420","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":127.17,"maximum":317.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":127.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":129.71,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":130.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":317.55,"additional_payer_notes":"APC"}]}]},{"description":"Draw blood off venous device","code_information":[{"code":"36591","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":127.17,"maximum":317.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":127.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":129.71,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":130.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":317.55,"additional_payer_notes":"APC"}]}]},{"description":"Collect blood from picc","code_information":[{"code":"36592","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":127.17,"maximum":317.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":127.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":129.71,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":130.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":317.55,"additional_payer_notes":"APC"}]}]},{"description":"Withdrawal of arterial blood","code_information":[{"code":"36600","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":127.17,"maximum":317.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":127.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":129.71,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":130.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":317.55,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of gum lesion","code_information":[{"code":"41800","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":127.17,"maximum":317.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":127.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":129.71,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":130.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":317.55,"additional_payer_notes":"APC"}]}]},{"description":"Diagnostic anoscopy spx","code_information":[{"code":"46600","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":127.17,"maximum":317.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":127.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":129.71,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":130.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":317.55,"additional_payer_notes":"APC"}]}]},{"description":"Insert bladder catheter","code_information":[{"code":"51701","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":127.17,"maximum":317.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":127.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":129.71,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":130.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":317.55,"additional_payer_notes":"APC"}]}]},{"description":"Insert temp bladder cath","code_information":[{"code":"51702","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":127.17,"maximum":317.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":127.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":129.71,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":130.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":317.55,"additional_payer_notes":"APC"}]}]},{"description":"Urine flow measurement","code_information":[{"code":"51736","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":127.17,"maximum":317.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":127.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":129.71,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":130.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":317.55,"additional_payer_notes":"APC"}]}]},{"description":"Dilate urethra stricture","code_information":[{"code":"53601","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":127.17,"maximum":317.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":127.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":129.71,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":130.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":317.55,"additional_payer_notes":"APC"}]}]},{"description":"Dilation of urethra","code_information":[{"code":"53661","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":127.17,"maximum":317.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":127.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":129.71,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":130.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":317.55,"additional_payer_notes":"APC"}]}]},{"description":"Remove foreign body from eye","code_information":[{"code":"65205","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":127.17,"maximum":317.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":127.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":129.71,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":130.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":317.55,"additional_payer_notes":"APC"}]}]},{"description":"Remove foreign body from eye","code_information":[{"code":"65222","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":127.17,"maximum":317.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":127.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":129.71,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":130.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":317.55,"additional_payer_notes":"APC"}]}]},{"description":"Revise eyelashes","code_information":[{"code":"67820","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":127.17,"maximum":317.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":127.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":129.71,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":130.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":317.55,"additional_payer_notes":"APC"}]}]},{"description":"Clear outer ear canal","code_information":[{"code":"69200","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":127.17,"maximum":317.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":127.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":129.71,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":130.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":317.55,"additional_payer_notes":"APC"}]}]},{"description":"Ophth us b & quant a","code_information":[{"code":"76510","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":127.17,"maximum":317.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":127.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":129.71,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":130.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":317.55,"additional_payer_notes":"APC"}]}]},{"description":"Blood typing serologic abo","code_information":[{"code":"86900","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":127.17,"maximum":317.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":127.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":129.71,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":130.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":317.55,"additional_payer_notes":"APC"}]}]},{"description":"Special stains group 2","code_information":[{"code":"88313","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":127.17,"maximum":317.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":127.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":129.71,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":130.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":317.55,"additional_payer_notes":"APC"}]}]},{"description":"Electrogastrography W/Test","code_information":[{"code":"91133","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":127.17,"maximum":317.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":127.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":129.71,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":130.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":317.55,"additional_payer_notes":"APC"}]}]},{"description":"Special eye evaluation","code_information":[{"code":"92020","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":127.17,"maximum":317.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":127.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":129.71,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":130.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":317.55,"additional_payer_notes":"APC"}]}]},{"description":"Visual field examination(s)","code_information":[{"code":"92083","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":127.17,"maximum":317.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":127.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":129.71,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":130.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":317.55,"additional_payer_notes":"APC"}]}]},{"description":"Ophthalmic biometry","code_information":[{"code":"92136","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":127.17,"maximum":317.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":127.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":129.71,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":130.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":317.55,"additional_payer_notes":"APC"}]}]},{"description":"Eye exam with photos","code_information":[{"code":"92250","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":127.17,"maximum":317.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":127.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":129.71,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":130.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":317.55,"additional_payer_notes":"APC"}]}]},{"description":"Electro-oculography","code_information":[{"code":"92270","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":127.17,"maximum":317.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":127.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":129.71,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":130.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":317.55,"additional_payer_notes":"APC"}]}]},{"description":"Internal eye photography","code_information":[{"code":"92286","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":127.17,"maximum":317.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":127.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":129.71,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":130.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":317.55,"additional_payer_notes":"APC"}]}]},{"description":"Internal eye photography","code_information":[{"code":"92287","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":127.17,"maximum":317.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":127.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":129.71,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":130.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":317.55,"additional_payer_notes":"APC"}]}]},{"description":"Contact lens fitting","code_information":[{"code":"92312","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":127.17,"maximum":317.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":127.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":129.71,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":130.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":317.55,"additional_payer_notes":"APC"}]}]},{"description":"Contact lens fitting","code_information":[{"code":"92313","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":127.17,"maximum":317.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":127.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":129.71,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":130.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":317.55,"additional_payer_notes":"APC"}]}]},{"description":"Rx cntact lens aphakia 1 eye","code_information":[{"code":"92315","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":127.17,"maximum":317.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":127.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":129.71,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":130.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":317.55,"additional_payer_notes":"APC"}]}]},{"description":"Rx cntact lens aphakia 2 eye","code_information":[{"code":"92316","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":127.17,"maximum":317.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":127.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":129.71,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":130.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":317.55,"additional_payer_notes":"APC"}]}]},{"description":"Modification of contact lens","code_information":[{"code":"92325","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":127.17,"maximum":317.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":127.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":129.71,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":130.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":317.55,"additional_payer_notes":"APC"}]}]},{"description":"Laryngeal function studies","code_information":[{"code":"92520","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":127.17,"maximum":317.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":127.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":129.71,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":130.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":317.55,"additional_payer_notes":"APC"}]}]},{"description":"Spontaneous nystagmus test","code_information":[{"code":"92541","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":127.17,"maximum":317.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":127.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":129.71,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":130.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":317.55,"additional_payer_notes":"APC"}]}]},{"description":"Positional nystagmus test","code_information":[{"code":"92542","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":127.17,"maximum":317.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":127.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":129.71,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":130.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":317.55,"additional_payer_notes":"APC"}]}]},{"description":"Posturography","code_information":[{"code":"92548","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":127.17,"maximum":317.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":127.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":129.71,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":130.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":317.55,"additional_payer_notes":"APC"}]}]},{"description":"Cdp-sot 6 cond w/i&r mct&adt","code_information":[{"code":"92549","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":127.17,"maximum":317.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":127.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":129.71,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":130.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":317.55,"additional_payer_notes":"APC"}]}]},{"description":"Pure tone audiometry air","code_information":[{"code":"92552","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":127.17,"maximum":317.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":127.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":129.71,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":130.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":317.55,"additional_payer_notes":"APC"}]}]},{"description":"Ecg monit/reprt up to 48 hrs","code_information":[{"code":"93225","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":127.17,"maximum":317.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":127.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":129.71,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":130.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":317.55,"additional_payer_notes":"APC"}]}]},{"description":"Ext ecg>48hr<7d scan a/r","code_information":[{"code":"93243","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":127.17,"maximum":317.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":127.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":129.71,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":130.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":317.55,"additional_payer_notes":"APC"}]}]},{"description":"Ext ecg>7d<15d scan a/r","code_information":[{"code":"93247","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":127.17,"maximum":317.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":127.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":129.71,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":130.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":317.55,"additional_payer_notes":"APC"}]}]},{"description":"Bioimpedance cv analysis","code_information":[{"code":"93701","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":127.17,"maximum":317.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":127.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":129.71,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":130.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":317.55,"additional_payer_notes":"APC"}]}]},{"description":"Ambulatory BP recording","code_information":[{"code":"93786","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":127.17,"maximum":317.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":127.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":129.71,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":130.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":317.55,"additional_payer_notes":"APC"}]}]},{"description":"Ambulatory BP analysis","code_information":[{"code":"93788","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":127.17,"maximum":317.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":127.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":129.71,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":130.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":317.55,"additional_payer_notes":"APC"}]}]},{"description":"Upr/l xtremity art 2 levels","code_information":[{"code":"93922","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":127.17,"maximum":317.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":127.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":129.71,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":130.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":317.55,"additional_payer_notes":"APC"}]}]},{"description":"Hast w/report","code_information":[{"code":"94452","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":127.17,"maximum":317.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":127.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":129.71,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":130.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":317.55,"additional_payer_notes":"APC"}]}]},{"description":"Hast w/oxygen titrate","code_information":[{"code":"94453","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":127.17,"maximum":317.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":127.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":129.71,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":130.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":317.55,"additional_payer_notes":"APC"}]}]},{"description":"Exercise tst brncspsm","code_information":[{"code":"94617","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":127.17,"maximum":317.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":127.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":129.71,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":130.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":317.55,"additional_payer_notes":"APC"}]}]},{"description":"Pulmonary stress testing","code_information":[{"code":"94618","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":127.17,"maximum":317.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":127.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":129.71,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":130.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":317.55,"additional_payer_notes":"APC"}]}]},{"description":"Cbt 1st hour","code_information":[{"code":"94644","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":127.17,"maximum":317.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":127.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":129.71,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":130.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":317.55,"additional_payer_notes":"APC"}]}]},{"description":"Chest wall manipulation","code_information":[{"code":"94667","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":127.17,"maximum":317.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":127.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":129.71,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":130.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":317.55,"additional_payer_notes":"APC"}]}]},{"description":"Chest wall manipulation","code_information":[{"code":"94668","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":127.17,"maximum":317.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":127.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":129.71,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":130.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":317.55,"additional_payer_notes":"APC"}]}]},{"description":"Photosensitivity tests","code_information":[{"code":"95056","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":127.17,"maximum":317.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":127.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":129.71,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":130.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":317.55,"additional_payer_notes":"APC"}]}]},{"description":"Eye allergy tests","code_information":[{"code":"95060","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":127.17,"maximum":317.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":127.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":129.71,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":130.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":317.55,"additional_payer_notes":"APC"}]}]},{"description":"Muscle test one limb","code_information":[{"code":"95860","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":127.17,"maximum":317.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":127.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":129.71,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":130.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":317.55,"additional_payer_notes":"APC"}]}]},{"description":"Muscle test 2 limbs","code_information":[{"code":"95861","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":127.17,"maximum":317.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":127.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":129.71,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":130.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":317.55,"additional_payer_notes":"APC"}]}]},{"description":"Muscle test larynx","code_information":[{"code":"95865","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":127.17,"maximum":317.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":127.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":129.71,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":130.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":317.55,"additional_payer_notes":"APC"}]}]},{"description":"Muscle test nonparaspinal","code_information":[{"code":"95870","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":127.17,"maximum":317.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":127.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":129.71,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":130.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":317.55,"additional_payer_notes":"APC"}]}]},{"description":"Quan puplmtry phy/qhp uni/bi","code_information":[{"code":"95919","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":127.17,"maximum":317.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":127.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":129.71,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":130.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":317.55,"additional_payer_notes":"APC"}]}]},{"description":"Autonomic nrv adrenrg inervj","code_information":[{"code":"95922","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":127.17,"maximum":317.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":127.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":129.71,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":130.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":317.55,"additional_payer_notes":"APC"}]}]},{"description":"Autonomic nrv syst funj test","code_information":[{"code":"95923","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":127.17,"maximum":317.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":127.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":129.71,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":130.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":317.55,"additional_payer_notes":"APC"}]}]},{"description":"Analyze neurostim no prog","code_information":[{"code":"95970","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":127.17,"maximum":317.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":127.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":129.71,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":130.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":317.55,"additional_payer_notes":"APC"}]}]},{"description":"Psycl/nrpsyc tst phy/qhp 1st","code_information":[{"code":"96136","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":127.17,"maximum":317.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":127.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":129.71,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":130.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":317.55,"additional_payer_notes":"APC"}]}]},{"description":"Phlebotomy","code_information":[{"code":"99195","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":127.17,"maximum":317.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":127.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":129.71,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":130.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":317.55,"additional_payer_notes":"APC"}]}]},{"description":"Extrnl counterpulse, per tx","code_information":[{"code":"G0166","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":127.17,"maximum":317.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":127.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":129.71,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":130.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":317.55,"additional_payer_notes":"APC"}]}]},{"description":"Clearance of airways","code_information":[{"code":"31720","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":209.30,"maximum":522.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":209.3,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":213.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":211.4,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":215.58,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":522.63,"additional_payer_notes":"APC"}]}]},{"description":"Surfactant Admin Thru Tube","code_information":[{"code":"94610","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":209.30,"maximum":522.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":209.3,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":213.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":211.4,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":215.58,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":522.63,"additional_payer_notes":"APC"}]}]},{"description":"Airway inhalation treatment","code_information":[{"code":"94640","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":209.30,"maximum":522.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":209.3,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":213.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":211.4,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":215.58,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":522.63,"additional_payer_notes":"APC"}]}]},{"description":"Aerosol inhalation treatment","code_information":[{"code":"94642","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":209.30,"maximum":522.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":209.3,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":213.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":211.4,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":215.58,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":522.63,"additional_payer_notes":"APC"}]}]},{"description":"Pos airway pressure cpap","code_information":[{"code":"94660","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":209.30,"maximum":522.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":209.3,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":213.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":211.4,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":215.58,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":522.63,"additional_payer_notes":"APC"}]}]},{"description":"Evaluate pt use of inhaler","code_information":[{"code":"94664","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":209.30,"maximum":522.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":209.3,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":213.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":211.4,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":215.58,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":522.63,"additional_payer_notes":"APC"}]}]},{"description":"Mechanical chest wall oscill","code_information":[{"code":"94669","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":209.30,"maximum":522.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":209.3,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":213.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":211.4,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":215.58,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":522.63,"additional_payer_notes":"APC"}]}]},{"description":"Osteopath manj 1-2 regions","code_information":[{"code":"98925","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":20.64,"maximum":51.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.64,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21.05,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20.84,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21.26,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":51.53,"additional_payer_notes":"APC"}]}]},{"description":"Osteopath manj 3-4 regions","code_information":[{"code":"98926","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":20.64,"maximum":51.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.64,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21.05,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20.84,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21.26,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":51.53,"additional_payer_notes":"APC"}]}]},{"description":"Osteopath manj 5-6 regions","code_information":[{"code":"98927","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":20.64,"maximum":51.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.64,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21.05,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20.84,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21.26,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":51.53,"additional_payer_notes":"APC"}]}]},{"description":"Osteopath manj 7-8 regions","code_information":[{"code":"98928","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":20.64,"maximum":51.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.64,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21.05,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20.84,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21.26,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":51.53,"additional_payer_notes":"APC"}]}]},{"description":"Osteopath manj 9-10 regions","code_information":[{"code":"98929","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":20.64,"maximum":51.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.64,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21.05,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20.84,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21.26,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":51.53,"additional_payer_notes":"APC"}]}]},{"description":"Chiropract manj 1-2 regions","code_information":[{"code":"98940","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":20.64,"maximum":51.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.64,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21.05,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20.84,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21.26,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":51.53,"additional_payer_notes":"APC"}]}]},{"description":"Chiropract manj 3-4 regions","code_information":[{"code":"98941","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":20.64,"maximum":51.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.64,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21.05,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20.84,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21.26,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":51.53,"additional_payer_notes":"APC"}]}]},{"description":"Chiropractic manj 5 regions","code_information":[{"code":"98942","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":20.64,"maximum":51.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.64,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21.05,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20.84,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21.26,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":51.53,"additional_payer_notes":"APC"}]}]},{"description":"Expose behav assessment","code_information":[{"code":"0362T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.81,"maximum":89.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.81,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.53,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.17,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.89,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":89.43,"additional_payer_notes":"APC"}]}]},{"description":"Exposure behavior treatment","code_information":[{"code":"0373T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.81,"maximum":89.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.81,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.53,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.17,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.89,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":89.43,"additional_payer_notes":"APC"}]}]},{"description":"Psychiatric service/therapy","code_information":[{"code":"90899","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.81,"maximum":89.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.81,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.53,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.17,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.89,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":89.43,"additional_payer_notes":"APC"}]}]},{"description":"Pt-focused hlth risk assmt","code_information":[{"code":"96160","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.81,"maximum":89.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.81,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.53,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.17,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.89,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":89.43,"additional_payer_notes":"APC"}]}]},{"description":"Caregiver health risk assmt","code_information":[{"code":"96161","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.81,"maximum":89.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.81,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.53,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.17,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.89,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":89.43,"additional_payer_notes":"APC"}]}]},{"description":"Hlth bhv ivntj grp 1st 30","code_information":[{"code":"96164","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.81,"maximum":89.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.81,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.53,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.17,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.89,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":89.43,"additional_payer_notes":"APC"}]}]},{"description":"Hlth bhv ivntj fam 1st 30","code_information":[{"code":"96167","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.81,"maximum":89.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.81,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.53,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.17,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.89,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":89.43,"additional_payer_notes":"APC"}]}]},{"description":"Grp adapt bhv tx by tech","code_information":[{"code":"97154","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.81,"maximum":89.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.81,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.53,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.17,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.89,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":89.43,"additional_payer_notes":"APC"}]}]},{"description":"Fam adapt bhv tx gdn phy/qhp","code_information":[{"code":"97156","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.81,"maximum":89.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.81,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.53,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.17,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.89,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":89.43,"additional_payer_notes":"APC"}]}]},{"description":"Mult fam adapt bhv tx gdn","code_information":[{"code":"97157","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.81,"maximum":89.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.81,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.53,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.17,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.89,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":89.43,"additional_payer_notes":"APC"}]}]},{"description":"Grp adapt bhv tx by phy/qhp","code_information":[{"code":"97158","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.81,"maximum":89.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.81,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.53,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.17,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.89,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":89.43,"additional_payer_notes":"APC"}]}]},{"description":"Behav chng smoking 3-10 min","code_information":[{"code":"99406","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.81,"maximum":89.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.81,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.53,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.17,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.89,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":89.43,"additional_payer_notes":"APC"}]}]},{"description":"Behav chng smoking > 10 min","code_information":[{"code":"99407","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.81,"maximum":89.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.81,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.53,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.17,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.89,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":89.43,"additional_payer_notes":"APC"}]}]},{"description":"Care mgmt svc bhvl hlth cond","code_information":[{"code":"99484","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.81,"maximum":89.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.81,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.53,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.17,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.89,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":89.43,"additional_payer_notes":"APC"}]}]},{"description":"Hopd mntl hlt, 15-29 min","code_information":[{"code":"C7900","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.81,"maximum":89.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.81,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.53,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.17,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.89,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":89.43,"additional_payer_notes":"APC"}]}]},{"description":"Hopd mntl hlt, grp","code_information":[{"code":"C7903","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.81,"maximum":89.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.81,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.53,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.17,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.89,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":89.43,"additional_payer_notes":"APC"}]}]},{"description":"Hiv prep counsel, clin staff","code_information":[{"code":"G0013","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.81,"maximum":89.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.81,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.53,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.17,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.89,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":89.43,"additional_payer_notes":"APC"}]}]},{"description":"Adm of soc dtr assess 5-15 m","code_information":[{"code":"G0136","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.81,"maximum":89.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.81,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.53,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.17,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.89,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":89.43,"additional_payer_notes":"APC"}]}]},{"description":"Care manage beh svs 20mins","code_information":[{"code":"G0323","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.81,"maximum":89.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.81,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.53,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.17,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.89,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":89.43,"additional_payer_notes":"APC"}]}]},{"description":"Alcohol/subs interv 15-30mn","code_information":[{"code":"G0396","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.81,"maximum":89.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.81,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.53,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.17,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.89,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":89.43,"additional_payer_notes":"APC"}]}]},{"description":"Annual alcohol screen 15 min","code_information":[{"code":"G0442","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.81,"maximum":89.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.81,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.53,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.17,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.89,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":89.43,"additional_payer_notes":"APC"}]}]},{"description":"Depression Screen annual","code_information":[{"code":"G0444","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.81,"maximum":89.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.81,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.53,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.17,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.89,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":89.43,"additional_payer_notes":"APC"}]}]},{"description":"Intens behave ther cardio dx","code_information":[{"code":"G0446","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.81,"maximum":89.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.81,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.53,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.17,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.89,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":89.43,"additional_payer_notes":"APC"}]}]},{"description":"Group behave couns 2-10","code_information":[{"code":"G0473","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.81,"maximum":89.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.81,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.53,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.17,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.89,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":89.43,"additional_payer_notes":"APC"}]}]},{"description":"Risk ascvd tst once pr 12 mo","code_information":[{"code":"G0537","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.81,"maximum":89.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.81,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.53,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.17,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.89,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":89.43,"additional_payer_notes":"APC"}]}]},{"description":"Adv prim care mgmt lvl 1","code_information":[{"code":"G0556","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.81,"maximum":89.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.81,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.53,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.17,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.89,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":89.43,"additional_payer_notes":"APC"}]}]},{"description":"Adv prim care mgmt lvl 2","code_information":[{"code":"G0557","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.81,"maximum":89.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.81,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.53,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.17,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.89,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":89.43,"additional_payer_notes":"APC"}]}]},{"description":"Care manage serv, pr cal mo","code_information":[{"code":"G0570","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.81,"maximum":89.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.81,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.53,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.17,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.89,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":89.43,"additional_payer_notes":"APC"}]}]},{"description":"Psych diagnostic evaluation","code_information":[{"code":"90791","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":169.65,"maximum":423.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":169.65,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":173.05,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":171.35,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":174.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":423.63,"additional_payer_notes":"APC"}]}]},{"description":"Psych diag eval w/med srvcs","code_information":[{"code":"90792","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":169.65,"maximum":423.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":169.65,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":173.05,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":171.35,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":174.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":423.63,"additional_payer_notes":"APC"}]}]},{"description":"Psytx w pt 30 minutes","code_information":[{"code":"90832","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":169.65,"maximum":423.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":169.65,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":173.05,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":171.35,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":174.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":423.63,"additional_payer_notes":"APC"}]}]},{"description":"Psytx w pt 45 minutes","code_information":[{"code":"90834","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":169.65,"maximum":423.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":169.65,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":173.05,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":171.35,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":174.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":423.63,"additional_payer_notes":"APC"}]}]},{"description":"Psytx w pt 60 minutes","code_information":[{"code":"90837","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":169.65,"maximum":423.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":169.65,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":173.05,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":171.35,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":174.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":423.63,"additional_payer_notes":"APC"}]}]},{"description":"Psytx crisis initial 60 min","code_information":[{"code":"90839","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":169.65,"maximum":423.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":169.65,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":173.05,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":171.35,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":174.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":423.63,"additional_payer_notes":"APC"}]}]},{"description":"Psychoanalysis","code_information":[{"code":"90845","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":169.65,"maximum":423.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":169.65,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":173.05,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":171.35,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":174.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":423.63,"additional_payer_notes":"APC"}]}]},{"description":"Family psytx w/o pt 50 min","code_information":[{"code":"90846","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":169.65,"maximum":423.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":169.65,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":173.05,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":171.35,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":174.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":423.63,"additional_payer_notes":"APC"}]}]},{"description":"Family psytx w/pt 50 min","code_information":[{"code":"90847","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":169.65,"maximum":423.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":169.65,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":173.05,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":171.35,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":174.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":423.63,"additional_payer_notes":"APC"}]}]},{"description":"Multiple family group psytx","code_information":[{"code":"90849","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":169.65,"maximum":423.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":169.65,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":173.05,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":171.35,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":174.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":423.63,"additional_payer_notes":"APC"}]}]},{"description":"Narcosynthesis","code_information":[{"code":"90865","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":169.65,"maximum":423.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":169.65,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":173.05,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":171.35,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":174.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":423.63,"additional_payer_notes":"APC"}]}]},{"description":"Hlth bhv ivntj indiv 1st 30","code_information":[{"code":"96158","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":169.65,"maximum":423.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":169.65,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":173.05,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":171.35,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":174.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":423.63,"additional_payer_notes":"APC"}]}]},{"description":"Adapt behavior tx phys/qhp","code_information":[{"code":"97155","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":169.65,"maximum":423.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":169.65,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":173.05,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":171.35,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":174.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":423.63,"additional_payer_notes":"APC"}]}]},{"description":"Cmplx chron care w/o pt vsit","code_information":[{"code":"99487","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":169.65,"maximum":423.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":169.65,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":173.05,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":171.35,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":174.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":423.63,"additional_payer_notes":"APC"}]}]},{"description":"Alcohol/subs interv >30 min","code_information":[{"code":"G0397","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":169.65,"maximum":423.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":169.65,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":173.05,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":171.35,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":174.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":423.63,"additional_payer_notes":"APC"}]}]},{"description":"Off base opioid tx 70min","code_information":[{"code":"G2086","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":169.65,"maximum":423.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":169.65,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":173.05,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":171.35,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":174.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":423.63,"additional_payer_notes":"APC"}]}]},{"description":"Off base opioid tx, 60 m","code_information":[{"code":"G2087","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":169.65,"maximum":423.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":169.65,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":173.05,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":171.35,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":174.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":423.63,"additional_payer_notes":"APC"}]}]},{"description":"Platelet pheres leukoreduced","code_information":[{"code":"P9035","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":511.59,"maximum":1277.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":511.59,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":521.82,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":516.71,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":526.94,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1277.44,"additional_payer_notes":"APC"}]}]},{"description":"Rbc dna hea 35 ag 11 bld grp","code_information":[{"code":"0001U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":720.0,"maximum":1797.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":720.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":734.4,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":727.2,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":741.6,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1797.84,"additional_payer_notes":"APC"}]}]},{"description":"Liver dis 10 assays w/ash","code_information":[{"code":"0002M","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":503.4,"maximum":1256.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":503.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":513.47,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":508.43,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":518.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1256.99,"additional_payer_notes":"APC"}]}]},{"description":"Onc clrct 3 ur metab alg plp","code_information":[{"code":"0002U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":25.0,"maximum":62.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25.25,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25.75,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":62.42,"additional_payer_notes":"APC"}]}]},{"description":"Liver dis 10 assays w/nash","code_information":[{"code":"0003M","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":503.4,"maximum":1256.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":503.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":513.47,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":508.43,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":518.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1256.99,"additional_payer_notes":"APC"}]}]},{"description":"Onc ovar 5 prtn ser alg scor","code_information":[{"code":"0003U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":950.0,"maximum":2372.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":950.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":969.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":959.5,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":978.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2372.15,"additional_payer_notes":"APC"}]}]},{"description":"Scoliosis dna alys","code_information":[{"code":"0004M","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":79.0,"maximum":197.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":79.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":80.58,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":79.79,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":81.37,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":197.26,"additional_payer_notes":"APC"}]}]},{"description":"Onco prst8 3 gene ur alg","code_information":[{"code":"0005U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":760.0,"maximum":1897.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":760.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":775.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":767.6,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":782.8,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1897.72,"additional_payer_notes":"APC"}]}]},{"description":"Onc hep gene risk classifier","code_information":[{"code":"0006M","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":150.0,"maximum":374.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":150.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":153.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":151.5,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":154.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":374.55,"additional_payer_notes":"APC"}]}]},{"description":"Onc gastro 51 gene nomogram","code_information":[{"code":"0007M","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":375.0,"maximum":936.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":375.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":382.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":378.75,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":386.25,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":936.38,"additional_payer_notes":"APC"}]}]},{"description":"Rx test prsmv ur w/def conf","code_information":[{"code":"0007U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":114.43,"maximum":285.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":114.43,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":116.72,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":115.57,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":117.86,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":285.73,"additional_payer_notes":"APC"}]}]},{"description":"Hpylori detcj abx rstnc dna","code_information":[{"code":"0008U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":597.91,"maximum":1492.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":597.91,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":609.87,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":603.89,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":615.85,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1492.98,"additional_payer_notes":"APC"}]}]},{"description":"Onc brst ca erbb2 amp/nonamp","code_information":[{"code":"0009U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":107.0,"maximum":267.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":107.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":109.14,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":108.07,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":110.21,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":267.18,"additional_payer_notes":"APC"}]}]},{"description":"Nfct ds strn typ whl gen seq","code_information":[{"code":"0010U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":427.26,"maximum":1066.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":427.26,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":435.81,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":431.53,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":440.08,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1066.87,"additional_payer_notes":"APC"}]}]},{"description":"Onc prst8 ca mrna 12 gen alg","code_information":[{"code":"0011M","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":760.0,"maximum":1897.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":760.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":775.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":767.6,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":782.8,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1897.72,"additional_payer_notes":"APC"}]}]},{"description":"Rx mntr lc-ms/ms oral fluid","code_information":[{"code":"0011U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":114.43,"maximum":285.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":114.43,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":116.72,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":115.57,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":117.86,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":285.73,"additional_payer_notes":"APC"}]}]},{"description":"Adrnl cortcl tum bchm asy 25","code_information":[{"code":"0015M","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1305.37,"maximum":3259.51,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1305.37,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1331.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1318.42,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1344.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3259.51,"additional_payer_notes":"APC"}]}]},{"description":"Onc bladder mrna 209 gen alg","code_information":[{"code":"0016M","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3489.63,"maximum":8713.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3489.63,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3559.42,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3524.53,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3594.32,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8713.61,"additional_payer_notes":"APC"}]}]},{"description":"Onc hmtlmf neo rna bcr/abl1","code_information":[{"code":"0016U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":163.96,"maximum":409.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":163.96,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":167.24,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":165.6,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":168.88,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":409.41,"additional_payer_notes":"APC"}]}]},{"description":"Onc dlbcl mrna 20 genes alg","code_information":[{"code":"0017M","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2510.21,"maximum":6267.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2510.21,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2560.41,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2535.31,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2585.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":6267.99,"additional_payer_notes":"APC"}]}]},{"description":"Onc hmtlmf neo jak2 mut dna","code_information":[{"code":"0017U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":91.66,"maximum":228.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":91.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":93.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":92.58,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":94.41,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":228.88,"additional_payer_notes":"APC"}]}]},{"description":"Trnsplj rnl meas cd154+cll","code_information":[{"code":"0018M","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":640.73,"maximum":1599.90,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":640.73,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":653.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":647.14,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":659.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1599.9,"additional_payer_notes":"APC"}]}]},{"description":"Onc thyr 10 microrna seq alg","code_information":[{"code":"0018U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3002.09,"maximum":7496.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3002.09,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3062.13,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3032.11,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3092.15,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7496.22,"additional_payer_notes":"APC"}]}]},{"description":"Cv ds plasma alys prtn bmrk","code_information":[{"code":"0019M","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":712.4,"maximum":1778.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":712.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":726.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":719.52,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":733.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1778.86,"additional_payer_notes":"APC"}]}]},{"description":"Onc rna tiss predict alg","code_information":[{"code":"0019U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3675.0,"maximum":9176.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3675.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3748.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3711.75,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3785.25,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":9176.48,"additional_payer_notes":"APC"}]}]},{"description":"Onc prst8 detcj 8 autoantb","code_information":[{"code":"0021U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":760.0,"maximum":1897.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":760.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":775.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":767.6,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":782.8,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1897.72,"additional_payer_notes":"APC"}]}]},{"description":"Trgt gen seq dna&rna 23 gene","code_information":[{"code":"0022U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1950.0,"maximum":4869.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1950.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1989.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1969.5,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2008.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4869.15,"additional_payer_notes":"APC"}]}]},{"description":"Onc aml dna detcj/nondetcj","code_information":[{"code":"0023U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":248.51,"maximum":620.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":248.51,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":253.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":251.0,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":255.97,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":620.53,"additional_payer_notes":"APC"}]}]},{"description":"Glyca nuc mr spectrsc quan","code_information":[{"code":"0024U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":34.19,"maximum":85.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":34.19,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34.87,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34.53,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":85.37,"additional_payer_notes":"APC"}]}]},{"description":"Tenofovir liq chrom ur quan","code_information":[{"code":"0025U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":114.43,"maximum":285.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":114.43,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":116.72,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":115.57,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":117.86,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":285.73,"additional_payer_notes":"APC"}]}]},{"description":"Onc thyr dna&mrna 112 genes","code_information":[{"code":"0026U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3600.0,"maximum":8989.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3600.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3672.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3636.0,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3708.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8989.2,"additional_payer_notes":"APC"}]}]},{"description":"Jak2 gene trgt seq alys","code_information":[{"code":"0027U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":121.91,"maximum":304.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":121.91,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":124.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":123.13,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":125.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":304.41,"additional_payer_notes":"APC"}]}]},{"description":"Rx metab advrs trgt seq alys","code_information":[{"code":"0029U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":742.27,"maximum":1853.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":742.27,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":757.12,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":749.69,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":764.54,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1853.45,"additional_payer_notes":"APC"}]}]},{"description":"Rx metab warf trgt seq alys","code_information":[{"code":"0030U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":134.13,"maximum":334.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":134.13,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":136.81,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":135.47,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":138.15,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":334.92,"additional_payer_notes":"APC"}]}]},{"description":"Cyp1a2 gene","code_information":[{"code":"0031U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":174.81,"maximum":436.50,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":174.81,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":178.31,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":176.56,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":180.05,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":436.5,"additional_payer_notes":"APC"}]}]},{"description":"Comt gene","code_information":[{"code":"0032U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":174.81,"maximum":436.50,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":174.81,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":178.31,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":176.56,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":180.05,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":436.5,"additional_payer_notes":"APC"}]}]},{"description":"Tpmt nudt15 genes","code_information":[{"code":"0034U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":466.17,"maximum":1164.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":466.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":475.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":470.83,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":480.16,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1164.03,"additional_payer_notes":"APC"}]}]},{"description":"Neuro csf prion prtn qual","code_information":[{"code":"0035U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":540.99,"maximum":1350.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":540.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":551.81,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":546.4,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":557.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1350.85,"additional_payer_notes":"APC"}]}]},{"description":"Xome tum & nml spec seq alys","code_information":[{"code":"0036U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4780.0,"maximum":11935.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4780.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4875.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4827.8,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4923.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":11935.66,"additional_payer_notes":"APC"}]}]},{"description":"Trgt gen seq dna 324 genes","code_information":[{"code":"0037U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3500.0,"maximum":8739.5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3500.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3570.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3535.0,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3605.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8739.5,"additional_payer_notes":"APC"}]}]},{"description":"Vitamin d srm microsamp quan","code_information":[{"code":"0038U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":29.6,"maximum":73.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29.6,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30.49,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":73.91,"additional_payer_notes":"APC"}]}]},{"description":"Dna antb 2strand hi avidity","code_information":[{"code":"0039U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.74,"maximum":34.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.74,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.01,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.88,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.15,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":34.31,"additional_payer_notes":"APC"}]}]},{"description":"Bcr/abl1 gene major bp quan","code_information":[{"code":"0040U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":409.9,"maximum":1023.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":409.9,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":418.1,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":414.0,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":422.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1023.52,"additional_payer_notes":"APC"}]}]},{"description":"B brgdrferi antb 5 prtn igm","code_information":[{"code":"0041U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.21,"maximum":42.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.21,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17.55,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17.38,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":42.97,"additional_payer_notes":"APC"}]}]},{"description":"B brgdrferi antb 12 prtn igg","code_information":[{"code":"0042U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.21,"maximum":42.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.21,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17.55,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17.38,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":42.97,"additional_payer_notes":"APC"}]}]},{"description":"Tbrf b grp antb 4 prtn igm","code_information":[{"code":"0043U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14.86,"maximum":37.11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.86,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15.16,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15.01,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":37.11,"additional_payer_notes":"APC"}]}]},{"description":"Tbrf b grp antb 4 prtn igg","code_information":[{"code":"0044U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14.86,"maximum":37.11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.86,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15.16,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15.01,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":37.11,"additional_payer_notes":"APC"}]}]},{"description":"Onc brst dux carc is 12 gene","code_information":[{"code":"0045U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3873.0,"maximum":9670.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3873.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3950.46,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3911.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3989.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":9670.88,"additional_payer_notes":"APC"}]}]},{"description":"Flt3 gene itd variants quan","code_information":[{"code":"0046U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":407.43,"maximum":1017.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":407.43,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":415.58,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":411.5,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":419.65,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1017.35,"additional_payer_notes":"APC"}]}]},{"description":"Onc prst8 mrna 17 gene alg","code_information":[{"code":"0047U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3873.0,"maximum":9670.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3873.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3950.46,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3911.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3989.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":9670.88,"additional_payer_notes":"APC"}]}]},{"description":"Onc sld org neo dna 468 gene","code_information":[{"code":"0048U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2919.6,"maximum":7290.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2919.6,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2977.99,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2948.8,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3007.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7290.24,"additional_payer_notes":"APC"}]}]},{"description":"Npm1 gene analysis quan","code_information":[{"code":"0049U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":407.43,"maximum":1017.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":407.43,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":415.58,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":411.5,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":419.65,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1017.35,"additional_payer_notes":"APC"}]}]},{"description":"Trgt gen seq dna 194 genes","code_information":[{"code":"0050U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2916.6,"maximum":7282.75,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2916.6,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2974.93,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2945.77,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3004.1,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7282.75,"additional_payer_notes":"APC"}]}]},{"description":"Rx mntr lc-ms/ms ur 31 pnl","code_information":[{"code":"0051U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":246.92,"maximum":616.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":246.92,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":251.86,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":249.39,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":254.33,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":616.56,"additional_payer_notes":"APC"}]}]},{"description":"Lpoprtn bld w/5 maj classes","code_information":[{"code":"0052U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":33.86,"maximum":84.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":33.86,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34.2,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":34.88,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":84.55,"additional_payer_notes":"APC"}]}]},{"description":"Rx mntr 14+ drugs & sbsts","code_information":[{"code":"0054U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":198.74,"maximum":496.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":198.74,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":202.71,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":200.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":204.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":496.25,"additional_payer_notes":"APC"}]}]},{"description":"Card hrt trnspl 96 dna seq","code_information":[{"code":"0055U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3240.0,"maximum":8090.28,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3240.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3304.8,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3272.4,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3337.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8090.28,"additional_payer_notes":"APC"}]}]},{"description":"Onc merkel cll carc srm quan","code_information":[{"code":"0058U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":322.96,"maximum":806.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":322.96,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":329.42,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":326.19,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":332.65,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":806.43,"additional_payer_notes":"APC"}]}]},{"description":"Onc merkel cll carc srm +/-","code_information":[{"code":"0059U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":322.96,"maximum":806.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":322.96,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":329.42,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":326.19,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":332.65,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":806.43,"additional_payer_notes":"APC"}]}]},{"description":"Twn zyg gen seq alys chrms2","code_information":[{"code":"0060U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":759.05,"maximum":1895.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":759.05,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":774.23,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":766.64,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":781.82,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1895.35,"additional_payer_notes":"APC"}]}]},{"description":"Tc meas 5 bmrk sfdi m-s alys","code_information":[{"code":"0061U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":25.1,"maximum":62.67,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25.1,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25.35,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25.85,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":62.67,"additional_payer_notes":"APC"}]}]},{"description":"Ai sle igg&igm alys 80 bmrk","code_information":[{"code":"0062U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":380.72,"maximum":950.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":380.72,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":388.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":384.53,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":392.14,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":950.66,"additional_payer_notes":"APC"}]}]},{"description":"Neuro autism 32 amines alg","code_information":[{"code":"0063U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":750.0,"maximum":1872.75,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":750.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":765.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":757.5,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":772.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1872.75,"additional_payer_notes":"APC"}]}]},{"description":"Antb tp total&rpr ia qual","code_information":[{"code":"0064U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":31.33,"maximum":78.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":31.33,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31.96,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31.64,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":32.27,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":78.23,"additional_payer_notes":"APC"}]}]},{"description":"Syfls tst nontreponemal antb","code_information":[{"code":"0065U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18.09,"maximum":45.17,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.09,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.27,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.63,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":45.17,"additional_payer_notes":"APC"}]}]},{"description":"Onc brst imhchem prfl 4 bmrk","code_information":[{"code":"0067U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1897.0,"maximum":4736.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1897.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1934.94,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1915.97,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1953.91,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4736.81,"additional_payer_notes":"APC"}]}]},{"description":"Candida species pnl amp prb","code_information":[{"code":"0068U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":142.63,"maximum":356.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":142.63,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":145.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":144.06,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":146.91,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":356.15,"additional_payer_notes":"APC"}]}]},{"description":"Onc clrct microrna mir-31-3p","code_information":[{"code":"0069U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":380.0,"maximum":948.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":380.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":387.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":383.8,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":391.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":948.86,"additional_payer_notes":"APC"}]}]},{"description":"Cyp2d6 gen com&slct rar vrnt","code_information":[{"code":"0070U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":676.37,"maximum":1688.90,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":676.37,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":689.9,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":683.13,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":696.66,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1688.9,"additional_payer_notes":"APC"}]}]},{"description":"Cyp2d6 full gene sequence","code_information":[{"code":"0071U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":600.0,"maximum":1498.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":600.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":612.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":606.0,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":618.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1498.2,"additional_payer_notes":"APC"}]}]},{"description":"Cyp2d6 gen cyp2d6-2d7 hybrid","code_information":[{"code":"0072U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":450.91,"maximum":1125.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":450.91,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":459.93,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":455.42,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":464.44,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1125.92,"additional_payer_notes":"APC"}]}]},{"description":"Cyp2d6 gen cyp2d7-2d6 hybrid","code_information":[{"code":"0073U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":450.91,"maximum":1125.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":450.91,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":459.93,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":455.42,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":464.44,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1125.92,"additional_payer_notes":"APC"}]}]},{"description":"Cyp2d6 nonduplicated gene","code_information":[{"code":"0074U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":450.91,"maximum":1125.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":450.91,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":459.93,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":455.42,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":464.44,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1125.92,"additional_payer_notes":"APC"}]}]},{"description":"Cyp2d6 5' gene dup/mlt","code_information":[{"code":"0075U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":450.91,"maximum":1125.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":450.91,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":459.93,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":455.42,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":464.44,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1125.92,"additional_payer_notes":"APC"}]}]},{"description":"Cyp2d6 3' gene dup/mlt","code_information":[{"code":"0076U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":450.91,"maximum":1125.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":450.91,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":459.93,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":455.42,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":464.44,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1125.92,"additional_payer_notes":"APC"}]}]},{"description":"Ig paraprotein qual bld/ur","code_information":[{"code":"0077U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":43.43,"maximum":108.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":43.43,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":44.3,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":43.86,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":44.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":108.44,"additional_payer_notes":"APC"}]}]},{"description":"Onc lng 5 clin rsk factr alg","code_information":[{"code":"0080U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3520.0,"maximum":8789.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3520.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3590.4,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3555.2,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3625.6,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8789.44,"additional_payer_notes":"APC"}]}]},{"description":"Rx test def 90+ rx/sbsts ur","code_information":[{"code":"0082U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":246.92,"maximum":616.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":246.92,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":251.86,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":249.39,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":254.33,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":616.56,"additional_payer_notes":"APC"}]}]},{"description":"Onc rspse chemo cntrst tomog","code_information":[{"code":"0083U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":167.35,"maximum":417.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":167.35,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":170.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":169.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":172.37,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":417.87,"additional_payer_notes":"APC"}]}]},{"description":"Rbc dna gnotyp 10 bld groups","code_information":[{"code":"0084U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":720.0,"maximum":1797.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":720.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":734.4,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":727.2,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":741.6,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1797.84,"additional_payer_notes":"APC"}]}]},{"description":"Nfct ds bact&fng org id 6+","code_information":[{"code":"0086U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":200.0,"maximum":499.4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":200.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":204.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":202.0,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":206.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":499.4,"additional_payer_notes":"APC"}]}]},{"description":"Crd hrt trnspl mrna 1283 gen","code_information":[{"code":"0087U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3159.42,"maximum":7889.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3159.42,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3222.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3191.01,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3254.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7889.07,"additional_payer_notes":"APC"}]}]},{"description":"Trnsplj kdn algrft rej 1494","code_information":[{"code":"0088U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3159.42,"maximum":7889.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3159.42,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3222.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3191.01,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3254.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7889.07,"additional_payer_notes":"APC"}]}]},{"description":"Onc mlnma prame & linc00518","code_information":[{"code":"0089U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":760.0,"maximum":1897.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":760.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":775.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":767.6,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":782.8,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1897.72,"additional_payer_notes":"APC"}]}]},{"description":"Onc cutan mlnma mrna 23 gene","code_information":[{"code":"0090U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1950.0,"maximum":4869.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1950.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1989.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1969.5,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2008.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4869.15,"additional_payer_notes":"APC"}]}]},{"description":"Onc lng 3 prtn bmrk plsm alg","code_information":[{"code":"0092U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2488.0,"maximum":6212.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2488.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2537.76,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2512.88,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2562.64,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":6212.54,"additional_payer_notes":"APC"}]}]},{"description":"Rx mntr 65 com drugs urine","code_information":[{"code":"0093U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":62.14,"maximum":155.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":62.14,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":63.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":62.76,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":64.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":155.16,"additional_payer_notes":"APC"}]}]},{"description":"Genome rapid sequence alys","code_information":[{"code":"0094U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7582.2,"maximum":18932.75,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7582.2,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7733.84,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7658.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7809.67,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":18932.75,"additional_payer_notes":"APC"}]}]},{"description":"Inflm ee elisa alys alg","code_information":[{"code":"0095U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":771.98,"maximum":1927.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":771.98,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":787.42,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":779.7,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":795.14,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1927.63,"additional_payer_notes":"APC"}]}]},{"description":"Hpv hi risk types male urine","code_information":[{"code":"0096U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.09,"maximum":87.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.09,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35.79,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.14,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":87.62,"additional_payer_notes":"APC"}]}]},{"description":"Hered colon ca do 15 genes","code_information":[{"code":"0101U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1743.95,"maximum":4354.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1743.95,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1778.83,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1761.39,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1796.27,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4354.64,"additional_payer_notes":"APC"}]}]},{"description":"Hered brst ca rltd do 17 gen","code_information":[{"code":"0102U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1303.95,"maximum":3255.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1303.95,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1330.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1316.99,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1343.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3255.96,"additional_payer_notes":"APC"}]}]},{"description":"Hered ova ca pnl 24 genes","code_information":[{"code":"0103U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1743.95,"maximum":4354.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1743.95,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1778.83,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1761.39,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1796.27,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4354.64,"additional_payer_notes":"APC"}]}]},{"description":"Neph ckd mult eclia tum nec","code_information":[{"code":"0105U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":950.0,"maximum":2372.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":950.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":969.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":959.5,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":978.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2372.15,"additional_payer_notes":"APC"}]}]},{"description":"Gstr emptg 7 timed brth spec","code_information":[{"code":"0106U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":874.49,"maximum":2183.60,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":874.49,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":891.98,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":883.23,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":900.72,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2183.6,"additional_payer_notes":"APC"}]}]},{"description":"C diff tox ag detcj ia stool","code_information":[{"code":"0107U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16.0,"maximum":39.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16.32,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16.16,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.48,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":39.95,"additional_payer_notes":"APC"}]}]},{"description":"Gi barrett esoph 9 prtn bmrk","code_information":[{"code":"0108U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4950.0,"maximum":12360.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4950.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5049.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4999.5,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5098.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":12360.15,"additional_payer_notes":"APC"}]}]},{"description":"Id aspergillus dna 4 species","code_information":[{"code":"0109U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":142.63,"maximum":356.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":142.63,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":145.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":144.06,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":146.91,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":356.15,"additional_payer_notes":"APC"}]}]},{"description":"Rx mntr 1+oral onc rx&sbsts","code_information":[{"code":"0110U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":27.11,"maximum":67.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27.11,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27.38,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":67.69,"additional_payer_notes":"APC"}]}]},{"description":"Onc colon ca kras&nras alys","code_information":[{"code":"0111U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":682.29,"maximum":1703.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":682.29,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":695.94,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":689.11,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":702.76,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1703.68,"additional_payer_notes":"APC"}]}]},{"description":"Iadi 16s&18s rrna genes","code_information":[{"code":"0112U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":356.13,"maximum":889.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":356.13,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":363.25,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":359.69,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":366.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":889.26,"additional_payer_notes":"APC"}]}]},{"description":"Onc prst8 pca3&tmprss2-erg","code_information":[{"code":"0113U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":760.0,"maximum":1897.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":760.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":775.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":767.6,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":782.8,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1897.72,"additional_payer_notes":"APC"}]}]},{"description":"Gi barretts esoph vim&ccna1","code_information":[{"code":"0114U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1938.01,"maximum":4839.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1938.01,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1976.77,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1957.39,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1996.15,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4839.21,"additional_payer_notes":"APC"}]}]},{"description":"Respir iadna 18 viral&2 bact","code_information":[{"code":"0115U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":275.35,"maximum":687.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":275.35,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":280.86,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":278.1,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":283.61,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":687.55,"additional_payer_notes":"APC"}]}]},{"description":"Rx mntr nzm ia 35+oral flu","code_information":[{"code":"0116U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":246.92,"maximum":616.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":246.92,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":251.86,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":249.39,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":254.33,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":616.56,"additional_payer_notes":"APC"}]}]},{"description":"Pain mgmt 11 endogenous anal","code_information":[{"code":"0117U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":840.65,"maximum":2099.10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":840.65,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":857.46,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":849.06,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":865.87,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2099.1,"additional_payer_notes":"APC"}]}]},{"description":"Trnsplj don-drv cll-fr dna","code_information":[{"code":"0118U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2753.25,"maximum":6874.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2753.25,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2808.32,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2780.78,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2835.85,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":6874.87,"additional_payer_notes":"APC"}]}]},{"description":"Crd ceramides liq chrom plsm","code_information":[{"code":"0119U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":83.76,"maximum":209.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":83.76,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":85.44,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84.6,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":86.27,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":209.15,"additional_payer_notes":"APC"}]}]},{"description":"Onc b cll lymphm mrna 58 gen","code_information":[{"code":"0120U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2510.21,"maximum":6267.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2510.21,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2560.41,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2535.31,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2585.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":6267.99,"additional_payer_notes":"APC"}]}]},{"description":"Sc dis vcam-1 whole blood","code_information":[{"code":"0121U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":509.2,"maximum":1271.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":509.2,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":519.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":514.29,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":524.48,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1271.47,"additional_payer_notes":"APC"}]}]},{"description":"Sc dis p-selectin whl blood","code_information":[{"code":"0122U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":526.23,"maximum":1314.00,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":526.23,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":536.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":531.49,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":542.02,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1314.0,"additional_payer_notes":"APC"}]}]},{"description":"Mchnl fragility rbc prflg","code_information":[{"code":"0123U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":357.63,"maximum":893.00,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":357.63,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":364.78,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":361.21,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":368.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":893.0,"additional_payer_notes":"APC"}]}]},{"description":"Hered brst ca rltd do panel","code_information":[{"code":"0129U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1303.95,"maximum":3255.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1303.95,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1330.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1316.99,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1343.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3255.96,"additional_payer_notes":"APC"}]}]},{"description":"Hered colon ca do mrna pnl","code_information":[{"code":"0130U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":584.9,"maximum":1460.50,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":584.9,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":596.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":590.75,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":602.45,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1460.5,"additional_payer_notes":"APC"}]}]},{"description":"Hered prst8 ca rltd do 11","code_information":[{"code":"0133U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":690.29,"maximum":1723.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":690.29,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":704.1,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":697.19,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":711.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1723.65,"additional_payer_notes":"APC"}]}]},{"description":"Hered pan ca mrna pnl 18 gen","code_information":[{"code":"0134U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":748.39,"maximum":1868.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":748.39,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":763.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":755.87,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":770.84,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1868.73,"additional_payer_notes":"APC"}]}]},{"description":"Atm mrna seq alys","code_information":[{"code":"0136U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":407.43,"maximum":1017.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":407.43,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":415.58,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":411.5,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":419.65,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1017.35,"additional_payer_notes":"APC"}]}]},{"description":"Palb2 mrna seq alys","code_information":[{"code":"0137U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":282.88,"maximum":706.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":282.88,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":288.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":285.71,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":291.37,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":706.35,"additional_payer_notes":"APC"}]}]},{"description":"Brca1 brca2 mrna seq alys","code_information":[{"code":"0138U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":468.33,"maximum":1169.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":468.33,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":477.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":473.01,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":482.38,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1169.42,"additional_payer_notes":"APC"}]}]},{"description":"Nfct ds fungi dna 15 trgt","code_information":[{"code":"0140U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":156.75,"maximum":391.40,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":156.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":159.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":158.32,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":161.45,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":391.4,"additional_payer_notes":"APC"}]}]},{"description":"Nfct ds bact&fng gram pos","code_information":[{"code":"0141U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":156.75,"maximum":391.40,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":156.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":159.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":158.32,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":161.45,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":391.4,"additional_payer_notes":"APC"}]}]},{"description":"Nfct ds bact&fng gram neg","code_information":[{"code":"0142U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":156.75,"maximum":391.40,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":156.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":159.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":158.32,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":161.45,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":391.4,"additional_payer_notes":"APC"}]}]},{"description":"Nfct bct fng prst dna >1000","code_information":[{"code":"0152U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2126.2,"maximum":5309.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2126.2,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2168.72,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2147.46,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2189.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":5309.12,"additional_payer_notes":"APC"}]}]},{"description":"Onc breast mrna 101 genes","code_information":[{"code":"0153U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3159.42,"maximum":7889.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3159.42,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3222.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3191.01,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3254.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7889.07,"additional_payer_notes":"APC"}]}]},{"description":"Fgfr3 gene analysis","code_information":[{"code":"0154U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":482.14,"maximum":1203.90,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":482.14,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":491.78,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":486.96,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":496.6,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1203.9,"additional_payer_notes":"APC"}]}]},{"description":"Pik3ca gene analysis","code_information":[{"code":"0155U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":274.83,"maximum":686.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":274.83,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":280.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":277.58,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":283.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":686.25,"additional_payer_notes":"APC"}]}]},{"description":"Copy number sequence alys","code_information":[{"code":"0156U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1740.0,"maximum":4344.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1740.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1774.8,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1757.4,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1792.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4344.78,"additional_payer_notes":"APC"}]}]},{"description":"Apc mrna seq alys","code_information":[{"code":"0157U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":282.88,"maximum":706.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":282.88,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":288.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":285.71,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":291.37,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":706.35,"additional_payer_notes":"APC"}]}]},{"description":"Mlh1 mrna seq alys","code_information":[{"code":"0158U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":282.88,"maximum":706.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":282.88,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":288.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":285.71,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":291.37,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":706.35,"additional_payer_notes":"APC"}]}]},{"description":"Msh2 mrna seq alys","code_information":[{"code":"0159U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":282.88,"maximum":706.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":282.88,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":288.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":285.71,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":291.37,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":706.35,"additional_payer_notes":"APC"}]}]},{"description":"Msh6 mrna seq alys","code_information":[{"code":"0160U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":282.88,"maximum":706.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":282.88,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":288.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":285.71,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":291.37,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":706.35,"additional_payer_notes":"APC"}]}]},{"description":"Pms2 mrna seq alys","code_information":[{"code":"0161U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":282.88,"maximum":706.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":282.88,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":288.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":285.71,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":291.37,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":706.35,"additional_payer_notes":"APC"}]}]},{"description":"Hered colon ca trgt mrna pnl","code_information":[{"code":"0162U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":486.54,"maximum":1214.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":486.54,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":496.27,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":491.41,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":501.14,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1214.89,"additional_payer_notes":"APC"}]}]},{"description":"Gi ibs ia anti-cdtb&vinculin","code_information":[{"code":"0164U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":112.02,"maximum":279.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":112.02,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":114.26,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":113.14,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":115.38,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":279.71,"additional_payer_notes":"APC"}]}]},{"description":"Peanut allg spec asmt 64 epi","code_information":[{"code":"0165U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":463.76,"maximum":1158.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":463.76,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":473.04,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":468.4,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":477.67,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1158.01,"additional_payer_notes":"APC"}]}]},{"description":"Liver ds 10 biochem asy srm","code_information":[{"code":"0166U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":503.4,"maximum":1256.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":503.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":513.47,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":508.43,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":518.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1256.99,"additional_payer_notes":"APC"}]}]},{"description":"Nudt15&tpmt gene com vrnt","code_information":[{"code":"0169U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":466.17,"maximum":1164.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":466.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":475.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":470.83,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":480.16,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1164.03,"additional_payer_notes":"APC"}]}]},{"description":"Neuro asd rna next gen seq","code_information":[{"code":"0170U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1950.0,"maximum":4869.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1950.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1989.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1969.5,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2008.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4869.15,"additional_payer_notes":"APC"}]}]},{"description":"Trgt gen seq alys pnl dna 23","code_information":[{"code":"0171U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1519.06,"maximum":3793.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1519.06,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1549.44,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1534.25,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1564.63,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3793.09,"additional_payer_notes":"APC"}]}]},{"description":"Onc sld tum alys brca1 brca2","code_information":[{"code":"0172U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3030.0,"maximum":7565.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3030.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3090.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3060.3,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3120.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7565.91,"additional_payer_notes":"APC"}]}]},{"description":"Psyc gen alys panel 14 genes","code_information":[{"code":"0173U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":466.17,"maximum":1164.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":466.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":475.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":470.83,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":480.16,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1164.03,"additional_payer_notes":"APC"}]}]},{"description":"Onc solid tumor 30 prtn trgt","code_information":[{"code":"0174U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1305.37,"maximum":3259.51,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1305.37,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1331.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1318.42,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1344.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3259.51,"additional_payer_notes":"APC"}]}]},{"description":"Psyc gen alys panel 15 genes","code_information":[{"code":"0175U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1336.09,"maximum":3336.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1336.09,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1362.81,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1349.45,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1376.17,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3336.22,"additional_payer_notes":"APC"}]}]},{"description":"Cdtb&vinculin igg antb ia","code_information":[{"code":"0176U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":64.19,"maximum":160.28,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":64.19,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":65.47,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":64.83,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":66.12,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":160.28,"additional_payer_notes":"APC"}]}]},{"description":"Onc brst ca dna pik3ca 11","code_information":[{"code":"0177U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":274.83,"maximum":686.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":274.83,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":280.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":277.58,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":283.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":686.25,"additional_payer_notes":"APC"}]}]},{"description":"Peanut allg asmt epi clin rx","code_information":[{"code":"0178U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":459.86,"maximum":1148.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":459.86,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":469.06,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":464.46,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":473.66,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1148.27,"additional_payer_notes":"APC"}]}]},{"description":"Onc nonsm cll lng ca alys 23","code_information":[{"code":"0179U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1943.21,"maximum":4852.20,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1943.21,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1982.07,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1962.64,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2001.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4852.2,"additional_payer_notes":"APC"}]}]},{"description":"Abo gnotyp abo 7 exons","code_information":[{"code":"0180U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":274.83,"maximum":686.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":274.83,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":280.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":277.58,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":283.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":686.25,"additional_payer_notes":"APC"}]}]},{"description":"Co gnotyp aqp1 exon 1","code_information":[{"code":"0181U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":185.2,"maximum":462.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":185.2,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":188.9,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":187.05,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":190.76,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":462.44,"additional_payer_notes":"APC"}]}]},{"description":"Crom gnotyp cd55 exons 1-10","code_information":[{"code":"0182U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":301.35,"maximum":752.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":301.35,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":307.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":304.36,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":310.39,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":752.47,"additional_payer_notes":"APC"}]}]},{"description":"Di gnotyp slc4a1 exon 19","code_information":[{"code":"0183U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":185.2,"maximum":462.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":185.2,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":188.9,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":187.05,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":190.76,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":462.44,"additional_payer_notes":"APC"}]}]},{"description":"Do gnotyp art4 exon 2","code_information":[{"code":"0184U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":185.2,"maximum":462.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":185.2,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":188.9,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":187.05,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":190.76,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":462.44,"additional_payer_notes":"APC"}]}]},{"description":"Fut1 gnotyp fut1 exon 4","code_information":[{"code":"0185U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":185.2,"maximum":462.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":185.2,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":188.9,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":187.05,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":190.76,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":462.44,"additional_payer_notes":"APC"}]}]},{"description":"Fut2 gnotyp fut2 exon 2","code_information":[{"code":"0186U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":185.2,"maximum":462.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":185.2,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":188.9,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":187.05,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":190.76,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":462.44,"additional_payer_notes":"APC"}]}]},{"description":"Fy gnotyp ackr1 exons 1-2","code_information":[{"code":"0187U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":274.83,"maximum":686.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":274.83,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":280.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":277.58,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":283.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":686.25,"additional_payer_notes":"APC"}]}]},{"description":"Ge gnotyp gypc exons 1-4","code_information":[{"code":"0188U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":274.83,"maximum":686.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":274.83,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":280.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":277.58,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":283.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":686.25,"additional_payer_notes":"APC"}]}]},{"description":"Gypa gnotyp ntrns 1 5 exon 2","code_information":[{"code":"0189U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":274.83,"maximum":686.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":274.83,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":280.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":277.58,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":283.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":686.25,"additional_payer_notes":"APC"}]}]},{"description":"Gypb gnotyp ntrns 1 5 seux 3","code_information":[{"code":"0190U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":274.83,"maximum":686.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":274.83,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":280.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":277.58,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":283.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":686.25,"additional_payer_notes":"APC"}]}]},{"description":"In gnotyp cd44 exons 2 3 6","code_information":[{"code":"0191U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":274.83,"maximum":686.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":274.83,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":280.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":277.58,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":283.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":686.25,"additional_payer_notes":"APC"}]}]},{"description":"Jk gnotyp slc14a1 exon 9","code_information":[{"code":"0192U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":274.83,"maximum":686.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":274.83,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":280.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":277.58,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":283.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":686.25,"additional_payer_notes":"APC"}]}]},{"description":"Jr gnotyp abcg2 exons 2-26","code_information":[{"code":"0193U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":282.88,"maximum":706.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":282.88,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":288.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":285.71,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":291.37,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":706.35,"additional_payer_notes":"APC"}]}]},{"description":"Kel gnotyp kel exon 8","code_information":[{"code":"0194U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":185.2,"maximum":462.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":185.2,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":188.9,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":187.05,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":190.76,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":462.44,"additional_payer_notes":"APC"}]}]},{"description":"Klf1 targeted sequencing","code_information":[{"code":"0195U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":375.25,"maximum":937.00,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":375.25,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":382.76,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":379.0,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":386.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":937.0,"additional_payer_notes":"APC"}]}]},{"description":"Lu gnotyp bcam exon 3","code_information":[{"code":"0196U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":185.2,"maximum":462.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":185.2,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":188.9,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":187.05,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":190.76,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":462.44,"additional_payer_notes":"APC"}]}]},{"description":"Lw gnotyp icam4 exon 1","code_information":[{"code":"0197U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":185.2,"maximum":462.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":185.2,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":188.9,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":187.05,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":190.76,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":462.44,"additional_payer_notes":"APC"}]}]},{"description":"Rhd&rhce gntyp rhd1-10&rhce5","code_information":[{"code":"0198U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":282.88,"maximum":706.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":282.88,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":288.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":285.71,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":291.37,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":706.35,"additional_payer_notes":"APC"}]}]},{"description":"Sc gnotyp ermap exons 4 12","code_information":[{"code":"0199U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":274.83,"maximum":686.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":274.83,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":280.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":277.58,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":283.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":686.25,"additional_payer_notes":"APC"}]}]},{"description":"Xk gnotyp xk exons 1-3","code_information":[{"code":"0200U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":274.83,"maximum":686.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":274.83,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":280.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":277.58,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":283.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":686.25,"additional_payer_notes":"APC"}]}]},{"description":"Yt gnotyp ache exon 2","code_information":[{"code":"0201U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":185.2,"maximum":462.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":185.2,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":188.9,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":187.05,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":190.76,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":462.44,"additional_payer_notes":"APC"}]}]},{"description":"Nfct ds 22 trgt sars-cov-2","code_information":[{"code":"0202U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":416.78,"maximum":1040.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":416.78,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":425.12,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":420.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":429.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1040.7,"additional_payer_notes":"APC"}]}]},{"description":"Ai ibd mrna xprsn prfl 17","code_information":[{"code":"0203U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":760.0,"maximum":1897.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":760.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":775.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":767.6,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":782.8,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1897.72,"additional_payer_notes":"APC"}]}]},{"description":"Oph amd alys 3 gene variants","code_information":[{"code":"0205U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":47.0,"maximum":117.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":47.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":47.94,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":47.47,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":48.41,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":117.36,"additional_payer_notes":"APC"}]}]},{"description":"Neuro alzheimer cell aggregj","code_information":[{"code":"0206U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2215.4,"maximum":5531.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2215.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2259.71,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2237.55,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2281.86,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":5531.85,"additional_payer_notes":"APC"}]}]},{"description":"Cytog const alys interrog","code_information":[{"code":"0209U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":787.15,"maximum":1965.51,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":787.15,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":802.89,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":795.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":810.76,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1965.51,"additional_payer_notes":"APC"}]}]},{"description":"Syphilis tst antb ia quan","code_information":[{"code":"0210U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18.63,"maximum":46.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.63,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.82,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":46.52,"additional_payer_notes":"APC"}]}]},{"description":"Onc pan-tum dna&rna gnrj seq","code_information":[{"code":"0211U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":8455.0,"maximum":21112.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8455.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8624.1,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8539.55,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8708.65,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":21112.14,"additional_payer_notes":"APC"}]}]},{"description":"Rare ds gen dna alys proband","code_information":[{"code":"0212U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5475.2,"maximum":13671.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5475.2,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5584.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5529.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5639.46,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":13671.57,"additional_payer_notes":"APC"}]}]},{"description":"Rare ds gen dna alys ea comp","code_information":[{"code":"0213U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2709.95,"maximum":6766.75,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2709.95,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2764.15,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2737.05,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2791.25,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":6766.75,"additional_payer_notes":"APC"}]}]},{"description":"Rare ds xom dna alys proband","code_information":[{"code":"0214U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5224.6,"maximum":13045.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5224.6,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5329.09,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5276.85,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5381.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":13045.83,"additional_payer_notes":"APC"}]}]},{"description":"Rare ds xom dna alys ea comp","code_information":[{"code":"0215U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2574.65,"maximum":6428.90,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2574.65,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2626.14,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2600.4,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2651.89,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":6428.9,"additional_payer_notes":"APC"}]}]},{"description":"Neuro inh ataxia dna 12 com","code_information":[{"code":"0216U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1537.02,"maximum":3837.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1537.02,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1567.76,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1552.39,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1583.13,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3837.94,"additional_payer_notes":"APC"}]}]},{"description":"Neuro inh ataxia dna 51 gene","code_information":[{"code":"0217U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2198.35,"maximum":5489.28,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2198.35,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2242.32,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2220.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2264.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":5489.28,"additional_payer_notes":"APC"}]}]},{"description":"Neuro musc dys dmd seq alys","code_information":[{"code":"0218U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2279.0,"maximum":5690.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2279.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2324.58,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2301.79,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2347.37,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":5690.66,"additional_payer_notes":"APC"}]}]},{"description":"Nfct agt hiv gnrj seq alys","code_information":[{"code":"0219U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":725.0,"maximum":1810.32,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":725.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":739.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":732.25,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":746.75,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1810.32,"additional_payer_notes":"APC"}]}]},{"description":"Onc brst ca ai assmt 12 feat","code_information":[{"code":"0220U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":706.25,"maximum":1763.51,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":706.25,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":720.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":713.31,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":727.44,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1763.51,"additional_payer_notes":"APC"}]}]},{"description":"Abo gnotyp next gnrj seq abo","code_information":[{"code":"0221U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":274.83,"maximum":686.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":274.83,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":280.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":277.58,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":283.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":686.25,"additional_payer_notes":"APC"}]}]},{"description":"Rhd&rhce gntyp next gnrj seq","code_information":[{"code":"0222U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":282.88,"maximum":706.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":282.88,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":288.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":285.71,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":291.37,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":706.35,"additional_payer_notes":"APC"}]}]},{"description":"Nfct ds 22 trgt sars-cov-2","code_information":[{"code":"0223U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":416.78,"maximum":1040.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":416.78,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":425.12,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":420.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":429.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1040.7,"additional_payer_notes":"APC"}]}]},{"description":"Antibody sars-cov-2 titer(s)","code_information":[{"code":"0224U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":51.43,"maximum":128.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":51.43,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":52.46,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":51.94,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":52.97,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":128.42,"additional_payer_notes":"APC"}]}]},{"description":"Nfct ds dna&rna 21 sarscov2","code_information":[{"code":"0225U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":416.78,"maximum":1040.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":416.78,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":425.12,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":420.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":429.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1040.7,"additional_payer_notes":"APC"}]}]},{"description":"Svnt sarscov2 elisa plsm srm","code_information":[{"code":"0226U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":42.28,"maximum":105.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":42.28,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":43.13,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":42.7,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":43.55,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":105.57,"additional_payer_notes":"APC"}]}]},{"description":"Rx asy prsmv 30+rx/metablt","code_information":[{"code":"0227U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":62.14,"maximum":155.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":62.14,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":63.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":62.76,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":64.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":155.16,"additional_payer_notes":"APC"}]}]},{"description":"Onc prst8 ma molec prfl alg","code_information":[{"code":"0228U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":173.03,"maximum":432.06,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":173.03,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":176.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":174.76,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":178.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":432.06,"additional_payer_notes":"APC"}]}]},{"description":"Bcat1 promoter mthyltn alys","code_information":[{"code":"0229U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":384.0,"maximum":958.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":384.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":391.68,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":387.84,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":395.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":958.85,"additional_payer_notes":"APC"}]}]},{"description":"Ar full sequence analysis","code_information":[{"code":"0230U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":301.35,"maximum":752.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":301.35,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":307.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":304.36,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":310.39,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":752.47,"additional_payer_notes":"APC"}]}]},{"description":"Cacna1a full gene analysis","code_information":[{"code":"0231U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":846.27,"maximum":2113.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":846.27,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":863.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":854.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":871.66,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2113.14,"additional_payer_notes":"APC"}]}]},{"description":"Cstb full gene analysis","code_information":[{"code":"0232U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":274.83,"maximum":686.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":274.83,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":280.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":277.58,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":283.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":686.25,"additional_payer_notes":"APC"}]}]},{"description":"Fxn gene analysis","code_information":[{"code":"0233U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":274.83,"maximum":686.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":274.83,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":280.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":277.58,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":283.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":686.25,"additional_payer_notes":"APC"}]}]},{"description":"Mecp2 full gene analysis","code_information":[{"code":"0234U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":527.87,"maximum":1318.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":527.87,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":538.43,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":533.15,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":543.71,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1318.09,"additional_payer_notes":"APC"}]}]},{"description":"Pten full gene analysis","code_information":[{"code":"0235U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":600.0,"maximum":1498.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":600.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":612.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":606.0,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":618.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1498.2,"additional_payer_notes":"APC"}]}]},{"description":"Smn1&smn2 full gene analysis","code_information":[{"code":"0236U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":602.7,"maximum":1504.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":602.7,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":614.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":608.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":620.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1504.94,"additional_payer_notes":"APC"}]}]},{"description":"Car ion chnlpthy gen seq pnl","code_information":[{"code":"0237U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":584.9,"maximum":1460.50,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":584.9,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":596.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":590.75,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":602.45,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1460.5,"additional_payer_notes":"APC"}]}]},{"description":"Onc lnch syn gen dna seq aly","code_information":[{"code":"0238U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":584.9,"maximum":1460.50,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":584.9,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":596.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":590.75,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":602.45,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1460.5,"additional_payer_notes":"APC"}]}]},{"description":"Trgt gen seq alys pnl 311+","code_information":[{"code":"0239U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3500.0,"maximum":8739.5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3500.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3570.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3535.0,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3605.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8739.5,"additional_payer_notes":"APC"}]}]},{"description":"Trgt gen seq alys pnl 55-74","code_information":[{"code":"0242U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5000.0,"maximum":12485.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5000.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5100.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5050.0,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5150.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":12485.0,"additional_payer_notes":"APC"}]}]},{"description":"Ob pe biochem assay pgf alg","code_information":[{"code":"0243U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":64.41,"maximum":160.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":64.41,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":65.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":65.05,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":66.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":160.83,"additional_payer_notes":"APC"}]}]},{"description":"Onc solid orgn dna 257 genes","code_information":[{"code":"0244U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3500.0,"maximum":8739.5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3500.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3570.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3535.0,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3605.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8739.5,"additional_payer_notes":"APC"}]}]},{"description":"Onc thyr mut alys 10 gen&37","code_information":[{"code":"0245U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1266.07,"maximum":3161.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1266.07,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1291.39,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1278.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1304.05,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3161.38,"additional_payer_notes":"APC"}]}]},{"description":"Rbc dna gnotyp 16 bld groups","code_information":[{"code":"0246U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":720.0,"maximum":1797.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":720.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":734.4,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":727.2,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":741.6,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1797.84,"additional_payer_notes":"APC"}]}]},{"description":"Ob prtrm brth ibp4 shbg meas","code_information":[{"code":"0247U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":750.0,"maximum":1872.75,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":750.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":765.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":757.5,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":772.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1872.75,"additional_payer_notes":"APC"}]}]},{"description":"Onc brn sphrd cll 12 rx pnl","code_information":[{"code":"0248U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3033.86,"maximum":7575.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3033.86,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3094.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3064.2,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3124.88,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7575.55,"additional_payer_notes":"APC"}]}]},{"description":"Onc brst alys 32 phsprtn alg","code_information":[{"code":"0249U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2219.13,"maximum":5541.17,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2219.13,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2263.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2241.32,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2285.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":5541.17,"additional_payer_notes":"APC"}]}]},{"description":"Onc sld org neo dna 505 gene","code_information":[{"code":"0250U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2919.6,"maximum":7290.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2919.6,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2977.99,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2948.8,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3007.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7290.24,"additional_payer_notes":"APC"}]}]},{"description":"Hepcidin-25 elisa serum/plsm","code_information":[{"code":"0251U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.27,"maximum":43.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.27,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17.62,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.79,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":43.12,"additional_payer_notes":"APC"}]}]},{"description":"Ftl aneuploidy str alys dna","code_information":[{"code":"0252U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":759.05,"maximum":1895.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":759.05,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":774.23,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":766.64,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":781.82,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1895.35,"additional_payer_notes":"APC"}]}]},{"description":"Rprdtve med rna gen prfl 238","code_information":[{"code":"0253U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3159.42,"maximum":7889.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3159.42,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3222.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3191.01,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3254.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7889.07,"additional_payer_notes":"APC"}]}]},{"description":"Reprdtve med alys 24 chrmsm","code_information":[{"code":"0254U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":759.05,"maximum":1895.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":759.05,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":774.23,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":766.64,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":781.82,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1895.35,"additional_payer_notes":"APC"}]}]},{"description":"Andrology infertility assmt","code_information":[{"code":"0255U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":31.6,"maximum":78.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":31.6,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32.23,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31.92,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":32.55,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":78.91,"additional_payer_notes":"APC"}]}]},{"description":"Tma/tmao prfl ms/ms ur alg","code_information":[{"code":"0256U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":159.95,"maximum":399.40,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":159.95,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":163.15,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":161.55,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":164.75,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":399.4,"additional_payer_notes":"APC"}]}]},{"description":"Vlcad leuk nzm actv whl bld","code_information":[{"code":"0257U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":712.47,"maximum":1779.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":712.47,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":726.72,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":719.59,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":733.84,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1779.04,"additional_payer_notes":"APC"}]}]},{"description":"Ai psor mrna 50-100 gen alg","code_information":[{"code":"0258U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3675.0,"maximum":9176.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3675.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3748.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3711.75,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3785.25,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":9176.48,"additional_payer_notes":"APC"}]}]},{"description":"Neph ckd nuc mrs meas gfr","code_information":[{"code":"0259U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":52.71,"maximum":131.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":52.71,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":53.76,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":53.24,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":54.29,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":131.62,"additional_payer_notes":"APC"}]}]},{"description":"Rare ds id opt genome mapg","code_information":[{"code":"0260U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1263.53,"maximum":3155.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1263.53,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1288.8,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1276.17,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1301.44,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3155.03,"additional_payer_notes":"APC"}]}]},{"description":"Onc clrct ca img alys w/ai","code_information":[{"code":"0261U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2513.25,"maximum":6275.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2513.25,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2563.52,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2538.38,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2588.65,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":6275.59,"additional_payer_notes":"APC"}]}]},{"description":"Onc sld tum rt-pcr 7 gen","code_information":[{"code":"0262U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3200.0,"maximum":7990.4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3200.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3264.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3232.0,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3296.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7990.4,"additional_payer_notes":"APC"}]}]},{"description":"Neuro asd meas 16 c metblt","code_information":[{"code":"0263U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":750.0,"maximum":1872.75,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":750.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":765.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":757.5,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":772.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1872.75,"additional_payer_notes":"APC"}]}]},{"description":"Rare ds id opt genome mapg","code_information":[{"code":"0264U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1263.53,"maximum":3155.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1263.53,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1288.8,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1276.17,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1301.44,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3155.03,"additional_payer_notes":"APC"}]}]},{"description":"Rar do whl gn&mtcdrl dna als","code_information":[{"code":"0265U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5475.8,"maximum":13673.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5475.8,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5585.32,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5530.56,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5640.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":13673.07,"additional_payer_notes":"APC"}]}]},{"description":"Unxpl cnst hrtbl do gn xprsn","code_information":[{"code":"0266U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3200.0,"maximum":7990.4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3200.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3264.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3232.0,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3296.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7990.4,"additional_payer_notes":"APC"}]}]},{"description":"Rare do id opt gen mapg&seq","code_information":[{"code":"0267U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6739.33,"maximum":16828.11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6739.33,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6874.12,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6806.72,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6941.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":16828.11,"additional_payer_notes":"APC"}]}]},{"description":"Hem ahus gen seq alys 15 gen","code_information":[{"code":"0268U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":608.17,"maximum":1518.60,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":608.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":620.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":614.25,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":626.42,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1518.6,"additional_payer_notes":"APC"}]}]},{"description":"Hem aut dm cgen trmbctpna 14","code_information":[{"code":"0269U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":608.17,"maximum":1518.60,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":608.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":620.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":614.25,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":626.42,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1518.6,"additional_payer_notes":"APC"}]}]},{"description":"Hem cgen coagj do 20 genes","code_information":[{"code":"0270U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":608.17,"maximum":1518.60,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":608.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":620.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":614.25,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":626.42,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1518.6,"additional_payer_notes":"APC"}]}]},{"description":"Hem cgen neutropenia 23 gen","code_information":[{"code":"0271U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":608.17,"maximum":1518.60,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":608.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":620.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":614.25,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":626.42,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1518.6,"additional_payer_notes":"APC"}]}]},{"description":"Hem genetic bld do 51 genes","code_information":[{"code":"0272U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":608.17,"maximum":1518.60,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":608.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":620.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":614.25,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":626.42,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1518.6,"additional_payer_notes":"APC"}]}]},{"description":"Hem gen hyprfibrnlysis 8 gen","code_information":[{"code":"0273U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":608.17,"maximum":1518.60,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":608.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":620.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":614.25,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":626.42,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1518.6,"additional_payer_notes":"APC"}]}]},{"description":"Hem gen pltlt do 43 genes","code_information":[{"code":"0274U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":608.17,"maximum":1518.60,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":608.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":620.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":614.25,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":626.42,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1518.6,"additional_payer_notes":"APC"}]}]},{"description":"Hem heprn nduc trmbctpna srm","code_information":[{"code":"0275U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18.37,"maximum":45.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.37,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.74,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.55,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":45.87,"additional_payer_notes":"APC"}]}]},{"description":"Hem inh thrombocytopenia 23","code_information":[{"code":"0276U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2448.56,"maximum":6114.05,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2448.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2497.53,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2473.05,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2522.02,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":6114.05,"additional_payer_notes":"APC"}]}]},{"description":"Hem gen pltlt funcj do 31","code_information":[{"code":"0277U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":608.17,"maximum":1518.60,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":608.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":620.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":614.25,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":626.42,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1518.6,"additional_payer_notes":"APC"}]}]},{"description":"Hem gen thrombosis 12 genes","code_information":[{"code":"0278U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":608.17,"maximum":1518.60,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":608.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":620.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":614.25,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":626.42,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1518.6,"additional_payer_notes":"APC"}]}]},{"description":"Hem vw factor&clgn iii bndg","code_information":[{"code":"0279U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.53,"maximum":28.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.53,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11.76,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11.65,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.88,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":28.79,"additional_payer_notes":"APC"}]}]},{"description":"Hem vw factor&clgn iv bndg","code_information":[{"code":"0280U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.27,"maximum":43.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.27,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17.62,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.79,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":43.12,"additional_payer_notes":"APC"}]}]},{"description":"Hem vwd propeptide ag lvl","code_information":[{"code":"0281U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.27,"maximum":43.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.27,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17.62,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.79,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":43.12,"additional_payer_notes":"APC"}]}]},{"description":"Rbc dna gntyp 12 bld grp gen","code_information":[{"code":"0282U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":720.0,"maximum":1797.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":720.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":734.4,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":727.2,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":741.6,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1797.84,"additional_payer_notes":"APC"}]}]},{"description":"Vw factor type 2b eval plsm","code_information":[{"code":"0283U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18.4,"maximum":45.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.77,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.58,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":45.94,"additional_payer_notes":"APC"}]}]},{"description":"Vw factor type 2n eval plsm","code_information":[{"code":"0284U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.27,"maximum":43.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.27,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17.62,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.79,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":43.12,"additional_payer_notes":"APC"}]}]},{"description":"Onc rsps radj cll fr dna tox","code_information":[{"code":"0285U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":443.31,"maximum":1106.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":443.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":452.18,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":447.74,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":456.61,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1106.95,"additional_payer_notes":"APC"}]}]},{"description":"Cep72 nudt15&tpmt gene alys","code_information":[{"code":"0286U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":134.13,"maximum":334.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":134.13,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":136.81,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":135.47,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":138.15,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":334.92,"additional_payer_notes":"APC"}]}]},{"description":"Onc thyr dna&mrna 112 genes","code_information":[{"code":"0287U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3600.0,"maximum":8989.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3600.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3672.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3636.0,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3708.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8989.2,"additional_payer_notes":"APC"}]}]},{"description":"Onc lung mrna quan pcr 11&3","code_information":[{"code":"0288U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3873.0,"maximum":9670.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3873.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3950.46,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3911.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3989.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":9670.88,"additional_payer_notes":"APC"}]}]},{"description":"Neuro alzheimer mrna 24 gen","code_information":[{"code":"0289U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":760.0,"maximum":1897.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":760.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":775.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":767.6,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":782.8,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1897.72,"additional_payer_notes":"APC"}]}]},{"description":"Pain mgmt mrna gen xprsn 36","code_information":[{"code":"0290U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":760.0,"maximum":1897.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":760.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":775.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":767.6,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":782.8,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1897.72,"additional_payer_notes":"APC"}]}]},{"description":"Psyc mood do mrna 144 genes","code_information":[{"code":"0291U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1755.0,"maximum":4382.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1755.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1790.1,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1772.55,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1807.65,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4382.23,"additional_payer_notes":"APC"}]}]},{"description":"Psyc strs do mrna 72 genes","code_information":[{"code":"0292U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1755.0,"maximum":4382.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1755.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1790.1,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1772.55,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1807.65,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4382.23,"additional_payer_notes":"APC"}]}]},{"description":"Psyc suicidal idea mrna 54","code_information":[{"code":"0293U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":760.0,"maximum":1897.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":760.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":775.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":767.6,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":782.8,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1897.72,"additional_payer_notes":"APC"}]}]},{"description":"Onc brst dux carc 7 proteins","code_information":[{"code":"0295U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5435.0,"maximum":13571.20,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5435.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5543.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5489.35,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5598.05,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":13571.2,"additional_payer_notes":"APC"}]}]},{"description":"Onc orl&/orop ca 20 mlc feat","code_information":[{"code":"0296U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1950.0,"maximum":4869.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1950.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1989.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1969.5,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2008.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4869.15,"additional_payer_notes":"APC"}]}]},{"description":"Onc pan tum whl gen seq dna","code_information":[{"code":"0297U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2919.6,"maximum":7290.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2919.6,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2977.99,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2948.8,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3007.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7290.24,"additional_payer_notes":"APC"}]}]},{"description":"Onc pan tum whl trns seq rna","code_information":[{"code":"0298U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2919.6,"maximum":7290.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2919.6,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2977.99,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2948.8,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3007.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7290.24,"additional_payer_notes":"APC"}]}]},{"description":"Onc pan tum whl gen opt mapg","code_information":[{"code":"0299U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1863.22,"maximum":4652.46,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1863.22,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1900.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1881.85,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1919.12,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4652.46,"additional_payer_notes":"APC"}]}]},{"description":"Onc pan tum whl gen seq&opt","code_information":[{"code":"0300U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4183.13,"maximum":10445.28,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4183.13,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4266.79,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4224.96,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4308.62,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":10445.28,"additional_payer_notes":"APC"}]}]},{"description":"Iadna bartonella ddpcr","code_information":[{"code":"0301U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":262.72,"maximum":656.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":262.72,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":267.97,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":265.35,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":270.6,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":656.01,"additional_payer_notes":"APC"}]}]},{"description":"Iadna brtnla ddpcr flwg liq","code_information":[{"code":"0302U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":361.37,"maximum":902.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":361.37,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":368.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":364.98,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":372.21,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":902.34,"additional_payer_notes":"APC"}]}]},{"description":"Hem rbc ads whl bld hypoxic","code_information":[{"code":"0303U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2201.62,"maximum":5497.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2201.62,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2245.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2223.64,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2267.67,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":5497.45,"additional_payer_notes":"APC"}]}]},{"description":"Hem rbc ads whl bld normoxic","code_information":[{"code":"0304U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2075.8,"maximum":5183.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2075.8,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2117.32,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2096.56,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2138.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":5183.27,"additional_payer_notes":"APC"}]}]},{"description":"Hem rbc fnclty&dfrm shr strs","code_information":[{"code":"0305U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":662.58,"maximum":1654.46,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":662.58,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":675.83,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":669.21,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":682.46,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1654.46,"additional_payer_notes":"APC"}]}]},{"description":"Onc mrd nxt-gnrj alys 1st","code_information":[{"code":"0306U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3878.45,"maximum":9684.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3878.45,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3956.02,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3917.23,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3994.8,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":9684.49,"additional_payer_notes":"APC"}]}]},{"description":"Onc mrd nxt-gnrj alys sbsq","code_information":[{"code":"0307U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":794.49,"maximum":1983.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":794.49,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":810.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":802.43,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":818.32,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1983.84,"additional_payer_notes":"APC"}]}]},{"description":"Crd cad alys 3 prtn plsm alg","code_information":[{"code":"0308U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":390.75,"maximum":975.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":390.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":398.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":394.66,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":402.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":975.7,"additional_payer_notes":"APC"}]}]},{"description":"Crd cv ds aly 4 prtn plm alg","code_information":[{"code":"0309U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":390.75,"maximum":975.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":390.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":398.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":394.66,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":402.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":975.7,"additional_payer_notes":"APC"}]}]},{"description":"Ped vsclts kd alys 3 bmrks","code_information":[{"code":"0310U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":390.75,"maximum":975.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":390.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":398.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":394.66,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":402.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":975.7,"additional_payer_notes":"APC"}]}]},{"description":"Nfct ds bct quan antmcrb sc","code_information":[{"code":"0311U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":8.08,"maximum":20.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.08,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8.24,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8.16,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.32,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":20.18,"additional_payer_notes":"APC"}]}]},{"description":"Ai ds sle alys 8 igg autoant","code_information":[{"code":"0312U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":840.65,"maximum":2099.10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":840.65,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":857.46,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":849.06,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":865.87,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2099.1,"additional_payer_notes":"APC"}]}]},{"description":"Onc pncrs dna&mrna seq 74","code_information":[{"code":"0313U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3600.0,"maximum":8989.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3600.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3672.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3636.0,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3708.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8989.2,"additional_payer_notes":"APC"}]}]},{"description":"Onc cutan mlnma mrna 35 gene","code_information":[{"code":"0314U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1950.0,"maximum":4869.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1950.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1989.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1969.5,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2008.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4869.15,"additional_payer_notes":"APC"}]}]},{"description":"Onc cutan sq cll ca mrna 40","code_information":[{"code":"0315U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":8500.0,"maximum":21224.5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8500.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8670.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8585.0,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8755.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":21224.5,"additional_payer_notes":"APC"}]}]},{"description":"B brgdrferi lyme ds ospa evl","code_information":[{"code":"0316U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18.66,"maximum":46.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.85,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":46.59,"additional_payer_notes":"APC"}]}]},{"description":"Onc lung ca 4-prb fish assay","code_information":[{"code":"0317U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2030.0,"maximum":5068.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2030.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2070.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2050.3,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2090.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":5068.91,"additional_payer_notes":"APC"}]}]},{"description":"Ped whl gen mthyltn alys 50+","code_information":[{"code":"0318U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1770.48,"maximum":4420.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1770.48,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1805.89,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1788.18,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1823.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4420.89,"additional_payer_notes":"APC"}]}]},{"description":"Neph rna pretrnspl perph bld","code_information":[{"code":"0319U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2650.0,"maximum":6617.05,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2650.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2703.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2676.5,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2729.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":6617.05,"additional_payer_notes":"APC"}]}]},{"description":"Neph rna psttrnspl perph bld","code_information":[{"code":"0320U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2650.0,"maximum":6617.05,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2650.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2703.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2676.5,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2729.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":6617.05,"additional_payer_notes":"APC"}]}]},{"description":"Iadna gu pthgn 20bct&fng org","code_information":[{"code":"0321U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":634.84,"maximum":1585.20,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":634.84,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":647.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":641.19,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":653.89,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1585.2,"additional_payer_notes":"APC"}]}]},{"description":"Neuro asd meas 14 acyl carn","code_information":[{"code":"0322U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":750.0,"maximum":1872.75,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":750.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":765.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":757.5,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":772.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1872.75,"additional_payer_notes":"APC"}]}]},{"description":"Iadna cns pthgn next gen seq","code_information":[{"code":"0323U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2126.2,"maximum":5309.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2126.2,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2168.72,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2147.46,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2189.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":5309.12,"additional_payer_notes":"APC"}]}]},{"description":"Drug assay 120+ rx&metablt","code_information":[{"code":"0328U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":114.43,"maximum":285.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":114.43,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":116.72,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":115.57,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":117.86,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":285.73,"additional_payer_notes":"APC"}]}]},{"description":"Iadna vag pthgn panel 27 org","code_information":[{"code":"0330U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":416.78,"maximum":1040.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":416.78,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":425.12,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":420.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":429.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1040.7,"additional_payer_notes":"APC"}]}]},{"description":"Onc pan tum gen prflg 8 dna","code_information":[{"code":"0332U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1142.06,"maximum":2851.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1142.06,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1164.9,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1153.48,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1176.32,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2851.72,"additional_payer_notes":"APC"}]}]},{"description":"Onc lvr surveilanc hcc cfdna","code_information":[{"code":"0333U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":662.32,"maximum":1653.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":662.32,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":675.57,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":668.94,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":682.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1653.81,"additional_payer_notes":"APC"}]}]},{"description":"Onc sld orgn tgsa dna 84/+","code_information":[{"code":"0334U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3500.0,"maximum":8739.5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3500.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3570.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3535.0,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3605.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8739.5,"additional_payer_notes":"APC"}]}]},{"description":"Rare ds whl gen seq fetal","code_information":[{"code":"0335U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5224.6,"maximum":13045.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5224.6,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5329.09,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5276.85,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5381.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":13045.83,"additional_payer_notes":"APC"}]}]},{"description":"Rare ds whl gen seq bld/slv","code_information":[{"code":"0336U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2574.65,"maximum":6428.90,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2574.65,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2626.14,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2600.4,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2651.89,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":6428.9,"additional_payer_notes":"APC"}]}]},{"description":"Onc plsm cell do&myeloma id","code_information":[{"code":"0337U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2435.0,"maximum":6080.20,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2435.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2483.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2459.35,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2508.05,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":6080.2,"additional_payer_notes":"APC"}]}]},{"description":"Onc sld tum crcg tum cl slct","code_information":[{"code":"0338U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2435.0,"maximum":6080.20,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2435.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2483.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2459.35,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2508.05,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":6080.2,"additional_payer_notes":"APC"}]}]},{"description":"Onc prst8 mrna hoxc6 & dlx1","code_information":[{"code":"0339U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":760.0,"maximum":1897.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":760.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":775.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":767.6,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":782.8,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1897.72,"additional_payer_notes":"APC"}]}]},{"description":"Onc pan ca alys mrd plasma","code_information":[{"code":"0340U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3590.0,"maximum":8964.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3590.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3661.8,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3625.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3697.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8964.23,"additional_payer_notes":"APC"}]}]},{"description":"Ftl aneup dna seq cmpr alys","code_information":[{"code":"0341U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1900.2,"maximum":4744.80,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1900.2,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1938.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1919.2,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1957.21,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4744.8,"additional_payer_notes":"APC"}]}]},{"description":"Onc prst8 xom aly 442 sncrna","code_information":[{"code":"0343U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":760.0,"maximum":1897.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":760.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":775.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":767.6,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":782.8,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1897.72,"additional_payer_notes":"APC"}]}]},{"description":"Hep nafld semiq evl 28 lipid","code_information":[{"code":"0344U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":792.17,"maximum":1978.05,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":792.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":808.01,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":800.09,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":815.94,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1978.05,"additional_payer_notes":"APC"}]}]},{"description":"Psyc genom alys pnl 15 gen","code_information":[{"code":"0345U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1336.09,"maximum":3336.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1336.09,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1362.81,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1349.45,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1376.17,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3336.22,"additional_payer_notes":"APC"}]}]},{"description":"Rx metab/pcx dna 16 gen alys","code_information":[{"code":"0347U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1336.09,"maximum":3336.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1336.09,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1362.81,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1349.45,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1376.17,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3336.22,"additional_payer_notes":"APC"}]}]},{"description":"Rx metab/pcx dna 25 gen alys","code_information":[{"code":"0348U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":742.27,"maximum":1853.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":742.27,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":757.12,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":749.69,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":764.54,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1853.45,"additional_payer_notes":"APC"}]}]},{"description":"Rx metab/pcx dna 27gen rx ia","code_information":[{"code":"0349U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":742.27,"maximum":1853.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":742.27,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":757.12,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":749.69,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":764.54,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1853.45,"additional_payer_notes":"APC"}]}]},{"description":"Rx metab/pcx dna 27 gen alys","code_information":[{"code":"0350U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1336.09,"maximum":3336.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1336.09,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1362.81,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1349.45,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1376.17,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3336.22,"additional_payer_notes":"APC"}]}]},{"description":"Nfct ds bct/viral trail ip10","code_information":[{"code":"0351U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":260.5,"maximum":650.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":260.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":265.71,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":263.1,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":268.32,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":650.47,"additional_payer_notes":"APC"}]}]},{"description":"Apol1 risk variants","code_information":[{"code":"0355U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":137.0,"maximum":342.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":137.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":139.74,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":138.37,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":141.11,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":342.09,"additional_payer_notes":"APC"}]}]},{"description":"Onc orop 17 dna ddpcr alg","code_information":[{"code":"0356U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1800.0,"maximum":4494.6,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1800.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1836.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1818.0,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1854.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4494.6,"additional_payer_notes":"APC"}]}]},{"description":"Neuro alys b-amyl 1-42&1-40","code_information":[{"code":"0358U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":260.5,"maximum":650.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":260.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":265.71,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":263.1,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":268.32,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":650.47,"additional_payer_notes":"APC"}]}]},{"description":"Onc prst8 ca alys all psa","code_information":[{"code":"0359U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":760.0,"maximum":1897.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":760.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":775.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":767.6,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":782.8,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1897.72,"additional_payer_notes":"APC"}]}]},{"description":"Onc lung elisa 7 autoant alg","code_information":[{"code":"0360U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":840.65,"maximum":2099.10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":840.65,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":857.46,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":849.06,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":865.87,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2099.1,"additional_payer_notes":"APC"}]}]},{"description":"Onc pap thyr ca rna 82&10","code_information":[{"code":"0362U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3600.0,"maximum":8989.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3600.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3672.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3636.0,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3708.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8989.2,"additional_payer_notes":"APC"}]}]},{"description":"Onc urthl mrna 5 gen alg","code_information":[{"code":"0363U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":760.0,"maximum":1897.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":760.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":775.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":767.6,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":782.8,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1897.72,"additional_payer_notes":"APC"}]}]},{"description":"Onc hl neo gen seq alys alg","code_information":[{"code":"0364U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2007.25,"maximum":5012.10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2007.25,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2047.4,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2027.32,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2067.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":5012.1,"additional_payer_notes":"APC"}]}]},{"description":"Onc bldr 10 prb bldr ca","code_information":[{"code":"0365U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":897.0,"maximum":2239.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":897.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":914.94,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":905.97,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":923.91,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2239.81,"additional_payer_notes":"APC"}]}]},{"description":"Onc bldr 10 prb recr bldr ca","code_information":[{"code":"0366U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":897.0,"maximum":2239.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":897.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":914.94,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":905.97,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":923.91,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2239.81,"additional_payer_notes":"APC"}]}]},{"description":"Onc bldr 10 flwg trurl rescj","code_information":[{"code":"0367U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":902.18,"maximum":2252.74,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":902.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":920.22,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":911.2,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":929.25,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2252.74,"additional_payer_notes":"APC"}]}]},{"description":"Iadna gu pthgn semiq dna16&1","code_information":[{"code":"0371U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":416.78,"maximum":1040.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":416.78,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":425.12,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":420.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":429.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1040.7,"additional_payer_notes":"APC"}]}]},{"description":"Nfct ds gu pthgn arg detcj","code_information":[{"code":"0372U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":416.78,"maximum":1040.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":416.78,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":425.12,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":420.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":429.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1040.7,"additional_payer_notes":"APC"}]}]},{"description":"Onc ovrn bchm asy 7 prtn alg","code_information":[{"code":"0375U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":897.0,"maximum":2239.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":897.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":914.94,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":905.97,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":923.91,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2239.81,"additional_payer_notes":"APC"}]}]},{"description":"Onc prst8 ca img alys 128","code_information":[{"code":"0376U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":706.25,"maximum":1763.51,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":706.25,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":720.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":713.31,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":727.44,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1763.51,"additional_payer_notes":"APC"}]}]},{"description":"Cv ds quan advsrm/plsm lprtn","code_information":[{"code":"0377U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":47.58,"maximum":118.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":47.58,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":48.53,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":48.06,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":49.01,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":118.81,"additional_payer_notes":"APC"}]}]},{"description":"Rfc1 repeat xpnsj vrnt alys","code_information":[{"code":"0378U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":137.0,"maximum":342.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":137.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":139.74,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":138.37,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":141.11,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":342.09,"additional_payer_notes":"APC"}]}]},{"description":"Tgsap sl or neo dna523&rna55","code_information":[{"code":"0379U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3288.51,"maximum":8211.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3288.51,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3354.28,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3321.4,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3387.17,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8211.41,"additional_payer_notes":"APC"}]}]},{"description":"Maple syrup ur ds mntr quan","code_information":[{"code":"0381U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":44.12,"maximum":110.17,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":44.12,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":45.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":44.56,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":45.44,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":110.17,"additional_payer_notes":"APC"}]}]},{"description":"Hyprphenylalninmia mntr quan","code_information":[{"code":"0382U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":51.64,"maximum":128.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":51.64,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":52.67,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":52.16,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":53.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":128.95,"additional_payer_notes":"APC"}]}]},{"description":"Tyrosinemia typ i mntr quan","code_information":[{"code":"0383U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":52.05,"maximum":129.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":52.05,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":53.09,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":52.57,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":53.61,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":129.97,"additional_payer_notes":"APC"}]}]},{"description":"Neph ckd rsk hi stg kdn ds","code_information":[{"code":"0384U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":750.0,"maximum":1872.75,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":750.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":765.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":757.5,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":772.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1872.75,"additional_payer_notes":"APC"}]}]},{"description":"Neph ckd alg rsk dbtc kdn ds","code_information":[{"code":"0385U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":390.75,"maximum":975.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":390.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":398.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":394.66,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":402.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":975.7,"additional_payer_notes":"APC"}]}]},{"description":"Onc mlnma ambra1&amlo","code_information":[{"code":"0387U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":948.5,"maximum":2368.40,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":948.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":967.47,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":957.98,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":976.96,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2368.4,"additional_payer_notes":"APC"}]}]},{"description":"Onc nonsm cll lng ca 37 gen","code_information":[{"code":"0388U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3500.0,"maximum":8739.5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3500.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3570.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3535.0,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3605.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8739.5,"additional_payer_notes":"APC"}]}]},{"description":"Ped fbrl kd ifi27&mcemp1 rna","code_information":[{"code":"0389U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":70.2,"maximum":175.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":70.2,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":71.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":70.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":72.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":175.29,"additional_payer_notes":"APC"}]}]},{"description":"Ob pe kdr eng&rbp4 ia alg","code_information":[{"code":"0390U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":64.41,"maximum":160.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":64.41,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":65.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":65.05,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":66.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":160.83,"additional_payer_notes":"APC"}]}]},{"description":"Onc sld tum dna&rna 437 gen","code_information":[{"code":"0391U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3600.0,"maximum":8989.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3600.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3672.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3636.0,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3708.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8989.2,"additional_payer_notes":"APC"}]}]},{"description":"Rx metab genrx ia 16 genes","code_information":[{"code":"0392U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1336.09,"maximum":3336.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1336.09,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1362.81,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1349.45,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1376.17,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3336.22,"additional_payer_notes":"APC"}]}]},{"description":"Neu prksn msfl ?-syncln prtn","code_information":[{"code":"0393U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":540.99,"maximum":1350.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":540.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":551.81,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":546.4,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":557.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1350.85,"additional_payer_notes":"APC"}]}]},{"description":"Pfas 16 pfas compnd lc ms/ms","code_information":[{"code":"0394U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":198.74,"maximum":496.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":198.74,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":202.71,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":200.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":204.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":496.25,"additional_payer_notes":"APC"}]}]},{"description":"Onc lng multiomics plsm alg","code_information":[{"code":"0395U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":797.45,"maximum":1991.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":797.45,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":813.4,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":805.42,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":821.37,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1991.23,"additional_payer_notes":"APC"}]}]},{"description":"Gi baret esph dna mthyln aly","code_information":[{"code":"0398U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1755.0,"maximum":4382.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1755.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1790.1,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1772.55,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1807.65,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4382.23,"additional_payer_notes":"APC"}]}]},{"description":"Neuro cere folate defncy srm","code_information":[{"code":"0399U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":300.0,"maximum":749.1,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":300.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":306.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":303.0,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":309.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":749.1,"additional_payer_notes":"APC"}]}]},{"description":"Crd c hrt ds 9 gen 12 vrnts","code_information":[{"code":"0401U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":489.68,"maximum":1222.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":489.68,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":499.47,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":494.58,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":504.37,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1222.73,"additional_payer_notes":"APC"}]}]},{"description":"Nfct agt sti mult amp prb tq","code_information":[{"code":"0402U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":142.63,"maximum":356.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":142.63,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":145.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":144.06,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":146.91,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":356.15,"additional_payer_notes":"APC"}]}]},{"description":"Onc prst8 mrna 18 gen dre ur","code_information":[{"code":"0403U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":760.0,"maximum":1897.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":760.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":775.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":767.6,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":782.8,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1897.72,"additional_payer_notes":"APC"}]}]},{"description":"Onc brst semiq meas thym kn","code_information":[{"code":"0404U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":322.96,"maximum":806.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":322.96,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":329.42,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":326.19,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":332.65,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":806.43,"additional_payer_notes":"APC"}]}]},{"description":"Onc pncrtc 59 mthltn blk mrk","code_information":[{"code":"0405U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1770.48,"maximum":4420.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1770.48,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1805.89,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1788.18,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1823.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4420.89,"additional_payer_notes":"APC"}]}]},{"description":"Onc lung flow cytmtry 5 mrk","code_information":[{"code":"0406U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":760.0,"maximum":1897.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":760.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":775.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":767.6,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":782.8,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1897.72,"additional_payer_notes":"APC"}]}]},{"description":"Neph dbtc ckd mult eclia alg","code_information":[{"code":"0407U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":950.0,"maximum":2372.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":950.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":969.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":959.5,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":978.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2372.15,"additional_payer_notes":"APC"}]}]},{"description":"Iaad blk ac wv bsnsr sarscv2","code_information":[{"code":"0408U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14.13,"maximum":35.28,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.13,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.41,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.27,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.55,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":35.28,"additional_payer_notes":"APC"}]}]},{"description":"Onc sld tum dna 80 & rna 36","code_information":[{"code":"0409U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2919.6,"maximum":7290.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2919.6,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2977.99,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2948.8,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3007.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7290.24,"additional_payer_notes":"APC"}]}]},{"description":"Onc pncrtc dna whl gn seq 5-","code_information":[{"code":"0410U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1160.0,"maximum":2896.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1160.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1183.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1171.6,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1194.8,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2896.52,"additional_payer_notes":"APC"}]}]},{"description":"Psyc genom alys pnl 15 gen","code_information":[{"code":"0411U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1336.09,"maximum":3336.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1336.09,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1362.81,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1349.45,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1376.17,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3336.22,"additional_payer_notes":"APC"}]}]},{"description":"Beta amyloid a?42/40 imprcip","code_information":[{"code":"0412U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":750.0,"maximum":1872.75,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":750.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":765.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":757.5,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":772.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1872.75,"additional_payer_notes":"APC"}]}]},{"description":"Onc hl neo opt gen mapg dna","code_information":[{"code":"0413U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1263.53,"maximum":3155.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1263.53,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1288.8,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1276.17,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1301.44,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3155.03,"additional_payer_notes":"APC"}]}]},{"description":"Onc lng aug alg aly whl sld8","code_information":[{"code":"0414U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":706.25,"maximum":1763.51,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":706.25,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":720.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":713.31,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":727.44,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1763.51,"additional_payer_notes":"APC"}]}]},{"description":"Cv ds acs bld alg 5 yr score","code_information":[{"code":"0415U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":390.75,"maximum":975.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":390.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":398.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":394.66,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":402.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":975.7,"additional_payer_notes":"APC"}]}]},{"description":"Rare ds alys 335 nuc genes","code_information":[{"code":"0417U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2842.53,"maximum":7097.80,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2842.53,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2899.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2870.96,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2927.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7097.8,"additional_payer_notes":"APC"}]}]},{"description":"Onc brst aug alg aly whl sl8","code_information":[{"code":"0418U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":706.25,"maximum":1763.51,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":706.25,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":720.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":713.31,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":727.44,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1763.51,"additional_payer_notes":"APC"}]}]},{"description":"Nrpsyc gen seq vrnt aly 13","code_information":[{"code":"0419U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1336.09,"maximum":3336.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1336.09,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1362.81,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1349.45,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1376.17,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3336.22,"additional_payer_notes":"APC"}]}]},{"description":"Onc urthl mrna xprsn 6 snp","code_information":[{"code":"0420U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1328.32,"maximum":3316.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1328.32,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1354.89,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1341.6,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1368.17,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3316.82,"additional_payer_notes":"APC"}]}]},{"description":"Onc pan solid tum alys dna","code_information":[{"code":"0422U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1943.21,"maximum":4852.20,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1943.21,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1982.07,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1962.64,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2001.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4852.2,"additional_payer_notes":"APC"}]}]},{"description":"Psyc genomic alys pnl 26 gen","code_information":[{"code":"0423U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":416.78,"maximum":1040.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":416.78,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":425.12,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":420.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":429.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1040.7,"additional_payer_notes":"APC"}]}]},{"description":"Onc prst8 xom alys 53 sncrna","code_information":[{"code":"0424U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":760.0,"maximum":1897.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":760.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":775.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":767.6,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":782.8,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1897.72,"additional_payer_notes":"APC"}]}]},{"description":"Genom rpd seq alys ea cmprtr","code_information":[{"code":"0425U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4094.39,"maximum":10223.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4094.39,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4176.28,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4135.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4217.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":10223.69,"additional_payer_notes":"APC"}]}]},{"description":"Genome ultra-rapid seq alys","code_information":[{"code":"0426U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7582.2,"maximum":18932.75,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7582.2,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7733.84,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7658.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7809.67,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":18932.75,"additional_payer_notes":"APC"}]}]},{"description":"Monocyte dstrbj wdth whl bld","code_information":[{"code":"0427U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.48,"maximum":11.19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.48,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4.57,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4.52,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.61,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":11.19,"additional_payer_notes":"APC"}]}]},{"description":"Hpv orop swab 14 hi-risk typ","code_information":[{"code":"0429U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.09,"maximum":87.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.09,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35.79,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.14,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":87.62,"additional_payer_notes":"APC"}]}]},{"description":"Gi malabs aat calpro pncrtc","code_information":[{"code":"0430U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":61.54,"maximum":153.67,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":61.54,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":62.77,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":62.16,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":63.39,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":153.67,"additional_payer_notes":"APC"}]}]},{"description":"Gly rcptr alpha1 igg srm/csf","code_information":[{"code":"0431U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":36.57,"maximum":91.32,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.57,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37.3,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.94,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":37.67,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":91.32,"additional_payer_notes":"APC"}]}]},{"description":"Klhl11 antb sr/csf asy qual","code_information":[{"code":"0432U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":36.57,"maximum":91.32,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.57,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37.3,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.94,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":37.67,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":91.32,"additional_payer_notes":"APC"}]}]},{"description":"Onc prst8 5 dna reg mrk pcr","code_information":[{"code":"0433U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":760.0,"maximum":1897.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":760.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":775.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":767.6,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":782.8,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1897.72,"additional_payer_notes":"APC"}]}]},{"description":"Rx metab advrs vrnt alys 25","code_information":[{"code":"0434U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":416.78,"maximum":1040.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":416.78,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":425.12,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":420.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":429.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1040.7,"additional_payer_notes":"APC"}]}]},{"description":"Onc chemo rx cytox csc 14 rx","code_information":[{"code":"0435U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3033.86,"maximum":7575.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3033.86,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3094.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3064.2,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3124.88,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7575.55,"additional_payer_notes":"APC"}]}]},{"description":"Onc lng plsm alys 388 prtn","code_information":[{"code":"0436U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1504.24,"maximum":3756.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1504.24,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1534.32,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1519.28,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1549.37,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3756.09,"additional_payer_notes":"APC"}]}]},{"description":"Psyc anxiety do mrna 15 bmrk","code_information":[{"code":"0437U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":760.0,"maximum":1897.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":760.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":775.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":767.6,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":782.8,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1897.72,"additional_payer_notes":"APC"}]}]},{"description":"Rx metab advrs vrnt alys 33","code_information":[{"code":"0438U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":416.78,"maximum":1040.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":416.78,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":425.12,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":420.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":429.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1040.7,"additional_payer_notes":"APC"}]}]},{"description":"Crd chd dna alys 5 snp 3 dna","code_information":[{"code":"0439U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":854.0,"maximum":2132.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":854.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":871.08,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":862.54,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":879.62,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2132.44,"additional_payer_notes":"APC"}]}]},{"description":"Crd chd dna alys 10 snp 6dna","code_information":[{"code":"0440U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":854.0,"maximum":2132.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":854.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":871.08,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":862.54,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":879.62,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2132.44,"additional_payer_notes":"APC"}]}]},{"description":"Nfct ds bct fngl/viral semiq","code_information":[{"code":"0441U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":444.08,"maximum":1108.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":444.08,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":452.96,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":448.52,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":457.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1108.87,"additional_payer_notes":"APC"}]}]},{"description":"Nfct ds respir nfctj mxa&crp","code_information":[{"code":"0442U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":41.38,"maximum":103.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":41.38,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":42.21,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":41.79,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":42.62,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":103.33,"additional_payer_notes":"APC"}]}]},{"description":"Neurflmnt lt chn ultrsens ia","code_information":[{"code":"0443U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":116.23,"maximum":290.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":116.23,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":118.55,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":117.39,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":119.72,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":290.23,"additional_payer_notes":"APC"}]}]},{"description":"Onc sld orgn neo tgsap 361","code_information":[{"code":"0444U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2919.6,"maximum":7290.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2919.6,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2977.99,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2948.8,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3007.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7290.24,"additional_payer_notes":"APC"}]}]},{"description":"Abeta42 & ptau181 eclia csf","code_information":[{"code":"0445U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":260.5,"maximum":650.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":260.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":265.71,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":263.1,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":268.32,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":650.47,"additional_payer_notes":"APC"}]}]},{"description":"Ai ds sle alys 10 cytokine","code_information":[{"code":"0446U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":840.65,"maximum":2099.10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":840.65,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":857.46,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":849.06,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":865.87,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2099.1,"additional_payer_notes":"APC"}]}]},{"description":"Ai ds sle alys 11 cytokine","code_information":[{"code":"0447U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":840.65,"maximum":2099.10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":840.65,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":857.46,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":849.06,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":865.87,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2099.1,"additional_payer_notes":"APC"}]}]},{"description":"Onc bldr mthyl penk lte-qmsp","code_information":[{"code":"0452U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":192.0,"maximum":479.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":192.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":195.84,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":193.92,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":197.76,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":479.42,"additional_payer_notes":"APC"}]}]},{"description":"Onc clrct ca cfdna qpcr asy","code_information":[{"code":"0453U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":192.0,"maximum":479.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":192.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":195.84,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":193.92,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":197.76,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":479.42,"additional_payer_notes":"APC"}]}]},{"description":"U rare ds id opt genome mapg","code_information":[{"code":"0454U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1263.53,"maximum":3155.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1263.53,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1288.8,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1276.17,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1301.44,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3155.03,"additional_payer_notes":"APC"}]}]},{"description":"Nfct agt sti mult amp prb ur","code_information":[{"code":"0455U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":142.63,"maximum":356.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":142.63,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":145.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":144.06,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":146.91,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":356.15,"additional_payer_notes":"APC"}]}]},{"description":"Pfas 9 cmpnd lcms/ms pls/sr","code_information":[{"code":"0457U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":198.74,"maximum":496.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":198.74,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":202.71,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":200.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":204.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":496.25,"additional_payer_notes":"APC"}]}]},{"description":"Onc brst ca s100 a8&a9 elisa","code_information":[{"code":"0458U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":260.5,"maximum":650.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":260.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":265.71,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":263.1,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":268.32,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":650.47,"additional_payer_notes":"APC"}]}]},{"description":"Abeta42 & ttau eclia csf","code_information":[{"code":"0459U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":260.5,"maximum":650.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":260.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":265.71,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":263.1,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":268.32,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":650.47,"additional_payer_notes":"APC"}]}]},{"description":"Onc whl bld/bucc rtpcr 24gen","code_information":[{"code":"0460U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":917.08,"maximum":2289.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":917.08,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":935.42,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":926.25,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":944.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2289.95,"additional_payer_notes":"APC"}]}]},{"description":"Onc rxgenom alys rtpcr 24gen","code_information":[{"code":"0461U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":917.08,"maximum":2289.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":917.08,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":935.42,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":926.25,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":944.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2289.95,"additional_payer_notes":"APC"}]}]},{"description":"Melatonin lvl tst slp std7/9","code_information":[{"code":"0462U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.27,"maximum":43.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.27,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17.62,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.79,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":43.12,"additional_payer_notes":"APC"}]}]},{"description":"Onc crvx mrna genxprsn 14bmk","code_information":[{"code":"0463U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":760.0,"maximum":1897.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":760.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":775.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":767.6,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":782.8,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1897.72,"additional_payer_notes":"APC"}]}]},{"description":"Onc clrct scr qrtsa dna mrk","code_information":[{"code":"0464U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":591.92,"maximum":1478.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":591.92,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":603.76,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":597.84,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":609.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1478.02,"additional_payer_notes":"APC"}]}]},{"description":"Onc urthl carc dna qmsp 2gen","code_information":[{"code":"0465U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1938.01,"maximum":4839.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1938.01,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1976.77,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1957.39,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1996.15,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4839.21,"additional_payer_notes":"APC"}]}]},{"description":"Crd cad dna gwas 564856 snp","code_information":[{"code":"0466U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":345.43,"maximum":862.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":345.43,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":352.34,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":348.88,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":355.79,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":862.54,"additional_payer_notes":"APC"}]}]},{"description":"Onc bldr dna ngs 60gen&aneup","code_information":[{"code":"0467U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1519.06,"maximum":3793.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1519.06,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1549.44,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1534.25,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1564.63,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3793.09,"additional_payer_notes":"APC"}]}]},{"description":"Hep nash mir34a5p ?2m ykl40","code_information":[{"code":"0468U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":251.7,"maximum":628.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":251.7,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":256.73,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":254.22,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":259.25,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":628.49,"additional_payer_notes":"APC"}]}]},{"description":"Rare ds whl gen seq ftl samp","code_information":[{"code":"0469U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1197.94,"maximum":2991.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1197.94,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1221.9,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1209.92,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1233.88,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2991.26,"additional_payer_notes":"APC"}]}]},{"description":"Onc orop detcj mrd 8 dna hpv","code_information":[{"code":"0470U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":597.91,"maximum":1492.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":597.91,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":609.87,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":603.89,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":615.85,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1492.98,"additional_payer_notes":"APC"}]}]},{"description":"Onc clrc ca 35 vrn kras&nras","code_information":[{"code":"0471U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":760.0,"maximum":1897.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":760.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":775.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":767.6,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":782.8,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1897.72,"additional_payer_notes":"APC"}]}]},{"description":"Ca vi psp&sp1 antb sj?gren","code_information":[{"code":"0472U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":27.9,"maximum":69.67,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27.9,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28.46,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28.18,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":69.67,"additional_payer_notes":"APC"}]}]},{"description":"Onc sld tum bld/slv 648 gene","code_information":[{"code":"0473U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4500.0,"maximum":11236.5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4500.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4590.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4545.0,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4635.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":11236.5,"additional_payer_notes":"APC"}]}]},{"description":"Hered pan ca gsap 88gene ngs","code_information":[{"code":"0474U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1303.95,"maximum":3255.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1303.95,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1330.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1316.99,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1343.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3255.96,"additional_payer_notes":"APC"}]}]},{"description":"Hered prst8 ca gsap 23 genes","code_information":[{"code":"0475U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1303.95,"maximum":3255.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1303.95,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1330.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1316.99,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1343.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3255.96,"additional_payer_notes":"APC"}]}]},{"description":"Rx metab psyc 14gen&cyp2d6","code_information":[{"code":"0476U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":416.78,"maximum":1040.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":416.78,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":425.12,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":420.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":429.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1040.7,"additional_payer_notes":"APC"}]}]},{"description":"Rx metab psy 14&cyp2d6 gn-rx","code_information":[{"code":"0477U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":416.78,"maximum":1040.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":416.78,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":425.12,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":420.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":429.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1040.7,"additional_payer_notes":"APC"}]}]},{"description":"Onc nsclc dna&rna dpcr 9 gen","code_information":[{"code":"0478U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":552.99,"maximum":1380.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":552.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":564.05,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":558.52,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":569.58,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1380.82,"additional_payer_notes":"APC"}]}]},{"description":"Tau phosphorylated ptau217","code_information":[{"code":"0479U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.27,"maximum":43.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.27,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17.62,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.79,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":43.12,"additional_payer_notes":"APC"}]}]},{"description":"Nfct ds csf metag ngs alys","code_information":[{"code":"0480U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2126.2,"maximum":5309.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2126.2,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2168.72,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2147.46,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2189.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":5309.12,"additional_payer_notes":"APC"}]}]},{"description":"Idh1 idh2&tert promoter ngs","code_information":[{"code":"0481U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":674.24,"maximum":1683.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":674.24,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":687.72,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":680.98,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":694.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1683.58,"additional_payer_notes":"APC"}]}]},{"description":"Ob pe biochem asy sfit1&pigf","code_information":[{"code":"0482U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":128.82,"maximum":321.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":128.82,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":131.4,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":130.11,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":132.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":321.66,"additional_payer_notes":"APC"}]}]},{"description":"Nfct ds ng gyra s91f pt mut","code_information":[{"code":"0483U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.09,"maximum":87.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.09,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35.79,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.14,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":87.62,"additional_payer_notes":"APC"}]}]},{"description":"Nfct ds mgen 23s rrna pt mut","code_information":[{"code":"0484U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.09,"maximum":87.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.09,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35.79,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.14,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":87.62,"additional_payer_notes":"APC"}]}]},{"description":"Onc sol tum cfdna&rna ngs gm","code_information":[{"code":"0485U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3649.48,"maximum":9112.75,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3649.48,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3722.47,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3685.97,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3758.96,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":9112.75,"additional_payer_notes":"APC"}]}]},{"description":"Onc pan sol tum ngs cfctdna","code_information":[{"code":"0486U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1644.25,"maximum":4105.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1644.25,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1677.14,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1660.69,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1693.58,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4105.69,"additional_payer_notes":"APC"}]}]},{"description":"Onc sol tum cfcdna tgsap 84","code_information":[{"code":"0487U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2919.6,"maximum":7290.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2919.6,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2977.99,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2948.8,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3007.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7290.24,"additional_payer_notes":"APC"}]}]},{"description":"Onc cutan/uveal mlnma cd146","code_information":[{"code":"0490U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2435.0,"maximum":6080.20,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2435.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2483.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2459.35,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2508.05,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":6080.2,"additional_payer_notes":"APC"}]}]},{"description":"Onc sol tum ctc slct er prtn","code_information":[{"code":"0491U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2435.0,"maximum":6080.20,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2435.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2483.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2459.35,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2508.05,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":6080.2,"additional_payer_notes":"APC"}]}]},{"description":"Onc sol tum ctc slctn pd-l1","code_information":[{"code":"0492U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2435.0,"maximum":6080.20,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2435.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2483.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2459.35,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2508.05,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":6080.2,"additional_payer_notes":"APC"}]}]},{"description":"Trnspl med quan dd-cfdna ngs","code_information":[{"code":"0493U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2753.25,"maximum":6874.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2753.25,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2808.32,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2780.78,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2835.85,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":6874.87,"additional_payer_notes":"APC"}]}]},{"description":"Rbc ag ftl rhd gene alys ngs","code_information":[{"code":"0494U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":759.05,"maximum":1895.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":759.05,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":774.23,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":766.64,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":781.82,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1895.35,"additional_payer_notes":"APC"}]}]},{"description":"Onc prst8 alys crcg plsm prt","code_information":[{"code":"0495U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":760.0,"maximum":1897.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":760.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":775.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":767.6,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":782.8,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1897.72,"additional_payer_notes":"APC"}]}]},{"description":"Onc clrct cfdna 8/7 genes","code_information":[{"code":"0496U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":485.86,"maximum":1213.19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":485.86,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":495.58,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":490.72,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":500.44,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1213.19,"additional_payer_notes":"APC"}]}]},{"description":"Onc prst8 mrna rt-pcr 6 gene","code_information":[{"code":"0497U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3873.0,"maximum":9670.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3873.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3950.46,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3911.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3989.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":9670.88,"additional_payer_notes":"APC"}]}]},{"description":"Onc clrct ngs mut detc 43gen","code_information":[{"code":"0498U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1345.31,"maximum":3359.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1345.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1372.22,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1358.76,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1385.67,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3359.24,"additional_payer_notes":"APC"}]}]},{"description":"Onc clrct&lng dna ngs 8gene","code_information":[{"code":"0499U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":597.91,"maximum":1492.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":597.91,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":609.87,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":603.89,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":615.85,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1492.98,"additional_payer_notes":"APC"}]}]},{"description":"Autoinflam ds vexas synd dna","code_information":[{"code":"0500U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":175.4,"maximum":437.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":175.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":178.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":177.15,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":180.66,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":437.97,"additional_payer_notes":"APC"}]}]},{"description":"Hpv e6/e7 mrk hi-rsk typ crv","code_information":[{"code":"0502U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.09,"maximum":87.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.09,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35.79,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.14,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":87.62,"additional_payer_notes":"APC"}]}]},{"description":"Neuro alz ds ?amyl&tau prtn","code_information":[{"code":"0503U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":750.0,"maximum":1872.75,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":750.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":765.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":757.5,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":772.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1872.75,"additional_payer_notes":"APC"}]}]},{"description":"Nfct ds uti id 17 path orgs","code_information":[{"code":"0504U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":416.78,"maximum":1040.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":416.78,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":425.12,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":420.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":429.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1040.7,"additional_payer_notes":"APC"}]}]},{"description":"Nfct ds vag infctj id 32orgs","code_information":[{"code":"0505U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":679.77,"maximum":1697.39,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":679.77,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":693.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":686.57,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":700.16,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1697.39,"additional_payer_notes":"APC"}]}]},{"description":"Gi barretts esophgl cell 89","code_information":[{"code":"0506U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1938.01,"maximum":4839.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1938.01,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1976.77,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1957.39,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1996.15,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4839.21,"additional_payer_notes":"APC"}]}]},{"description":"Onc ovr dna whole gen w/5hmc","code_information":[{"code":"0507U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1160.0,"maximum":2896.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1160.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1183.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1171.6,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1194.8,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2896.52,"additional_payer_notes":"APC"}]}]},{"description":"Onc pncrtc ca alg alys 16gen","code_information":[{"code":"0510U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":473.91,"maximum":1183.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":473.91,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":483.39,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":478.65,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":488.13,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1183.35,"additional_payer_notes":"APC"}]}]},{"description":"Onc sol tum 3dmicroenvir 36+","code_information":[{"code":"0511U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3033.86,"maximum":7575.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3033.86,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3094.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3064.2,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3124.88,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7575.55,"additional_payer_notes":"APC"}]}]},{"description":"Onc prst8 alys dgtz img msi","code_information":[{"code":"0512U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":706.25,"maximum":1763.51,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":706.25,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":720.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":713.31,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":727.44,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1763.51,"additional_payer_notes":"APC"}]}]},{"description":"Onc prst8 alg alys msi&hrd","code_information":[{"code":"0513U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":706.25,"maximum":1763.51,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":706.25,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":720.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":713.31,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":727.44,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1763.51,"additional_payer_notes":"APC"}]}]},{"description":"Gi ibd ia quan deter adl lvl","code_information":[{"code":"0514U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":38.57,"maximum":96.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":38.57,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39.34,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38.96,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":39.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":96.31,"additional_payer_notes":"APC"}]}]},{"description":"Gi ibd ia quan deter ifx lvl","code_information":[{"code":"0515U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":38.57,"maximum":96.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":38.57,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39.34,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38.96,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":39.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":96.31,"additional_payer_notes":"APC"}]}]},{"description":"Rx metab rxgenomic gnotyp 40","code_information":[{"code":"0516U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":416.78,"maximum":1040.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":416.78,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":425.12,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":420.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":429.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1040.7,"additional_payer_notes":"APC"}]}]},{"description":"Ther rx mntr 80+ psyactiv rx","code_information":[{"code":"0517U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":246.92,"maximum":616.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":246.92,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":251.86,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":249.39,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":254.33,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":616.56,"additional_payer_notes":"APC"}]}]},{"description":"Ther rx mntr 90+ pn&mtl hlth","code_information":[{"code":"0518U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":246.92,"maximum":616.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":246.92,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":251.86,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":249.39,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":254.33,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":616.56,"additional_payer_notes":"APC"}]}]},{"description":"Ther rx mntr meds p/d/a 110+","code_information":[{"code":"0519U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":246.92,"maximum":616.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":246.92,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":251.86,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":249.39,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":254.33,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":616.56,"additional_payer_notes":"APC"}]}]},{"description":"Ther rx mntr 200+ rx/sbsts","code_information":[{"code":"0520U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":246.92,"maximum":616.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":246.92,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":251.86,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":249.39,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":254.33,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":616.56,"additional_payer_notes":"APC"}]}]},{"description":"Rf iga&igm ccp antb sr-a ia","code_information":[{"code":"0521U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":51.8,"maximum":129.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":51.8,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":52.84,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":52.32,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":53.35,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":129.34,"additional_payer_notes":"APC"}]}]},{"description":"Ca vi psp&sp1 antb cl semiql","code_information":[{"code":"0522U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":260.5,"maximum":650.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":260.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":265.71,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":263.1,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":268.32,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":650.47,"additional_payer_notes":"APC"}]}]},{"description":"Onc soltum dna ngs snv 22gen","code_information":[{"code":"0523U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1352.09,"maximum":3376.17,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1352.09,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1379.13,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1365.61,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1392.65,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3376.17,"additional_payer_notes":"APC"}]}]},{"description":"Ob pe sflt-1/plgf ia srm/pls","code_information":[{"code":"0524U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":128.82,"maximum":321.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":128.82,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":131.4,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":130.11,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":132.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":321.66,"additional_payer_notes":"APC"}]}]},{"description":"Onc sphrd cell cul 11-rx pnl","code_information":[{"code":"0525U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3033.86,"maximum":7575.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3033.86,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3094.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3064.2,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3124.88,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7575.55,"additional_payer_notes":"APC"}]}]},{"description":"Hsv 1&2 vzv amp prb tq pthgn","code_information":[{"code":"0527U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":142.63,"maximum":356.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":142.63,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":145.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":144.06,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":146.91,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":356.15,"additional_payer_notes":"APC"}]}]},{"description":"Lrt iad 18bct/8vir&7arg rna","code_information":[{"code":"0528U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":634.84,"maximum":1585.20,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":634.84,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":647.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":641.19,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":653.89,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1585.2,"additional_payer_notes":"APC"}]}]},{"description":"Onc pan-sol tum ctdna 77 gen","code_information":[{"code":"0530U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2919.6,"maximum":7290.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2919.6,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2977.99,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2948.8,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3007.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7290.24,"additional_payer_notes":"APC"}]}]},{"description":"Rare ds whlgen&mitochdrl dna","code_information":[{"code":"0532U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5031.2,"maximum":12562.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5031.2,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5131.82,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5081.51,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5182.14,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":12562.91,"additional_payer_notes":"APC"}]}]},{"description":"Rx metab advrs gnotyp 16gens","code_information":[{"code":"0533U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":416.78,"maximum":1040.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":416.78,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":425.12,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":420.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":429.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1040.7,"additional_payer_notes":"APC"}]}]},{"description":"Pfas lc-ms/ms plsm/srm quan","code_information":[{"code":"0535U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":62.14,"maximum":155.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":62.14,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":63.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":62.76,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":64.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":155.16,"additional_payer_notes":"APC"}]}]},{"description":"Rbcag ftl rhd pcr alys exon4","code_information":[{"code":"0536U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":192.0,"maximum":479.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":192.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":195.84,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":193.92,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":197.76,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":479.42,"additional_payer_notes":"APC"}]}]},{"description":"Onc clrct ca cfdna >2500 dmr","code_information":[{"code":"0537U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1495.0,"maximum":3733.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1495.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1524.9,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1509.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1539.85,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3733.02,"additional_payer_notes":"APC"}]}]},{"description":"Onc sol tum ngts ffpe 600gen","code_information":[{"code":"0538U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2989.55,"maximum":7464.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2989.55,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3049.34,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3019.45,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3079.24,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7464.91,"additional_payer_notes":"APC"}]}]},{"description":"Onc sol tumor cfctdna 152gen","code_information":[{"code":"0539U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3288.51,"maximum":8211.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3288.51,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3354.28,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3321.4,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3387.17,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8211.41,"additional_payer_notes":"APC"}]}]},{"description":"Trnsplj med quan dd-cfdna","code_information":[{"code":"0540U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2753.25,"maximum":6874.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2753.25,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2808.32,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2780.78,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2835.85,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":6874.87,"additional_payer_notes":"APC"}]}]},{"description":"Onc sol tum ngs dna 517 gens","code_information":[{"code":"0543U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2989.55,"maximum":7464.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2989.55,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3049.34,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3019.45,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3079.24,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7464.91,"additional_payer_notes":"APC"}]}]},{"description":"Achr antb id imfluor livecll","code_information":[{"code":"0545U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":37.73,"maximum":94.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":37.73,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38.11,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":38.86,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":94.21,"additional_payer_notes":"APC"}]}]},{"description":"Ldns lrp4 antb imflr livecll","code_information":[{"code":"0546U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":37.73,"maximum":94.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":37.73,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38.11,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":38.86,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":94.21,"additional_payer_notes":"APC"}]}]},{"description":"Neurflmnt lt chn cleia plsm","code_information":[{"code":"0547U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":116.23,"maximum":290.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":116.23,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":118.55,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":117.39,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":119.72,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":290.23,"additional_payer_notes":"APC"}]}]},{"description":"Gfap cleia plasma","code_information":[{"code":"0548U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":116.23,"maximum":290.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":116.23,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":118.55,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":117.39,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":119.72,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":290.23,"additional_payer_notes":"APC"}]}]},{"description":"Onc urthl dna mthyltd rt pcr","code_information":[{"code":"0549U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":760.0,"maximum":1897.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":760.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":775.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":767.6,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":782.8,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1897.72,"additional_payer_notes":"APC"}]}]},{"description":"Repr med pga embry te strux","code_information":[{"code":"0553U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":759.05,"maximum":1895.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":759.05,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":774.23,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":766.64,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":781.82,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1895.35,"additional_payer_notes":"APC"}]}]},{"description":"Repr med pga 24chrm te bx qc","code_information":[{"code":"0554U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":759.05,"maximum":1895.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":759.05,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":774.23,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":766.64,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":781.82,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1895.35,"additional_payer_notes":"APC"}]}]},{"description":"Repr med pga embryonic te qc","code_information":[{"code":"0555U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":759.05,"maximum":1895.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":759.05,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":774.23,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":766.64,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":781.82,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1895.35,"additional_payer_notes":"APC"}]}]},{"description":"Nfct ds p-s dna&rna 12 trgts","code_information":[{"code":"0556U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":142.63,"maximum":356.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":142.63,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":145.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":144.06,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":146.91,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":356.15,"additional_payer_notes":"APC"}]}]},{"description":"Nfct ds bv dna mrk vag fluid","code_information":[{"code":"0557U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":262.99,"maximum":656.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":262.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":268.25,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":265.62,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":270.88,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":656.69,"additional_payer_notes":"APC"}]}]},{"description":"Onc clrct elisa bf7 ag serum","code_information":[{"code":"0558U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":20.81,"maximum":51.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.81,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21.23,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21.43,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":51.96,"additional_payer_notes":"APC"}]}]},{"description":"Onc brs quan elisa bf9ag srm","code_information":[{"code":"0559U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":20.81,"maximum":51.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.81,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21.23,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21.43,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":51.96,"additional_payer_notes":"APC"}]}]},{"description":"Onc mrd gsa cfdna baseline","code_information":[{"code":"0560U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3878.45,"maximum":9684.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3878.45,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3956.02,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3917.23,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3994.8,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":9684.49,"additional_payer_notes":"APC"}]}]},{"description":"Onc mrd gsa cfdna subsequent","code_information":[{"code":"0561U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":794.49,"maximum":1983.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":794.49,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":810.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":802.43,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":818.32,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1983.84,"additional_payer_notes":"APC"}]}]},{"description":"Onc sol tum tgsa 33gens snvs","code_information":[{"code":"0562U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":597.91,"maximum":1492.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":597.91,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":609.87,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":603.89,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":615.85,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1492.98,"additional_payer_notes":"APC"}]}]},{"description":"Nfct ds pthgn-sna 11vir&4bct","code_information":[{"code":"0563U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":416.78,"maximum":1040.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":416.78,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":425.12,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":420.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":429.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1040.7,"additional_payer_notes":"APC"}]}]},{"description":"Nfct ds pthgn-sna 10vir&4bct","code_information":[{"code":"0564U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":416.78,"maximum":1040.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":416.78,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":425.12,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":420.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":429.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1040.7,"additional_payer_notes":"APC"}]}]},{"description":"Onc hcc ngs detc 6626epigalt","code_information":[{"code":"0565U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1160.0,"maximum":2896.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1160.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1183.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1171.6,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1194.8,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2896.52,"additional_payer_notes":"APC"}]}]},{"description":"Onc lng qpcr-bsd alys 13dmrs","code_information":[{"code":"0566U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":416.78,"maximum":1040.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":416.78,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":425.12,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":420.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":429.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1040.7,"additional_payer_notes":"APC"}]}]},{"description":"Rare ds whl gen seq srs&lrs","code_information":[{"code":"0567U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5031.2,"maximum":12562.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5031.2,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5131.82,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5081.51,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5182.14,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":12562.91,"additional_payer_notes":"APC"}]}]},{"description":"Neurol dementia ?amyl ptau","code_information":[{"code":"0568U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":897.0,"maximum":2239.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":897.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":914.94,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":905.97,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":923.91,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2239.81,"additional_payer_notes":"APC"}]}]},{"description":"Neurol tbi alys gfap&uch-l1","code_information":[{"code":"0570U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":260.5,"maximum":650.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":260.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":265.71,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":263.1,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":268.32,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":650.47,"additional_payer_notes":"APC"}]}]},{"description":"Onc sol tum dna80&rna10g ngs","code_information":[{"code":"0571U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2919.6,"maximum":7290.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2919.6,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2977.99,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2948.8,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3007.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7290.24,"additional_payer_notes":"APC"}]}]},{"description":"Trnsplj med lar rtpcr 4genes","code_information":[{"code":"0575U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":380.0,"maximum":948.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":380.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":387.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":383.8,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":391.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":948.86,"additional_payer_notes":"APC"}]}]},{"description":"Trnsplj med lar quan ddcfdna","code_information":[{"code":"0576U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3240.0,"maximum":8090.28,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3240.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3304.8,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3272.4,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3337.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8090.28,"additional_payer_notes":"APC"}]}]},{"description":"Onc ovr serum alys 39 gps","code_information":[{"code":"0577U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":246.92,"maximum":616.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":246.92,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":251.86,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":249.39,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":254.33,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":616.56,"additional_payer_notes":"APC"}]}]},{"description":"Onc cutan mln rna qpcr 10gen","code_information":[{"code":"0578U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3873.0,"maximum":9670.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3873.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3950.46,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3911.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3989.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":9670.88,"additional_payer_notes":"APC"}]}]},{"description":"Nfro dbtc ckd elisa apoa4","code_information":[{"code":"0579U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":390.75,"maximum":975.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":390.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":398.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":394.66,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":402.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":975.7,"additional_payer_notes":"APC"}]}]},{"description":"Bbrgdrferi antb detc 24rprtn","code_information":[{"code":"0580U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.21,"maximum":42.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.21,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17.55,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17.38,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":42.97,"additional_payer_notes":"APC"}]}]},{"description":"Trnspl med antb nohla 39trgt","code_information":[{"code":"0581U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":325.8,"maximum":813.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":325.8,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":332.32,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":329.06,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":335.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":813.52,"additional_payer_notes":"APC"}]}]},{"description":"Rare ds rpd whlgen dna vrnts","code_information":[{"code":"0582U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7582.2,"maximum":18932.75,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7582.2,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7733.84,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7658.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7809.67,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":18932.75,"additional_payer_notes":"APC"}]}]},{"description":"Rare ds rpd whlgen cmptr dna","code_information":[{"code":"0583U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3791.1,"maximum":9466.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3791.1,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3866.92,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3829.01,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3904.83,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":9466.38,"additional_payer_notes":"APC"}]}]},{"description":"Neuro csf prion prtn qual","code_information":[{"code":"0584U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":540.99,"maximum":1350.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":540.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":551.81,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":546.4,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":557.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1350.85,"additional_payer_notes":"APC"}]}]},{"description":"Tgsap so neo cfdna 521 genes","code_information":[{"code":"0585U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2919.6,"maximum":7290.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2919.6,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2977.99,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2948.8,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3007.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7290.24,"additional_payer_notes":"APC"}]}]},{"description":"Onc mrna gen xprsn 216 genes","code_information":[{"code":"0586U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2919.6,"maximum":7290.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2919.6,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2977.99,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2948.8,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3007.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7290.24,"additional_payer_notes":"APC"}]}]},{"description":"Ther rx mntr 60-150rx&metabl","code_information":[{"code":"0587U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":114.43,"maximum":285.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":114.43,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":116.72,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":115.57,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":117.86,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":285.73,"additional_payer_notes":"APC"}]}]},{"description":"Nfct ds bct/vir 32genes mrna","code_information":[{"code":"0588U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":760.0,"maximum":1897.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":760.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":775.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":767.6,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":782.8,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1897.72,"additional_payer_notes":"APC"}]}]},{"description":"Pfas24cmpnd hi-perf lc-ms/ms","code_information":[{"code":"0589U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":198.74,"maximum":496.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":198.74,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":202.71,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":200.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":204.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":496.25,"additional_payer_notes":"APC"}]}]},{"description":"Onc prst8 ca 3prtns plsm srm","code_information":[{"code":"0591U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":760.0,"maximum":1897.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":760.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":775.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":767.6,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":782.8,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1897.72,"additional_payer_notes":"APC"}]}]},{"description":"Onc hl neo dna tgs 417 genes","code_information":[{"code":"0592U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2919.6,"maximum":7290.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2919.6,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2977.99,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2948.8,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3007.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7290.24,"additional_payer_notes":"APC"}]}]},{"description":"Nfct ds gu pthgn dna 46trgt","code_information":[{"code":"0593U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":634.84,"maximum":1585.20,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":634.84,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":647.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":641.19,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":653.89,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1585.2,"additional_payer_notes":"APC"}]}]},{"description":"Nfct ds tfp vctrbrn&zoonotic","code_information":[{"code":"0595U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":262.99,"maximum":656.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":262.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":268.25,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":265.62,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":270.88,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":656.69,"additional_payer_notes":"APC"}]}]},{"description":"Gi ibs igg antb 18food items","code_information":[{"code":"0598U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":300.0,"maximum":749.1,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":300.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":306.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":303.0,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":309.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":749.1,"additional_payer_notes":"APC"}]}]},{"description":"Onc pncrtc ca mult ia serum","code_information":[{"code":"0599U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":897.0,"maximum":2239.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":897.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":914.94,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":905.97,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":923.91,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2239.81,"additional_payer_notes":"APC"}]}]},{"description":"Routine venipuncture","code_information":[{"code":"36415","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9.34,"maximum":23.32,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.34,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9.53,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9.43,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.62,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":23.32,"additional_payer_notes":"APC"}]}]},{"description":"Metabolic panel ionized ca","code_information":[{"code":"80047","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.73,"maximum":34.28,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.73,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.87,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.14,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":34.28,"additional_payer_notes":"APC"}]}]},{"description":"Metabolic panel total ca","code_information":[{"code":"80048","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":8.46,"maximum":21.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8.63,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8.54,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.71,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":21.12,"additional_payer_notes":"APC"}]}]},{"description":"Electrolyte panel","code_information":[{"code":"80051","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7.01,"maximum":17.50,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.01,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7.15,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7.08,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17.5,"additional_payer_notes":"APC"}]}]},{"description":"Comprehen metabolic panel","code_information":[{"code":"80053","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10.56,"maximum":26.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10.77,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10.67,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.88,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":26.37,"additional_payer_notes":"APC"}]}]},{"description":"Obstetric panel","code_information":[{"code":"80055","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":47.81,"maximum":119.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":47.81,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":48.77,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":48.29,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":49.24,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":119.38,"additional_payer_notes":"APC"}]}]},{"description":"Lipid panel","code_information":[{"code":"80061","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.39,"maximum":33.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.39,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.66,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.52,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.79,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":33.43,"additional_payer_notes":"APC"}]}]},{"description":"Renal function panel","code_information":[{"code":"80069","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":8.68,"maximum":21.67,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.68,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8.85,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8.77,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.94,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":21.67,"additional_payer_notes":"APC"}]}]},{"description":"Acute hepatitis panel","code_information":[{"code":"80074","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":47.63,"maximum":118.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":47.63,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":48.58,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":48.11,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":49.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":118.93,"additional_payer_notes":"APC"}]}]},{"description":"Hepatic function panel","code_information":[{"code":"80076","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":8.17,"maximum":20.40,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8.25,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.42,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":20.4,"additional_payer_notes":"APC"}]}]},{"description":"Obstetric panel","code_information":[{"code":"80081","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":74.86,"maximum":186.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":74.86,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":76.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":75.61,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":77.11,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":186.93,"additional_payer_notes":"APC"}]}]},{"description":"Drug assay acetaminophen","code_information":[{"code":"80143","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18.64,"maximum":46.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.64,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19.01,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.83,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":46.54,"additional_payer_notes":"APC"}]}]},{"description":"Drug assay adalimumab","code_information":[{"code":"80145","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":38.57,"maximum":96.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":38.57,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39.34,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38.96,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":39.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":96.31,"additional_payer_notes":"APC"}]}]},{"description":"Assay of amikacin","code_information":[{"code":"80150","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":15.08,"maximum":37.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.08,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15.23,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":37.65,"additional_payer_notes":"APC"}]}]},{"description":"Drug assay amiodarone","code_information":[{"code":"80151","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18.64,"maximum":46.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.64,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19.01,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.83,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":46.54,"additional_payer_notes":"APC"}]}]},{"description":"Drug assay caffeine","code_information":[{"code":"80155","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":38.57,"maximum":96.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":38.57,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39.34,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38.96,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":39.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":96.31,"additional_payer_notes":"APC"}]}]},{"description":"Assay carbamazepine total","code_information":[{"code":"80156","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14.57,"maximum":36.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.57,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.86,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.72,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.01,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":36.38,"additional_payer_notes":"APC"}]}]},{"description":"Assay carbamazepine free","code_information":[{"code":"80157","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.25,"maximum":33.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.25,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.52,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.38,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.65,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":33.09,"additional_payer_notes":"APC"}]}]},{"description":"Drug assay cyclosporine","code_information":[{"code":"80158","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18.05,"maximum":45.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.05,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.41,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.23,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":45.07,"additional_payer_notes":"APC"}]}]},{"description":"Drug assay clozapine","code_information":[{"code":"80159","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":20.15,"maximum":50.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.15,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20.55,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20.35,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.75,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":50.31,"additional_payer_notes":"APC"}]}]},{"description":"Asy carbamazepin 10,11-epxid","code_information":[{"code":"80161","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18.64,"maximum":46.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.64,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19.01,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.83,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":46.54,"additional_payer_notes":"APC"}]}]},{"description":"Assay of digoxin total","code_information":[{"code":"80162","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.28,"maximum":33.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.28,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.55,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.41,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":33.16,"additional_payer_notes":"APC"}]}]},{"description":"Assay of digoxin free","code_information":[{"code":"80163","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.28,"maximum":33.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.28,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.55,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.41,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":33.16,"additional_payer_notes":"APC"}]}]},{"description":"Assay dipropylacetic acd tot","code_information":[{"code":"80164","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.54,"maximum":33.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.54,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.81,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.68,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":33.81,"additional_payer_notes":"APC"}]}]},{"description":"Dipropylacetic acid free","code_information":[{"code":"80165","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.54,"maximum":33.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.54,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.81,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.68,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":33.81,"additional_payer_notes":"APC"}]}]},{"description":"Drug assay felbamate","code_information":[{"code":"80167","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18.64,"maximum":46.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.64,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19.01,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.83,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":46.54,"additional_payer_notes":"APC"}]}]},{"description":"Assay of ethosuximide","code_information":[{"code":"80168","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16.34,"maximum":40.80,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.34,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16.67,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16.5,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.83,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":40.8,"additional_payer_notes":"APC"}]}]},{"description":"Drug assay everolimus","code_information":[{"code":"80169","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.73,"maximum":34.28,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.73,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.87,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.14,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":34.28,"additional_payer_notes":"APC"}]}]},{"description":"Assay of gentamicin","code_information":[{"code":"80170","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16.38,"maximum":40.90,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.38,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16.71,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16.54,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.87,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":40.9,"additional_payer_notes":"APC"}]}]},{"description":"Drug screen quant gabapentin","code_information":[{"code":"80171","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":21.67,"maximum":54.11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22.1,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21.89,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22.32,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":54.11,"additional_payer_notes":"APC"}]}]},{"description":"Assay Of Haloperidol","code_information":[{"code":"80173","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":15.78,"maximum":39.40,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.78,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16.1,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15.94,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.25,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":39.4,"additional_payer_notes":"APC"}]}]},{"description":"Drug screen quan lamotrigine","code_information":[{"code":"80175","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.25,"maximum":33.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.25,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.52,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.38,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.65,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":33.09,"additional_payer_notes":"APC"}]}]},{"description":"Assay of lidocaine","code_information":[{"code":"80176","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14.69,"maximum":36.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.69,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.98,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.84,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.13,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":36.68,"additional_payer_notes":"APC"}]}]},{"description":"Drug scrn quan levetiracetam","code_information":[{"code":"80177","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.25,"maximum":33.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.25,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.52,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.38,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.65,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":33.09,"additional_payer_notes":"APC"}]}]},{"description":"Assay of lithium","code_information":[{"code":"80178","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6.61,"maximum":16.51,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6.74,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6.68,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":16.51,"additional_payer_notes":"APC"}]}]},{"description":"Drug assay salicylate","code_information":[{"code":"80179","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18.64,"maximum":46.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.64,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19.01,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.83,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":46.54,"additional_payer_notes":"APC"}]}]},{"description":"Drug scrn quan mycophenolate","code_information":[{"code":"80180","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18.05,"maximum":45.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.05,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.41,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.23,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":45.07,"additional_payer_notes":"APC"}]}]},{"description":"Drug assay flecainide","code_information":[{"code":"80181","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18.64,"maximum":46.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.64,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19.01,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.83,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":46.54,"additional_payer_notes":"APC"}]}]},{"description":"Drug scrn quant oxcarbazepin","code_information":[{"code":"80183","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.25,"maximum":33.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.25,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.52,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.38,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.65,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":33.09,"additional_payer_notes":"APC"}]}]},{"description":"Assay of phenobarbital","code_information":[{"code":"80184","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":15.3,"maximum":38.20,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.3,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15.45,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.76,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":38.2,"additional_payer_notes":"APC"}]}]},{"description":"Assay of phenytoin total","code_information":[{"code":"80185","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.25,"maximum":33.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.25,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.52,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.38,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.65,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":33.09,"additional_payer_notes":"APC"}]}]},{"description":"Assay of phenytoin free","code_information":[{"code":"80186","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.76,"maximum":34.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.76,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.04,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.17,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":34.36,"additional_payer_notes":"APC"}]}]},{"description":"Drug assay posaconazole","code_information":[{"code":"80187","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":27.11,"maximum":67.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27.11,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27.38,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":67.69,"additional_payer_notes":"APC"}]}]},{"description":"Assay of primidone","code_information":[{"code":"80188","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16.59,"maximum":41.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.59,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16.92,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16.76,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.09,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":41.43,"additional_payer_notes":"APC"}]}]},{"description":"Drug assay itraconzaole","code_information":[{"code":"80189","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":27.11,"maximum":67.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27.11,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27.38,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":67.69,"additional_payer_notes":"APC"}]}]},{"description":"Assay of procainamide","code_information":[{"code":"80190","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":60.0,"maximum":149.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":60.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":61.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":60.6,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":61.8,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":149.82,"additional_payer_notes":"APC"}]}]},{"description":"Assay of procainamide","code_information":[{"code":"80192","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16.75,"maximum":41.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17.08,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16.92,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.25,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":41.82,"additional_payer_notes":"APC"}]}]},{"description":"Drug assay leflunomide","code_information":[{"code":"80193","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":38.57,"maximum":96.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":38.57,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39.34,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38.96,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":39.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":96.31,"additional_payer_notes":"APC"}]}]},{"description":"Assay of quinidine","code_information":[{"code":"80194","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14.6,"maximum":36.46,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.6,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.89,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.75,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.04,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":36.46,"additional_payer_notes":"APC"}]}]},{"description":"Assay of sirolimus","code_information":[{"code":"80195","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.73,"maximum":34.28,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.73,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.87,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.14,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":34.28,"additional_payer_notes":"APC"}]}]},{"description":"Assay of tacrolimus","code_information":[{"code":"80197","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.73,"maximum":34.28,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.73,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.87,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.14,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":34.28,"additional_payer_notes":"APC"}]}]},{"description":"Assay of theophylline","code_information":[{"code":"80198","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14.14,"maximum":35.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.14,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.42,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.28,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.56,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":35.31,"additional_payer_notes":"APC"}]}]},{"description":"Drug screen quant tiagabine","code_information":[{"code":"80199","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":27.11,"maximum":67.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27.11,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27.38,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":67.69,"additional_payer_notes":"APC"}]}]},{"description":"Assay of tobramycin","code_information":[{"code":"80200","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16.13,"maximum":40.28,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.13,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16.29,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.61,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":40.28,"additional_payer_notes":"APC"}]}]},{"description":"Assay of topiramate","code_information":[{"code":"80201","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.92,"maximum":29.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.92,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.16,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.04,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":29.76,"additional_payer_notes":"APC"}]}]},{"description":"Assay of vancomycin","code_information":[{"code":"80202","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.54,"maximum":33.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.54,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.81,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.68,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":33.81,"additional_payer_notes":"APC"}]}]},{"description":"Drug screen quant zonisamide","code_information":[{"code":"80203","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.25,"maximum":33.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.25,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.52,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.38,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.65,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":33.09,"additional_payer_notes":"APC"}]}]},{"description":"Drug assay methotrexate","code_information":[{"code":"80204","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":38.57,"maximum":96.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":38.57,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39.34,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38.96,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":39.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":96.31,"additional_payer_notes":"APC"}]}]},{"description":"Drug assay rufinamide","code_information":[{"code":"80210","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":27.11,"maximum":67.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27.11,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27.38,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":67.69,"additional_payer_notes":"APC"}]}]},{"description":"Drug asy hydroxychloroquine","code_information":[{"code":"80220","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18.64,"maximum":46.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.64,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19.01,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.83,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":46.54,"additional_payer_notes":"APC"}]}]},{"description":"Drug assay infliximab","code_information":[{"code":"80230","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":38.57,"maximum":96.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":38.57,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39.34,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38.96,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":39.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":96.31,"additional_payer_notes":"APC"}]}]},{"description":"Drug assay lacosamide","code_information":[{"code":"80235","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":27.11,"maximum":67.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27.11,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27.38,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":67.69,"additional_payer_notes":"APC"}]}]},{"description":"Drug assay vedolizumab","code_information":[{"code":"80280","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":38.57,"maximum":96.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":38.57,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39.34,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38.96,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":39.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":96.31,"additional_payer_notes":"APC"}]}]},{"description":"Drug assay voriconazole","code_information":[{"code":"80285","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":27.11,"maximum":67.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27.11,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27.38,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":67.69,"additional_payer_notes":"APC"}]}]},{"description":"Quantitative assay drug","code_information":[{"code":"80299","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18.64,"maximum":46.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.64,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19.01,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.83,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":46.54,"additional_payer_notes":"APC"}]}]},{"description":"Drug test prsmv dir opt obs","code_information":[{"code":"80305","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.6,"maximum":31.46,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.6,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.85,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.98,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":31.46,"additional_payer_notes":"APC"}]}]},{"description":"Drug test prsmv instrmnt","code_information":[{"code":"80306","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.14,"maximum":42.80,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.14,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17.31,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.65,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":42.8,"additional_payer_notes":"APC"}]}]},{"description":"Drug test prsmv chem anlyzr","code_information":[{"code":"80307","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":62.14,"maximum":155.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":62.14,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":63.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":62.76,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":64.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":155.16,"additional_payer_notes":"APC"}]}]},{"description":"Acth stimulation panel","code_information":[{"code":"80400","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":32.62,"maximum":81.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":32.62,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33.27,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":33.6,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":81.45,"additional_payer_notes":"APC"}]}]},{"description":"Acth stimulation panel","code_information":[{"code":"80402","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":86.96,"maximum":217.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":86.96,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":88.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":87.83,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":89.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":217.14,"additional_payer_notes":"APC"}]}]},{"description":"Acth stimulation panel","code_information":[{"code":"80406","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":78.26,"maximum":195.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":78.26,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":79.83,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":79.04,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":80.61,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":195.42,"additional_payer_notes":"APC"}]}]},{"description":"Aldosterone suppression eval","code_information":[{"code":"80408","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":125.5,"maximum":313.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":125.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.01,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":126.76,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":129.27,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":313.37,"additional_payer_notes":"APC"}]}]},{"description":"Calcitonin stimul panel","code_information":[{"code":"80410","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":80.37,"maximum":200.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":80.37,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":81.98,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":81.17,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":82.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":200.68,"additional_payer_notes":"APC"}]}]},{"description":"CRH stimulation panel","code_information":[{"code":"80412","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":801.62,"maximum":2001.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":801.62,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":817.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":809.64,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":825.67,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2001.65,"additional_payer_notes":"APC"}]}]},{"description":"Testosterone response","code_information":[{"code":"80414","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":51.64,"maximum":128.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":51.64,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":52.67,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":52.16,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":53.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":128.95,"additional_payer_notes":"APC"}]}]},{"description":"Estradiol response panel","code_information":[{"code":"80415","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":55.89,"maximum":139.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":55.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":57.01,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":56.45,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":57.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":139.56,"additional_payer_notes":"APC"}]}]},{"description":"Renin stimulation panel","code_information":[{"code":"80416","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":209.32,"maximum":522.67,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":209.32,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":213.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":211.41,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":215.6,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":522.67,"additional_payer_notes":"APC"}]}]},{"description":"Renin stimulation panel","code_information":[{"code":"80417","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":43.99,"maximum":109.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":43.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":44.87,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":44.43,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":45.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":109.84,"additional_payer_notes":"APC"}]}]},{"description":"Pituitary evaluation panel","code_information":[{"code":"80418","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":579.48,"maximum":1446.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":579.48,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":591.07,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":585.27,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":596.86,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1446.96,"additional_payer_notes":"APC"}]}]},{"description":"Dexamethasone panel","code_information":[{"code":"80420","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":161.88,"maximum":404.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":161.88,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":165.12,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":163.5,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":166.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":404.21,"additional_payer_notes":"APC"}]}]},{"description":"Glucagon tolerance panel","code_information":[{"code":"80422","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":46.07,"maximum":115.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":46.07,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":46.99,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":46.53,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":47.45,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":115.04,"additional_payer_notes":"APC"}]}]},{"description":"Glucagon tolerance panel","code_information":[{"code":"80424","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":50.5,"maximum":126.10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":50.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":51.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":51.0,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":52.02,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":126.1,"additional_payer_notes":"APC"}]}]},{"description":"Gonadotropin hormone panel","code_information":[{"code":"80426","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":148.41,"maximum":370.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":148.41,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":151.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":149.89,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":152.86,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":370.58,"additional_payer_notes":"APC"}]}]},{"description":"Growth hormone panel","code_information":[{"code":"80428","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":66.7,"maximum":166.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":66.7,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":68.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":67.37,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":68.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":166.55,"additional_payer_notes":"APC"}]}]},{"description":"Growth hormone panel","code_information":[{"code":"80430","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":129.33,"maximum":322.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":129.33,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":131.92,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":130.62,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":133.21,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":322.94,"additional_payer_notes":"APC"}]}]},{"description":"Insulin suppression panel","code_information":[{"code":"80432","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":165.61,"maximum":413.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":165.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":168.92,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":167.27,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":170.58,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":413.53,"additional_payer_notes":"APC"}]}]},{"description":"Insulin tolerance panel","code_information":[{"code":"80434","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":285.03,"maximum":711.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":285.03,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":290.73,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":287.88,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":293.58,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":711.72,"additional_payer_notes":"APC"}]}]},{"description":"Insulin tolerance panel","code_information":[{"code":"80435","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":103.0,"maximum":257.19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":103.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":105.06,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":104.03,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":106.09,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":257.19,"additional_payer_notes":"APC"}]}]},{"description":"Metyrapone panel","code_information":[{"code":"80436","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":91.16,"maximum":227.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":91.16,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":92.98,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":92.07,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":93.89,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":227.63,"additional_payer_notes":"APC"}]}]},{"description":"TRH stimulation panel","code_information":[{"code":"80438","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":50.41,"maximum":125.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":50.41,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":51.42,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":50.91,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":51.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":125.87,"additional_payer_notes":"APC"}]}]},{"description":"TRH stimulation panel","code_information":[{"code":"80439","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":67.21,"maximum":167.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":67.21,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":68.55,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":67.88,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":69.23,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":167.82,"additional_payer_notes":"APC"}]}]},{"description":"Urinalysis nonauto w/scope","code_information":[{"code":"81000","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.02,"maximum":10.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.02,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4.1,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4.06,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.14,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":10.04,"additional_payer_notes":"APC"}]}]},{"description":"Urinalysis auto w/scope","code_information":[{"code":"81001","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3.17,"maximum":7.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3.23,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3.2,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3.27,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7.92,"additional_payer_notes":"APC"}]}]},{"description":"Urinalysis nonauto w/o scope","code_information":[{"code":"81002","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3.48,"maximum":8.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3.48,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3.55,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3.51,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3.58,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8.69,"additional_payer_notes":"APC"}]}]},{"description":"Urinalysis auto w/o scope","code_information":[{"code":"81003","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2.25,"maximum":5.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2.25,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2.3,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2.27,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2.32,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":5.62,"additional_payer_notes":"APC"}]}]},{"description":"Urinalysis","code_information":[{"code":"81005","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2.17,"maximum":5.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2.21,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2.19,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2.24,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":5.42,"additional_payer_notes":"APC"}]}]},{"description":"Urine screen for bacteria","code_information":[{"code":"81007","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":29.98,"maximum":74.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29.98,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30.58,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30.28,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30.88,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":74.86,"additional_payer_notes":"APC"}]}]},{"description":"Microscopic exam of urine","code_information":[{"code":"81015","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3.05,"maximum":7.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3.05,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3.11,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3.08,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3.14,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7.62,"additional_payer_notes":"APC"}]}]},{"description":"Urinalysis glass test","code_information":[{"code":"81020","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.7,"maximum":11.74,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.7,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4.79,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4.75,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.84,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":11.74,"additional_payer_notes":"APC"}]}]},{"description":"Urine pregnancy test","code_information":[{"code":"81025","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":8.61,"maximum":21.50,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8.78,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8.7,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.87,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":21.5,"additional_payer_notes":"APC"}]}]},{"description":"Urinalysis volume measure","code_information":[{"code":"81050","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3.64,"maximum":9.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3.64,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3.71,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3.68,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3.75,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":9.09,"additional_payer_notes":"APC"}]}]},{"description":"Hpa-1 genotyping","code_information":[{"code":"81105","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":122.22,"maximum":305.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":122.22,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":124.66,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":123.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":125.89,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":305.18,"additional_payer_notes":"APC"}]}]},{"description":"Hpa-2 genotyping","code_information":[{"code":"81106","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":122.22,"maximum":305.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":122.22,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":124.66,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":123.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":125.89,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":305.18,"additional_payer_notes":"APC"}]}]},{"description":"Hpa-3 genotyping","code_information":[{"code":"81107","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":122.22,"maximum":305.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":122.22,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":124.66,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":123.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":125.89,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":305.18,"additional_payer_notes":"APC"}]}]},{"description":"Hpa-4 genotyping","code_information":[{"code":"81108","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":122.22,"maximum":305.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":122.22,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":124.66,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":123.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":125.89,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":305.18,"additional_payer_notes":"APC"}]}]},{"description":"Hpa-5 genotyping","code_information":[{"code":"81109","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":122.22,"maximum":305.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":122.22,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":124.66,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":123.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":125.89,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":305.18,"additional_payer_notes":"APC"}]}]},{"description":"Hpa-6 genotyping","code_information":[{"code":"81110","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":122.22,"maximum":305.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":122.22,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":124.66,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":123.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":125.89,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":305.18,"additional_payer_notes":"APC"}]}]},{"description":"Hpa-9 genotyping","code_information":[{"code":"81111","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":122.22,"maximum":305.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":122.22,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":124.66,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":123.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":125.89,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":305.18,"additional_payer_notes":"APC"}]}]},{"description":"Hpa-15 genotyping","code_information":[{"code":"81112","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":122.22,"maximum":305.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":122.22,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":124.66,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":123.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":125.89,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":305.18,"additional_payer_notes":"APC"}]}]},{"description":"Idh1 common variants","code_information":[{"code":"81120","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":193.25,"maximum":482.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":193.25,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":197.12,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":195.18,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":199.05,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":482.55,"additional_payer_notes":"APC"}]}]},{"description":"Idh2 common variants","code_information":[{"code":"81121","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":295.79,"maximum":738.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":295.79,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":301.71,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":298.75,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":304.66,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":738.59,"additional_payer_notes":"APC"}]}]},{"description":"DMD dup/delet analysis","code_information":[{"code":"81161","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":279.0,"maximum":696.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":279.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":284.58,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":281.79,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":287.37,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":696.66,"additional_payer_notes":"APC"}]}]},{"description":"Brca1&2 seq & full dup/del","code_information":[{"code":"81162","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1824.88,"maximum":4556.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1824.88,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1861.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1843.13,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1879.63,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4556.73,"additional_payer_notes":"APC"}]}]},{"description":"Brca1&2 gene full seq alys","code_information":[{"code":"81163","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":468.0,"maximum":1168.60,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":468.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":477.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":472.68,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":482.04,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1168.6,"additional_payer_notes":"APC"}]}]},{"description":"Brca1&2 gen ful dup/del alys","code_information":[{"code":"81164","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":584.23,"maximum":1458.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":584.23,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":595.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":590.07,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":601.76,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1458.82,"additional_payer_notes":"APC"}]}]},{"description":"Brca1 gene full seq alys","code_information":[{"code":"81165","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":282.88,"maximum":706.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":282.88,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":288.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":285.71,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":291.37,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":706.35,"additional_payer_notes":"APC"}]}]},{"description":"Brca1 gene full dup/del alys","code_information":[{"code":"81166","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":301.35,"maximum":752.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":301.35,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":307.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":304.36,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":310.39,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":752.47,"additional_payer_notes":"APC"}]}]},{"description":"Brca2 gene full dup/del alys","code_information":[{"code":"81167","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":282.88,"maximum":706.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":282.88,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":288.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":285.71,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":291.37,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":706.35,"additional_payer_notes":"APC"}]}]},{"description":"Ccnd1/igh translocation alys","code_information":[{"code":"81168","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":207.31,"maximum":517.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":207.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":211.46,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":209.38,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":213.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":517.65,"additional_payer_notes":"APC"}]}]},{"description":"Abl1 gene","code_information":[{"code":"81170","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":300.0,"maximum":749.1,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":300.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":306.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":303.0,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":309.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":749.1,"additional_payer_notes":"APC"}]}]},{"description":"Aff2 gene detc abnor alleles","code_information":[{"code":"81171","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":137.0,"maximum":342.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":137.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":139.74,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":138.37,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":141.11,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":342.09,"additional_payer_notes":"APC"}]}]},{"description":"Aff2 gene charac alleles","code_information":[{"code":"81172","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":274.83,"maximum":686.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":274.83,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":280.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":277.58,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":283.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":686.25,"additional_payer_notes":"APC"}]}]},{"description":"Ar gene full gene sequence","code_information":[{"code":"81173","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":301.35,"maximum":752.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":301.35,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":307.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":304.36,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":310.39,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":752.47,"additional_payer_notes":"APC"}]}]},{"description":"Ar gene known famil variant","code_information":[{"code":"81174","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":185.2,"maximum":462.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":185.2,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":188.9,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":187.05,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":190.76,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":462.44,"additional_payer_notes":"APC"}]}]},{"description":"Asxl1 full gene sequence","code_information":[{"code":"81175","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":676.5,"maximum":1689.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":676.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":690.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":683.26,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":696.8,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1689.22,"additional_payer_notes":"APC"}]}]},{"description":"Asxl1 gene target seq alys","code_information":[{"code":"81176","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":241.9,"maximum":604.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":241.9,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":246.74,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":244.32,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":249.16,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":604.02,"additional_payer_notes":"APC"}]}]},{"description":"Atn1 gene detc abnor alleles","code_information":[{"code":"81177","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":137.0,"maximum":342.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":137.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":139.74,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":138.37,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":141.11,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":342.09,"additional_payer_notes":"APC"}]}]},{"description":"Atxn1 gene detc abnor allele","code_information":[{"code":"81178","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":137.0,"maximum":342.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":137.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":139.74,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":138.37,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":141.11,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":342.09,"additional_payer_notes":"APC"}]}]},{"description":"Atxn2 gene detc abnor allele","code_information":[{"code":"81179","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":137.0,"maximum":342.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":137.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":139.74,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":138.37,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":141.11,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":342.09,"additional_payer_notes":"APC"}]}]},{"description":"Atxn3 gene detc abnor allele","code_information":[{"code":"81180","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":137.0,"maximum":342.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":137.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":139.74,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":138.37,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":141.11,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":342.09,"additional_payer_notes":"APC"}]}]},{"description":"Atxn7 gene detc abnor allele","code_information":[{"code":"81181","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":137.0,"maximum":342.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":137.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":139.74,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":138.37,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":141.11,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":342.09,"additional_payer_notes":"APC"}]}]},{"description":"Atxn8os gen detc abnor allel","code_information":[{"code":"81182","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":137.0,"maximum":342.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":137.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":139.74,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":138.37,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":141.11,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":342.09,"additional_payer_notes":"APC"}]}]},{"description":"Atxn10 gene detc abnor allel","code_information":[{"code":"81183","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":137.0,"maximum":342.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":137.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":139.74,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":138.37,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":141.11,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":342.09,"additional_payer_notes":"APC"}]}]},{"description":"Cacna1a gen detc abnor allel","code_information":[{"code":"81184","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":137.0,"maximum":342.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":137.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":139.74,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":138.37,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":141.11,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":342.09,"additional_payer_notes":"APC"}]}]},{"description":"Cacna1a gene full gene seq","code_information":[{"code":"81185","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":846.27,"maximum":2113.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":846.27,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":863.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":854.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":871.66,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2113.14,"additional_payer_notes":"APC"}]}]},{"description":"Cacna1a gen known famil vrnt","code_information":[{"code":"81186","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":185.2,"maximum":462.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":185.2,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":188.9,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":187.05,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":190.76,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":462.44,"additional_payer_notes":"APC"}]}]},{"description":"Cnbp gene detc abnor allele","code_information":[{"code":"81187","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":137.0,"maximum":342.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":137.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":139.74,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":138.37,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":141.11,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":342.09,"additional_payer_notes":"APC"}]}]},{"description":"Cstb gene detc abnor allele","code_information":[{"code":"81188","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":137.0,"maximum":342.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":137.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":139.74,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":138.37,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":141.11,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":342.09,"additional_payer_notes":"APC"}]}]},{"description":"Cstb gene full gene sequence","code_information":[{"code":"81189","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":274.83,"maximum":686.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":274.83,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":280.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":277.58,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":283.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":686.25,"additional_payer_notes":"APC"}]}]},{"description":"Cstb gene known famil vrnt","code_information":[{"code":"81190","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":185.2,"maximum":462.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":185.2,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":188.9,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":187.05,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":190.76,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":462.44,"additional_payer_notes":"APC"}]}]},{"description":"Ntrk1 translocation analysis","code_information":[{"code":"81191","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":207.31,"maximum":517.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":207.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":211.46,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":209.38,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":213.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":517.65,"additional_payer_notes":"APC"}]}]},{"description":"Ntrk2 translocation analysis","code_information":[{"code":"81192","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":207.31,"maximum":517.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":207.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":211.46,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":209.38,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":213.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":517.65,"additional_payer_notes":"APC"}]}]},{"description":"Ntrk3 translocation analysis","code_information":[{"code":"81193","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":207.31,"maximum":517.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":207.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":211.46,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":209.38,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":213.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":517.65,"additional_payer_notes":"APC"}]}]},{"description":"Ntrk translocation analysis","code_information":[{"code":"81194","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":518.28,"maximum":1294.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":518.28,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":528.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":523.46,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":533.83,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1294.15,"additional_payer_notes":"APC"}]}]},{"description":"Cytog genom-wid alys hem mal","code_information":[{"code":"81195","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1863.22,"maximum":4652.46,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1863.22,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1900.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1881.85,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1919.12,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4652.46,"additional_payer_notes":"APC"}]}]},{"description":"Aspa gene","code_information":[{"code":"81200","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":47.25,"maximum":117.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":47.25,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":48.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":47.72,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":48.67,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":117.98,"additional_payer_notes":"APC"}]}]},{"description":"Apc gene full sequence","code_information":[{"code":"81201","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":780.0,"maximum":1947.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":780.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":795.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":787.8,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":803.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1947.66,"additional_payer_notes":"APC"}]}]},{"description":"Apc gene known fam variants","code_information":[{"code":"81202","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":280.0,"maximum":699.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":280.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":285.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":282.8,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":288.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":699.16,"additional_payer_notes":"APC"}]}]},{"description":"Apc gene dup/delet variants","code_information":[{"code":"81203","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":200.0,"maximum":499.4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":200.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":204.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":202.0,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":206.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":499.4,"additional_payer_notes":"APC"}]}]},{"description":"Ar gene charac alleles","code_information":[{"code":"81204","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":137.0,"maximum":342.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":137.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":139.74,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":138.37,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":141.11,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":342.09,"additional_payer_notes":"APC"}]}]},{"description":"Bckdhb gene","code_information":[{"code":"81205","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":94.99,"maximum":237.19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":94.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":96.89,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":95.94,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":97.84,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":237.19,"additional_payer_notes":"APC"}]}]},{"description":"Bcr/abl1 gene major bp","code_information":[{"code":"81206","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":163.96,"maximum":409.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":163.96,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":167.24,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":165.6,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":168.88,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":409.41,"additional_payer_notes":"APC"}]}]},{"description":"Bcr/abl1 gene minor bp","code_information":[{"code":"81207","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":144.84,"maximum":361.67,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":144.84,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":147.74,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":146.29,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":149.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":361.67,"additional_payer_notes":"APC"}]}]},{"description":"Bcr/abl1 gene other bp","code_information":[{"code":"81208","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":214.62,"maximum":535.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":214.62,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":218.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":216.77,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":221.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":535.91,"additional_payer_notes":"APC"}]}]},{"description":"Blm gene","code_information":[{"code":"81209","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":39.31,"maximum":98.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":39.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":40.1,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39.7,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":40.49,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":98.16,"additional_payer_notes":"APC"}]}]},{"description":"Braf gene","code_information":[{"code":"81210","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":175.4,"maximum":437.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":175.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":178.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":177.15,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":180.66,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":437.97,"additional_payer_notes":"APC"}]}]},{"description":"Brca1&2 185&5385&6174 var","code_information":[{"code":"81212","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":440.0,"maximum":1098.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":440.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":448.8,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":444.4,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":453.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1098.68,"additional_payer_notes":"APC"}]}]},{"description":"Brca1 gene known fam variant","code_information":[{"code":"81215","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":375.25,"maximum":937.00,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":375.25,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":382.76,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":379.0,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":386.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":937.0,"additional_payer_notes":"APC"}]}]},{"description":"Brca2 gene full sequence","code_information":[{"code":"81216","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":185.12,"maximum":462.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":185.12,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":188.82,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":186.97,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":190.67,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":462.24,"additional_payer_notes":"APC"}]}]},{"description":"Brca2 gene known fam variant","code_information":[{"code":"81217","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":375.25,"maximum":937.00,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":375.25,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":382.76,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":379.0,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":386.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":937.0,"additional_payer_notes":"APC"}]}]},{"description":"Cebpa gene full sequence","code_information":[{"code":"81218","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":241.9,"maximum":604.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":241.9,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":246.74,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":244.32,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":249.16,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":604.02,"additional_payer_notes":"APC"}]}]},{"description":"Calr gene com variants","code_information":[{"code":"81219","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":121.63,"maximum":303.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":121.63,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":124.06,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":122.85,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":125.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":303.71,"additional_payer_notes":"APC"}]}]},{"description":"Cftr gene com variants","code_information":[{"code":"81220","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":556.6,"maximum":1389.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":556.6,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":567.73,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":562.17,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":573.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1389.83,"additional_payer_notes":"APC"}]}]},{"description":"Cftr gene known fam variants","code_information":[{"code":"81221","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":97.22,"maximum":242.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":97.22,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":99.16,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":98.19,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":100.14,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":242.76,"additional_payer_notes":"APC"}]}]},{"description":"Cftr gene dup/delet variants","code_information":[{"code":"81222","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":435.07,"maximum":1086.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":435.07,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":443.77,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":439.42,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":448.12,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1086.37,"additional_payer_notes":"APC"}]}]},{"description":"Cftr gene full sequence","code_information":[{"code":"81223","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":499.0,"maximum":1246.00,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":499.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":508.98,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":503.99,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":513.97,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1246.0,"additional_payer_notes":"APC"}]}]},{"description":"Cftr gene intron poly t","code_information":[{"code":"81224","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":168.75,"maximum":421.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":168.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":172.12,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":170.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":173.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":421.37,"additional_payer_notes":"APC"}]}]},{"description":"Cyp2c19 gene com variants","code_information":[{"code":"81225","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":291.36,"maximum":727.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":291.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":297.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":294.27,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":300.1,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":727.53,"additional_payer_notes":"APC"}]}]},{"description":"Cyp2d6 gene com variants","code_information":[{"code":"81226","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":450.91,"maximum":1125.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":450.91,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":459.93,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":455.42,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":464.44,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1125.92,"additional_payer_notes":"APC"}]}]},{"description":"Cyp2c9 gene com variants","code_information":[{"code":"81227","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":174.81,"maximum":436.50,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":174.81,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":178.31,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":176.56,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":180.05,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":436.5,"additional_payer_notes":"APC"}]}]},{"description":"Cytogen micrarray copy nmbr","code_information":[{"code":"81228","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":900.0,"maximum":2247.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":900.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":918.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":909.0,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":927.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2247.3,"additional_payer_notes":"APC"}]}]},{"description":"Cytogen m array copy no&snp","code_information":[{"code":"81229","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1160.0,"maximum":2896.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1160.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1183.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1171.6,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1194.8,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2896.52,"additional_payer_notes":"APC"}]}]},{"description":"Cyp3a4 gene common variants","code_information":[{"code":"81230","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":174.81,"maximum":436.50,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":174.81,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":178.31,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":176.56,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":180.05,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":436.5,"additional_payer_notes":"APC"}]}]},{"description":"Cyp3a5 gene common variants","code_information":[{"code":"81231","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":174.81,"maximum":436.50,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":174.81,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":178.31,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":176.56,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":180.05,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":436.5,"additional_payer_notes":"APC"}]}]},{"description":"Dpyd gene common variants","code_information":[{"code":"81232","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":174.81,"maximum":436.50,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":174.81,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":178.31,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":176.56,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":180.05,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":436.5,"additional_payer_notes":"APC"}]}]},{"description":"Btk gene common variants","code_information":[{"code":"81233","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":175.4,"maximum":437.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":175.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":178.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":177.15,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":180.66,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":437.97,"additional_payer_notes":"APC"}]}]},{"description":"Dmpk gene detc abnor allele","code_information":[{"code":"81234","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":137.0,"maximum":342.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":137.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":139.74,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":138.37,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":141.11,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":342.09,"additional_payer_notes":"APC"}]}]},{"description":"Egfr gene com variants","code_information":[{"code":"81235","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":324.58,"maximum":810.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":324.58,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":331.07,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":327.83,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":334.32,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":810.48,"additional_payer_notes":"APC"}]}]},{"description":"Ezh2 gene full gene sequence","code_information":[{"code":"81236","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":282.88,"maximum":706.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":282.88,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":288.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":285.71,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":291.37,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":706.35,"additional_payer_notes":"APC"}]}]},{"description":"Ezh2 gene common variants","code_information":[{"code":"81237","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":175.4,"maximum":437.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":175.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":178.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":177.15,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":180.66,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":437.97,"additional_payer_notes":"APC"}]}]},{"description":"F9 full gene sequence","code_information":[{"code":"81238","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":600.0,"maximum":1498.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":600.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":612.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":606.0,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":618.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1498.2,"additional_payer_notes":"APC"}]}]},{"description":"Dmpk gene charac alleles","code_information":[{"code":"81239","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":274.83,"maximum":686.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":274.83,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":280.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":277.58,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":283.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":686.25,"additional_payer_notes":"APC"}]}]},{"description":"F2 gene","code_information":[{"code":"81240","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":65.69,"maximum":164.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":65.69,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":67.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":66.35,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":67.66,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":164.03,"additional_payer_notes":"APC"}]}]},{"description":"F5 gene","code_information":[{"code":"81241","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":73.37,"maximum":183.20,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":73.37,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":74.84,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":74.1,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":75.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":183.2,"additional_payer_notes":"APC"}]}]},{"description":"Fancc gene","code_information":[{"code":"81242","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":36.62,"maximum":91.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.62,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.99,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":37.72,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":91.44,"additional_payer_notes":"APC"}]}]},{"description":"Fmr1 gene detection","code_information":[{"code":"81243","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":57.04,"maximum":142.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":57.04,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":58.18,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":57.61,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":58.75,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":142.43,"additional_payer_notes":"APC"}]}]},{"description":"Fmr1 gene characterization","code_information":[{"code":"81244","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":44.89,"maximum":112.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":44.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":45.79,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":45.34,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":46.24,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":112.09,"additional_payer_notes":"APC"}]}]},{"description":"Flt3 gene","code_information":[{"code":"81245","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":165.51,"maximum":413.28,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":165.51,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":168.82,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":167.17,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":170.48,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":413.28,"additional_payer_notes":"APC"}]}]},{"description":"Flt3 gene analysis","code_information":[{"code":"81246","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":83.0,"maximum":207.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":83.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84.66,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":83.83,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":85.49,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":207.25,"additional_payer_notes":"APC"}]}]},{"description":"G6pd gene alys cmn variant","code_information":[{"code":"81247","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":174.81,"maximum":436.50,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":174.81,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":178.31,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":176.56,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":180.05,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":436.5,"additional_payer_notes":"APC"}]}]},{"description":"G6pd known familial variant","code_information":[{"code":"81248","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":375.25,"maximum":937.00,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":375.25,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":382.76,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":379.0,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":386.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":937.0,"additional_payer_notes":"APC"}]}]},{"description":"G6pd full gene sequence","code_information":[{"code":"81249","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":600.0,"maximum":1498.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":600.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":612.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":606.0,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":618.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1498.2,"additional_payer_notes":"APC"}]}]},{"description":"G6pc gene","code_information":[{"code":"81250","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":58.49,"maximum":146.05,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":58.49,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":59.66,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":59.07,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":60.24,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":146.05,"additional_payer_notes":"APC"}]}]},{"description":"Gba gene","code_information":[{"code":"81251","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":47.25,"maximum":117.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":47.25,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":48.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":47.72,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":48.67,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":117.98,"additional_payer_notes":"APC"}]}]},{"description":"Gjb2 gene full sequence","code_information":[{"code":"81252","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":101.12,"maximum":252.50,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":101.12,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":103.14,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":102.13,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":104.15,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":252.5,"additional_payer_notes":"APC"}]}]},{"description":"Gjb2 gene known fam variants","code_information":[{"code":"81253","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":61.52,"maximum":153.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":61.52,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":62.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":62.14,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":63.37,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":153.62,"additional_payer_notes":"APC"}]}]},{"description":"Gjb6 gene com variants","code_information":[{"code":"81254","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.0,"maximum":87.40,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35.35,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.05,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":87.4,"additional_payer_notes":"APC"}]}]},{"description":"Hexa gene","code_information":[{"code":"81255","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":51.45,"maximum":128.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":51.45,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":52.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":51.96,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":52.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":128.47,"additional_payer_notes":"APC"}]}]},{"description":"Hfe gene","code_information":[{"code":"81256","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":65.36,"maximum":163.20,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":65.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":66.67,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":66.01,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":67.32,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":163.2,"additional_payer_notes":"APC"}]}]},{"description":"Hba1/hba2 gene","code_information":[{"code":"81257","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":102.26,"maximum":255.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":102.26,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":104.31,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":103.28,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":105.33,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":255.34,"additional_payer_notes":"APC"}]}]},{"description":"Hba1/hba2 gene fam vrnt","code_information":[{"code":"81258","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":375.25,"maximum":937.00,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":375.25,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":382.76,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":379.0,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":386.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":937.0,"additional_payer_notes":"APC"}]}]},{"description":"Hba1/hba2 full gene sequence","code_information":[{"code":"81259","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":600.0,"maximum":1498.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":600.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":612.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":606.0,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":618.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1498.2,"additional_payer_notes":"APC"}]}]},{"description":"Ikbkap gene","code_information":[{"code":"81260","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":39.31,"maximum":98.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":39.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":40.1,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39.7,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":40.49,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":98.16,"additional_payer_notes":"APC"}]}]},{"description":"Igh gene rearrange amp meth","code_information":[{"code":"81261","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":197.99,"maximum":494.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":197.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":201.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":199.97,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":203.93,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":494.38,"additional_payer_notes":"APC"}]}]},{"description":"Igh gene rearrang dir probe","code_information":[{"code":"81262","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":68.55,"maximum":171.17,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":68.55,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":69.92,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":69.24,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":70.61,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":171.17,"additional_payer_notes":"APC"}]}]},{"description":"Igh vari regional mutation","code_information":[{"code":"81263","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":294.52,"maximum":735.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":294.52,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":300.41,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":297.47,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":303.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":735.42,"additional_payer_notes":"APC"}]}]},{"description":"Igk rearrangeabn clonal pop","code_information":[{"code":"81264","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":172.73,"maximum":431.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":172.73,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":176.18,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":174.46,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":177.91,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":431.31,"additional_payer_notes":"APC"}]}]},{"description":"Str markers specimen anal","code_information":[{"code":"81265","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":233.07,"maximum":581.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":233.07,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":237.73,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":235.4,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":240.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":581.98,"additional_payer_notes":"APC"}]}]},{"description":"Str markers spec anal addl","code_information":[{"code":"81266","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":304.81,"maximum":761.11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":304.81,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":310.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":307.86,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":313.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":761.11,"additional_payer_notes":"APC"}]}]},{"description":"Chimerism anal no cell selec","code_information":[{"code":"81267","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":207.46,"maximum":518.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":207.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":211.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":209.53,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":213.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":518.03,"additional_payer_notes":"APC"}]}]},{"description":"Chimerism anal w/cell select","code_information":[{"code":"81268","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":260.79,"maximum":651.19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":260.79,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":266.01,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":263.4,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":268.61,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":651.19,"additional_payer_notes":"APC"}]}]},{"description":"Hba1/hba2 gene dup/del vrnts","code_information":[{"code":"81269","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":202.4,"maximum":505.39,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":202.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":206.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":204.42,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":208.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":505.39,"additional_payer_notes":"APC"}]}]},{"description":"Jak2 gene","code_information":[{"code":"81270","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":91.66,"maximum":228.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":91.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":93.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":92.58,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":94.41,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":228.88,"additional_payer_notes":"APC"}]}]},{"description":"Htt gene detc abnor alleles","code_information":[{"code":"81271","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":137.0,"maximum":342.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":137.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":139.74,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":138.37,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":141.11,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":342.09,"additional_payer_notes":"APC"}]}]},{"description":"Kit gene targeted seq analys","code_information":[{"code":"81272","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":329.51,"maximum":822.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":329.51,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":336.1,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":332.81,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":339.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":822.79,"additional_payer_notes":"APC"}]}]},{"description":"Kit gene analys d816 variant","code_information":[{"code":"81273","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":124.87,"maximum":311.80,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":124.87,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":127.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":126.12,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":128.62,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":311.8,"additional_payer_notes":"APC"}]}]},{"description":"Htt gene charac alleles","code_information":[{"code":"81274","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":274.83,"maximum":686.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":274.83,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":280.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":277.58,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":283.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":686.25,"additional_payer_notes":"APC"}]}]},{"description":"Kras gene variants exon 2","code_information":[{"code":"81275","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":193.25,"maximum":482.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":193.25,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":197.12,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":195.18,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":199.05,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":482.55,"additional_payer_notes":"APC"}]}]},{"description":"Kras gene addl variants","code_information":[{"code":"81276","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":193.25,"maximum":482.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":193.25,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":197.12,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":195.18,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":199.05,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":482.55,"additional_payer_notes":"APC"}]}]},{"description":"Cytogenomic neo microra alys","code_information":[{"code":"81277","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1160.0,"maximum":2896.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1160.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1183.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1171.6,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1194.8,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2896.52,"additional_payer_notes":"APC"}]}]},{"description":"Igh@/bcl2 translocation alys","code_information":[{"code":"81278","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":207.31,"maximum":517.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":207.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":211.46,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":209.38,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":213.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":517.65,"additional_payer_notes":"APC"}]}]},{"description":"Jak2 gene trgt sequence alys","code_information":[{"code":"81279","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":185.2,"maximum":462.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":185.2,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":188.9,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":187.05,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":190.76,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":462.44,"additional_payer_notes":"APC"}]}]},{"description":"Ifnl3 gene","code_information":[{"code":"81283","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":73.37,"maximum":183.20,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":73.37,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":74.84,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":74.1,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":75.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":183.2,"additional_payer_notes":"APC"}]}]},{"description":"Fxn gene detc abnor alleles","code_information":[{"code":"81284","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":137.0,"maximum":342.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":137.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":139.74,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":138.37,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":141.11,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":342.09,"additional_payer_notes":"APC"}]}]},{"description":"Fxn gene charac alleles","code_information":[{"code":"81285","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":274.83,"maximum":686.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":274.83,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":280.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":277.58,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":283.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":686.25,"additional_payer_notes":"APC"}]}]},{"description":"Fxn gene full gene sequence","code_information":[{"code":"81286","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":274.83,"maximum":686.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":274.83,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":280.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":277.58,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":283.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":686.25,"additional_payer_notes":"APC"}]}]},{"description":"Mgmt gene methylation anal","code_information":[{"code":"81287","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":124.64,"maximum":311.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":124.64,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":127.13,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":125.89,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":128.38,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":311.23,"additional_payer_notes":"APC"}]}]},{"description":"Mlh1 gene","code_information":[{"code":"81288","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":192.32,"maximum":480.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":192.32,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":196.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":194.24,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":198.09,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":480.22,"additional_payer_notes":"APC"}]}]},{"description":"Fxn gene known famil variant","code_information":[{"code":"81289","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":185.2,"maximum":462.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":185.2,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":188.9,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":187.05,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":190.76,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":462.44,"additional_payer_notes":"APC"}]}]},{"description":"Mcoln1 gene","code_information":[{"code":"81290","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":39.31,"maximum":98.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":39.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":40.1,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39.7,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":40.49,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":98.16,"additional_payer_notes":"APC"}]}]},{"description":"Mthfr gene","code_information":[{"code":"81291","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":65.34,"maximum":163.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":65.34,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":66.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":65.99,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":67.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":163.15,"additional_payer_notes":"APC"}]}]},{"description":"Mlh1 gene full seq","code_information":[{"code":"81292","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":675.4,"maximum":1686.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":675.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":688.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":682.15,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":695.66,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1686.47,"additional_payer_notes":"APC"}]}]},{"description":"Mlh1 gene known variants","code_information":[{"code":"81293","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":331.0,"maximum":826.51,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":331.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":337.62,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":334.31,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":340.93,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":826.51,"additional_payer_notes":"APC"}]}]},{"description":"Mlh1 gene dup/delete variant","code_information":[{"code":"81294","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":202.4,"maximum":505.39,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":202.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":206.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":204.42,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":208.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":505.39,"additional_payer_notes":"APC"}]}]},{"description":"Msh2 gene full seq","code_information":[{"code":"81295","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":381.7,"maximum":953.10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":381.7,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":389.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":385.52,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":393.15,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":953.1,"additional_payer_notes":"APC"}]}]},{"description":"Msh2 gene known variants","code_information":[{"code":"81296","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":337.73,"maximum":843.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":337.73,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":344.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":341.11,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":347.86,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":843.31,"additional_payer_notes":"APC"}]}]},{"description":"Msh2 gene dup/delete variant","code_information":[{"code":"81297","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":213.3,"maximum":532.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":213.3,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":217.57,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":215.43,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":219.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":532.61,"additional_payer_notes":"APC"}]}]},{"description":"Msh6 gene full seq","code_information":[{"code":"81298","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":641.85,"maximum":1602.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":641.85,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":654.69,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":648.27,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":661.11,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1602.7,"additional_payer_notes":"APC"}]}]},{"description":"Msh6 gene known variants","code_information":[{"code":"81299","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":308.0,"maximum":769.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":308.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":314.16,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":311.08,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":317.24,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":769.08,"additional_payer_notes":"APC"}]}]},{"description":"Msh6 gene dup/delete variant","code_information":[{"code":"81300","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":238.0,"maximum":594.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":238.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":242.76,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":240.38,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":245.14,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":594.29,"additional_payer_notes":"APC"}]}]},{"description":"Microsatellite instability","code_information":[{"code":"81301","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":348.56,"maximum":870.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":348.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":355.53,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":352.05,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":359.02,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":870.35,"additional_payer_notes":"APC"}]}]},{"description":"Mecp2 gene full seq","code_information":[{"code":"81302","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":527.87,"maximum":1318.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":527.87,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":538.43,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":533.15,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":543.71,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1318.09,"additional_payer_notes":"APC"}]}]},{"description":"Mecp2 gene known variant","code_information":[{"code":"81303","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":120.0,"maximum":299.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":120.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":122.4,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":121.2,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":123.6,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":299.64,"additional_payer_notes":"APC"}]}]},{"description":"Mecp2 gene dup/delet variant","code_information":[{"code":"81304","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":150.0,"maximum":374.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":150.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":153.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":151.5,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":154.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":374.55,"additional_payer_notes":"APC"}]}]},{"description":"Myd88 gene p.leu265pro vrnt","code_information":[{"code":"81305","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":175.4,"maximum":437.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":175.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":178.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":177.15,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":180.66,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":437.97,"additional_payer_notes":"APC"}]}]},{"description":"Nudt15 gene common variants","code_information":[{"code":"81306","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":291.36,"maximum":727.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":291.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":297.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":294.27,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":300.1,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":727.53,"additional_payer_notes":"APC"}]}]},{"description":"Palb2 gene full gene seq","code_information":[{"code":"81307","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":676.5,"maximum":1689.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":676.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":690.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":683.26,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":696.8,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1689.22,"additional_payer_notes":"APC"}]}]},{"description":"Palb2 gene known famil vrnt","code_information":[{"code":"81308","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":301.35,"maximum":752.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":301.35,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":307.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":304.36,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":310.39,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":752.47,"additional_payer_notes":"APC"}]}]},{"description":"Pik3ca gene trgt seq alys","code_information":[{"code":"81309","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":274.83,"maximum":686.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":274.83,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":280.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":277.58,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":283.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":686.25,"additional_payer_notes":"APC"}]}]},{"description":"Npm1 gene","code_information":[{"code":"81310","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":246.52,"maximum":615.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":246.52,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":251.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":248.99,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":253.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":615.56,"additional_payer_notes":"APC"}]}]},{"description":"Nras gene variants exon 2&3","code_information":[{"code":"81311","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":295.79,"maximum":738.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":295.79,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":301.71,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":298.75,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":304.66,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":738.59,"additional_payer_notes":"APC"}]}]},{"description":"Pabpn1 gene detc abnor allel","code_information":[{"code":"81312","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":137.0,"maximum":342.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":137.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":139.74,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":138.37,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":141.11,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":342.09,"additional_payer_notes":"APC"}]}]},{"description":"Pca3/klk3 antigen","code_information":[{"code":"81313","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":255.05,"maximum":636.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":255.05,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":260.15,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":257.6,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":262.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":636.86,"additional_payer_notes":"APC"}]}]},{"description":"Pdgfra gene","code_information":[{"code":"81314","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":329.51,"maximum":822.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":329.51,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":336.1,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":332.81,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":339.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":822.79,"additional_payer_notes":"APC"}]}]},{"description":"Pml/raralpha com breakpoints","code_information":[{"code":"81315","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":207.31,"maximum":517.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":207.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":211.46,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":209.38,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":213.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":517.65,"additional_payer_notes":"APC"}]}]},{"description":"Pml/raralpha 1 breakpoint","code_information":[{"code":"81316","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":207.31,"maximum":517.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":207.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":211.46,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":209.38,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":213.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":517.65,"additional_payer_notes":"APC"}]}]},{"description":"Pms2 gene full seq analysis","code_information":[{"code":"81317","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":676.5,"maximum":1689.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":676.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":690.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":683.26,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":696.8,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1689.22,"additional_payer_notes":"APC"}]}]},{"description":"Pms2 known familial variants","code_information":[{"code":"81318","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":331.0,"maximum":826.51,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":331.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":337.62,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":334.31,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":340.93,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":826.51,"additional_payer_notes":"APC"}]}]},{"description":"Pms2 gene dup/delet variants","code_information":[{"code":"81319","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":203.5,"maximum":508.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":203.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":207.57,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":205.54,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":209.6,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":508.14,"additional_payer_notes":"APC"}]}]},{"description":"Plcg2 gene common variants","code_information":[{"code":"81320","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":291.36,"maximum":727.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":291.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":297.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":294.27,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":300.1,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":727.53,"additional_payer_notes":"APC"}]}]},{"description":"Pten gene full sequence","code_information":[{"code":"81321","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":600.0,"maximum":1498.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":600.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":612.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":606.0,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":618.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1498.2,"additional_payer_notes":"APC"}]}]},{"description":"Pten gene known fam variant","code_information":[{"code":"81322","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":46.6,"maximum":116.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":46.6,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":47.53,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":47.07,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":48.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":116.36,"additional_payer_notes":"APC"}]}]},{"description":"Pten gene dup/delet variant","code_information":[{"code":"81323","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":300.0,"maximum":749.1,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":300.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":306.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":303.0,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":309.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":749.1,"additional_payer_notes":"APC"}]}]},{"description":"Pmp22 gene dup/delet","code_information":[{"code":"81324","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":758.36,"maximum":1893.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":758.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":773.53,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":765.94,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":781.11,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1893.62,"additional_payer_notes":"APC"}]}]},{"description":"Pmp22 gene full sequence","code_information":[{"code":"81325","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":769.58,"maximum":1921.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":769.58,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":784.97,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":777.28,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":792.67,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1921.64,"additional_payer_notes":"APC"}]}]},{"description":"Pmp22 gene known fam variant","code_information":[{"code":"81326","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":46.6,"maximum":116.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":46.6,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":47.53,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":47.07,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":48.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":116.36,"additional_payer_notes":"APC"}]}]},{"description":"Sept9 methylation analysis","code_information":[{"code":"81327","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":192.0,"maximum":479.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":192.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":195.84,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":193.92,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":197.76,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":479.42,"additional_payer_notes":"APC"}]}]},{"description":"Slco1b1 gene com variants","code_information":[{"code":"81328","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":174.81,"maximum":436.50,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":174.81,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":178.31,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":176.56,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":180.05,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":436.5,"additional_payer_notes":"APC"}]}]},{"description":"Smn1 gene dos/deletion alys","code_information":[{"code":"81329","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":137.0,"maximum":342.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":137.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":139.74,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":138.37,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":141.11,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":342.09,"additional_payer_notes":"APC"}]}]},{"description":"Smpd1 gene common variants","code_information":[{"code":"81330","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":47.0,"maximum":117.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":47.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":47.94,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":47.47,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":48.41,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":117.36,"additional_payer_notes":"APC"}]}]},{"description":"Snrpn/ube3a gene","code_information":[{"code":"81331","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":51.07,"maximum":127.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":51.07,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":52.09,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":51.58,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":52.6,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":127.52,"additional_payer_notes":"APC"}]}]},{"description":"Serpina1 gene","code_information":[{"code":"81332","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":43.65,"maximum":108.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":43.65,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":44.52,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":44.09,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":44.96,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":108.99,"additional_payer_notes":"APC"}]}]},{"description":"Tgfbi gene common variants","code_information":[{"code":"81333","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":137.0,"maximum":342.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":137.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":139.74,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":138.37,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":141.11,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":342.09,"additional_payer_notes":"APC"}]}]},{"description":"Runx1 gene targeted seq alys","code_information":[{"code":"81334","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":329.51,"maximum":822.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":329.51,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":336.1,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":332.81,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":339.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":822.79,"additional_payer_notes":"APC"}]}]},{"description":"Tpmt gene com variants","code_information":[{"code":"81335","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":174.81,"maximum":436.50,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":174.81,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":178.31,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":176.56,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":180.05,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":436.5,"additional_payer_notes":"APC"}]}]},{"description":"Smn1 gene full gene sequence","code_information":[{"code":"81336","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":301.35,"maximum":752.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":301.35,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":307.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":304.36,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":310.39,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":752.47,"additional_payer_notes":"APC"}]}]},{"description":"Smn1 gen nown famil seq vrnt","code_information":[{"code":"81337","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":185.2,"maximum":462.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":185.2,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":188.9,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":187.05,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":190.76,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":462.44,"additional_payer_notes":"APC"}]}]},{"description":"Mpl gene common variants","code_information":[{"code":"81338","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":150.33,"maximum":375.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":150.33,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":153.34,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":151.83,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":154.84,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":375.37,"additional_payer_notes":"APC"}]}]},{"description":"Mpl gene seq alys exon 10","code_information":[{"code":"81339","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":185.2,"maximum":462.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":185.2,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":188.9,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":187.05,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":190.76,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":462.44,"additional_payer_notes":"APC"}]}]},{"description":"Trb@ gene rearrange amplify","code_information":[{"code":"81340","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":208.92,"maximum":521.67,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":208.92,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":213.1,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":211.01,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":215.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":521.67,"additional_payer_notes":"APC"}]}]},{"description":"Trb@ gene rearrange dirprobe","code_information":[{"code":"81341","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":49.59,"maximum":123.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":49.59,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":50.58,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":50.09,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":51.08,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":123.83,"additional_payer_notes":"APC"}]}]},{"description":"Trg gene rearrangement anal","code_information":[{"code":"81342","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":201.5,"maximum":503.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":201.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":205.53,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":203.52,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":207.54,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":503.15,"additional_payer_notes":"APC"}]}]},{"description":"Ppp2r2b gen detc abnor allel","code_information":[{"code":"81343","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":137.0,"maximum":342.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":137.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":139.74,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":138.37,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":141.11,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":342.09,"additional_payer_notes":"APC"}]}]},{"description":"Tbp gene detc abnor alleles","code_information":[{"code":"81344","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":137.0,"maximum":342.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":137.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":139.74,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":138.37,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":141.11,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":342.09,"additional_payer_notes":"APC"}]}]},{"description":"Tert gene targeted seq alys","code_information":[{"code":"81345","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":185.2,"maximum":462.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":185.2,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":188.9,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":187.05,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":190.76,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":462.44,"additional_payer_notes":"APC"}]}]},{"description":"Tyms gene com variants","code_information":[{"code":"81346","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":174.81,"maximum":436.50,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":174.81,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":178.31,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":176.56,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":180.05,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":436.5,"additional_payer_notes":"APC"}]}]},{"description":"Sf3b1 gene common variants","code_information":[{"code":"81347","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":193.25,"maximum":482.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":193.25,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":197.12,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":195.18,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":199.05,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":482.55,"additional_payer_notes":"APC"}]}]},{"description":"Srsf2 gene common variants","code_information":[{"code":"81348","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":175.4,"maximum":437.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":175.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":178.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":177.15,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":180.66,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":437.97,"additional_payer_notes":"APC"}]}]},{"description":"Cytog alys chrml abnr lw-ps","code_information":[{"code":"81349","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1197.94,"maximum":2991.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1197.94,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1221.9,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1209.92,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1233.88,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2991.26,"additional_payer_notes":"APC"}]}]},{"description":"Ugt1a1 gene","code_information":[{"code":"81350","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":234.0,"maximum":584.30,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":234.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":238.68,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":236.34,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":241.02,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":584.3,"additional_payer_notes":"APC"}]}]},{"description":"Tp53 gene full gene sequence","code_information":[{"code":"81351","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":641.85,"maximum":1602.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":641.85,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":654.69,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":648.27,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":661.11,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1602.7,"additional_payer_notes":"APC"}]}]},{"description":"Tp53 gene trgt sequence alys","code_information":[{"code":"81352","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":329.51,"maximum":822.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":329.51,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":336.1,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":332.81,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":339.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":822.79,"additional_payer_notes":"APC"}]}]},{"description":"Tp53 gene known famil vrnt","code_information":[{"code":"81353","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":308.0,"maximum":769.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":308.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":314.16,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":311.08,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":317.24,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":769.08,"additional_payer_notes":"APC"}]}]},{"description":"Cytog alys chrml abnor ogm","code_information":[{"code":"81354","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1263.53,"maximum":3155.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1263.53,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1288.8,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1276.17,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1301.44,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3155.03,"additional_payer_notes":"APC"}]}]},{"description":"Vkorc1 gene","code_information":[{"code":"81355","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":88.2,"maximum":220.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":88.2,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":89.96,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":89.08,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":90.85,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":220.24,"additional_payer_notes":"APC"}]}]},{"description":"U2af1 gene common variants","code_information":[{"code":"81357","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":193.25,"maximum":482.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":193.25,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":197.12,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":195.18,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":199.05,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":482.55,"additional_payer_notes":"APC"}]}]},{"description":"Zrsr2 gene common variants","code_information":[{"code":"81360","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":193.25,"maximum":482.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":193.25,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":197.12,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":195.18,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":199.05,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":482.55,"additional_payer_notes":"APC"}]}]},{"description":"Hbb gene com variants","code_information":[{"code":"81361","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":174.81,"maximum":436.50,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":174.81,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":178.31,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":176.56,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":180.05,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":436.5,"additional_payer_notes":"APC"}]}]},{"description":"Hbb gene known fam variant","code_information":[{"code":"81362","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":375.25,"maximum":937.00,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":375.25,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":382.76,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":379.0,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":386.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":937.0,"additional_payer_notes":"APC"}]}]},{"description":"Hbb gene dup/del variants","code_information":[{"code":"81363","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":202.4,"maximum":505.39,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":202.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":206.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":204.42,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":208.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":505.39,"additional_payer_notes":"APC"}]}]},{"description":"Hbb full gene sequence","code_information":[{"code":"81364","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":324.58,"maximum":810.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":324.58,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":331.07,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":327.83,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":334.32,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":810.48,"additional_payer_notes":"APC"}]}]},{"description":"Hla i & ii typing lr","code_information":[{"code":"81370","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":402.12,"maximum":1004.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":402.12,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":410.16,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":406.14,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":414.18,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1004.09,"additional_payer_notes":"APC"}]}]},{"description":"Hla i & ii type verify lr","code_information":[{"code":"81371","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":404.52,"maximum":1010.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":404.52,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":412.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":408.57,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":416.66,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1010.09,"additional_payer_notes":"APC"}]}]},{"description":"Hla i typing complete lr","code_information":[{"code":"81372","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":403.59,"maximum":1007.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":403.59,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":411.66,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":407.63,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":415.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1007.76,"additional_payer_notes":"APC"}]}]},{"description":"Hla i typing 1 locus lr","code_information":[{"code":"81373","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":127.43,"maximum":318.19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":127.43,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":129.98,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.7,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":131.25,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":318.19,"additional_payer_notes":"APC"}]}]},{"description":"Hla i typing 1 antigen lr","code_information":[{"code":"81374","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":74.33,"maximum":185.60,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":74.33,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":75.82,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":75.07,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":76.56,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":185.6,"additional_payer_notes":"APC"}]}]},{"description":"Hla ii typing ag equiv lr","code_information":[{"code":"81375","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":220.74,"maximum":551.19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":220.74,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":225.15,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":222.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":227.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":551.19,"additional_payer_notes":"APC"}]}]},{"description":"Hla ii typing 1 locus lr","code_information":[{"code":"81376","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":122.22,"maximum":305.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":122.22,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":124.66,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":123.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":125.89,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":305.18,"additional_payer_notes":"APC"}]}]},{"description":"Hla ii type 1 ag equiv lr","code_information":[{"code":"81377","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":94.74,"maximum":236.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":94.74,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":96.63,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":95.69,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":97.58,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":236.57,"additional_payer_notes":"APC"}]}]},{"description":"Hla i & ii typing hr","code_information":[{"code":"81378","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":345.57,"maximum":862.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":345.57,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":352.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":349.03,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":355.94,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":862.89,"additional_payer_notes":"APC"}]}]},{"description":"Hla i typing complete hr","code_information":[{"code":"81379","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":335.38,"maximum":837.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":335.38,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":342.09,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":338.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":345.44,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":837.44,"additional_payer_notes":"APC"}]}]},{"description":"Hla i typing 1 locus hr","code_information":[{"code":"81380","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":177.25,"maximum":442.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":177.25,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":180.8,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":179.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":182.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":442.59,"additional_payer_notes":"APC"}]}]},{"description":"Hla i typing 1 allele hr","code_information":[{"code":"81381","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":169.9,"maximum":424.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":169.9,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":173.3,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":171.6,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":175.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":424.24,"additional_payer_notes":"APC"}]}]},{"description":"Hla ii typing 1 loc hr","code_information":[{"code":"81382","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":123.68,"maximum":308.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":123.68,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":126.15,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":124.92,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":127.39,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":308.83,"additional_payer_notes":"APC"}]}]},{"description":"Hla ii typing 1 allele hr","code_information":[{"code":"81383","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":109.13,"maximum":272.50,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":109.13,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":111.31,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":110.22,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":112.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":272.5,"additional_payer_notes":"APC"}]}]},{"description":"Mopath procedure level 1","code_information":[{"code":"81400","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":63.96,"maximum":159.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":63.96,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":65.24,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":64.6,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":65.88,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":159.71,"additional_payer_notes":"APC"}]}]},{"description":"Mopath procedure level 2","code_information":[{"code":"81401","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":137.0,"maximum":342.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":137.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":139.74,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":138.37,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":141.11,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":342.09,"additional_payer_notes":"APC"}]}]},{"description":"Mopath procedure level 3","code_information":[{"code":"81402","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":150.33,"maximum":375.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":150.33,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":153.34,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":151.83,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":154.84,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":375.37,"additional_payer_notes":"APC"}]}]},{"description":"Mopath procedure level 4","code_information":[{"code":"81403","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":185.2,"maximum":462.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":185.2,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":188.9,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":187.05,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":190.76,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":462.44,"additional_payer_notes":"APC"}]}]},{"description":"Mopath procedure level 5","code_information":[{"code":"81404","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":274.83,"maximum":686.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":274.83,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":280.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":277.58,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":283.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":686.25,"additional_payer_notes":"APC"}]}]},{"description":"Mopath procedure level 6","code_information":[{"code":"81405","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":301.35,"maximum":752.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":301.35,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":307.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":304.36,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":310.39,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":752.47,"additional_payer_notes":"APC"}]}]},{"description":"Mopath procedure level 7","code_information":[{"code":"81406","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":282.88,"maximum":706.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":282.88,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":288.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":285.71,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":291.37,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":706.35,"additional_payer_notes":"APC"}]}]},{"description":"Mopath procedure level 8","code_information":[{"code":"81407","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":846.27,"maximum":2113.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":846.27,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":863.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":854.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":871.66,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2113.14,"additional_payer_notes":"APC"}]}]},{"description":"Mopath procedure level 9","code_information":[{"code":"81408","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2000.0,"maximum":4994.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2000.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2040.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2020.0,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2060.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4994.0,"additional_payer_notes":"APC"}]}]},{"description":"Aortic dysfunction/dilation","code_information":[{"code":"81410","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":504.0,"maximum":1258.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":504.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":514.08,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":509.04,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":519.12,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1258.49,"additional_payer_notes":"APC"}]}]},{"description":"Aortic dysfunction/dilation","code_information":[{"code":"81411","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1350.19,"maximum":3371.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1350.19,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1377.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1363.69,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1390.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3371.42,"additional_payer_notes":"APC"}]}]},{"description":"Ashkenazi jewish assoc dis","code_information":[{"code":"81412","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2448.56,"maximum":6114.05,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2448.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2497.53,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2473.05,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2522.02,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":6114.05,"additional_payer_notes":"APC"}]}]},{"description":"Car ion chnnlpath inc 10 gns","code_information":[{"code":"81413","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":584.9,"maximum":1460.50,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":584.9,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":596.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":590.75,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":602.45,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1460.5,"additional_payer_notes":"APC"}]}]},{"description":"Car ion chnnlpath inc 2 gns","code_information":[{"code":"81414","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":584.9,"maximum":1460.50,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":584.9,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":596.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":590.75,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":602.45,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1460.5,"additional_payer_notes":"APC"}]}]},{"description":"Exome sequence analysis","code_information":[{"code":"81415","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4780.0,"maximum":11935.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4780.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4875.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4827.8,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4923.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":11935.66,"additional_payer_notes":"APC"}]}]},{"description":"Exome sequence analysis","code_information":[{"code":"81416","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12000.0,"maximum":29964.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12000.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12240.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12120.0,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12360.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":29964.0,"additional_payer_notes":"APC"}]}]},{"description":"Exome re-evaluation","code_information":[{"code":"81417","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":320.0,"maximum":799.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":320.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":326.4,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":323.2,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":329.6,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":799.04,"additional_payer_notes":"APC"}]}]},{"description":"Rx metab gen seq alys pnl 6","code_information":[{"code":"81418","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":917.08,"maximum":2289.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":917.08,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":935.42,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":926.25,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":944.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2289.95,"additional_payer_notes":"APC"}]}]},{"description":"Epilepsy gen seq alys panel","code_information":[{"code":"81419","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2448.56,"maximum":6114.05,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2448.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2497.53,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2473.05,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2522.02,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":6114.05,"additional_payer_notes":"APC"}]}]},{"description":"Fetal chrmoml aneuploidy","code_information":[{"code":"81420","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":759.05,"maximum":1895.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":759.05,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":774.23,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":766.64,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":781.82,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1895.35,"additional_payer_notes":"APC"}]}]},{"description":"Fetal chrmoml microdeltj","code_information":[{"code":"81422","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":759.05,"maximum":1895.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":759.05,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":774.23,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":766.64,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":781.82,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1895.35,"additional_payer_notes":"APC"}]}]},{"description":"Genome sequence analysis","code_information":[{"code":"81425","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5031.2,"maximum":12562.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5031.2,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5131.82,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5081.51,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5182.14,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":12562.91,"additional_payer_notes":"APC"}]}]},{"description":"Genome sequence analysis","code_information":[{"code":"81426","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2709.95,"maximum":6766.75,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2709.95,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2764.15,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2737.05,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2791.25,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":6766.75,"additional_payer_notes":"APC"}]}]},{"description":"Genome re-evaluation","code_information":[{"code":"81427","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2337.65,"maximum":5837.11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2337.65,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2384.4,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2361.03,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2407.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":5837.11,"additional_payer_notes":"APC"}]}]},{"description":"Hearing loss sequence analys","code_information":[{"code":"81430","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1625.0,"maximum":4057.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1625.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1657.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1641.25,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1673.75,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":4057.62,"additional_payer_notes":"APC"}]}]},{"description":"Hearing loss dup/del analys","code_information":[{"code":"81431","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":679.57,"maximum":1696.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":679.57,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":693.16,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":686.37,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":699.96,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1696.89,"additional_payer_notes":"APC"}]}]},{"description":"Hrdtry brst ca-rlatd dsordrs","code_information":[{"code":"81432","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1303.95,"maximum":3255.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1303.95,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1330.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1316.99,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1343.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3255.96,"additional_payer_notes":"APC"}]}]},{"description":"Hereditary retinal disorders","code_information":[{"code":"81434","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":597.91,"maximum":1492.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":597.91,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":609.87,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":603.89,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":615.85,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1492.98,"additional_payer_notes":"APC"}]}]},{"description":"Hereditary colon ca dsordrs","code_information":[{"code":"81435","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1303.95,"maximum":3255.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1303.95,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1330.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1316.99,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1343.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3255.96,"additional_payer_notes":"APC"}]}]},{"description":"Heredtry nurondcrn tum dsrdr","code_information":[{"code":"81437","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1303.95,"maximum":3255.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1303.95,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1330.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1316.99,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1343.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3255.96,"additional_payer_notes":"APC"}]}]},{"description":"Inherited cardmypthy 5 gns","code_information":[{"code":"81439","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":584.9,"maximum":1460.50,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":584.9,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":596.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":590.75,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":602.45,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1460.5,"additional_payer_notes":"APC"}]}]},{"description":"Mitochondrial gene","code_information":[{"code":"81440","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3324.0,"maximum":8300.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3324.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3390.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3357.24,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3423.72,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8300.03,"additional_payer_notes":"APC"}]}]},{"description":"Ibmfs seq alys pnl 30 genes","code_information":[{"code":"81441","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2448.56,"maximum":6114.05,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2448.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2497.53,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2473.05,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2522.02,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":6114.05,"additional_payer_notes":"APC"}]}]},{"description":"Noonan spectrum disorders","code_information":[{"code":"81442","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2143.6,"maximum":5352.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2143.6,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2186.47,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2165.04,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2207.91,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":5352.57,"additional_payer_notes":"APC"}]}]},{"description":"Genetic tstg severe inh cond","code_information":[{"code":"81443","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2448.56,"maximum":6114.05,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2448.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2497.53,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2473.05,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2522.02,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":6114.05,"additional_payer_notes":"APC"}]}]},{"description":"Targeted genomic seq analys","code_information":[{"code":"81445","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":597.91,"maximum":1492.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":597.91,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":609.87,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":603.89,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":615.85,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1492.98,"additional_payer_notes":"APC"}]}]},{"description":"Hrdtry perph neurphy panel","code_information":[{"code":"81448","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":584.9,"maximum":1460.50,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":584.9,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":596.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":590.75,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":602.45,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1460.5,"additional_payer_notes":"APC"}]}]},{"description":"Tgsap so neo 5-50 rna alys","code_information":[{"code":"81449","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":597.91,"maximum":1492.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":597.91,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":609.87,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":603.89,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":615.85,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1492.98,"additional_payer_notes":"APC"}]}]},{"description":"Targeted genomic seq analys","code_information":[{"code":"81450","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":759.53,"maximum":1896.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":759.53,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":774.72,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":767.13,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":782.32,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1896.55,"additional_payer_notes":"APC"}]}]},{"description":"Tgsap hl neo 5-50 rna alys","code_information":[{"code":"81451","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":759.53,"maximum":1896.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":759.53,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":774.72,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":767.13,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":782.32,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1896.55,"additional_payer_notes":"APC"}]}]},{"description":"Targeted genomic seq analys","code_information":[{"code":"81455","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2919.6,"maximum":7290.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2919.6,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2977.99,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2948.8,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3007.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7290.24,"additional_payer_notes":"APC"}]}]},{"description":"Tgsap so/hl 51/< rna alys","code_information":[{"code":"81456","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2919.6,"maximum":7290.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2919.6,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2977.99,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2948.8,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3007.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7290.24,"additional_payer_notes":"APC"}]}]},{"description":"So neo gsap dna mcrstl ins","code_information":[{"code":"81457","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":896.87,"maximum":2239.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":896.87,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":914.81,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":905.84,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":923.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2239.48,"additional_payer_notes":"APC"}]}]},{"description":"So gsap dna cpy nmbr&mcrstl","code_information":[{"code":"81458","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1046.35,"maximum":2612.74,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1046.35,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1067.28,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1056.81,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1077.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2612.74,"additional_payer_notes":"APC"}]}]},{"description":"So neo gsap dna/dna&rna","code_information":[{"code":"81459","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2989.55,"maximum":7464.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2989.55,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3049.34,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3019.45,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3079.24,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7464.91,"additional_payer_notes":"APC"}]}]},{"description":"Whole mitochondrial genome","code_information":[{"code":"81460","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1287.0,"maximum":3213.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1287.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1312.74,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1299.87,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1325.61,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3213.64,"additional_payer_notes":"APC"}]}]},{"description":"So gsap cll fr dna/dna&rna","code_information":[{"code":"81462","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1195.83,"maximum":2985.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1195.83,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1219.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1207.79,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1231.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2985.99,"additional_payer_notes":"APC"}]}]},{"description":"So gsap cl fr cpy nmbr&mcrst","code_information":[{"code":"81463","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1345.31,"maximum":3359.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1345.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1372.22,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1358.76,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1385.67,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3359.24,"additional_payer_notes":"APC"}]}]},{"description":"So gsap cll fr mcrstl ins","code_information":[{"code":"81464","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3288.51,"maximum":8211.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3288.51,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3354.28,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3321.4,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3387.17,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8211.41,"additional_payer_notes":"APC"}]}]},{"description":"Whole mitochondrial genome","code_information":[{"code":"81465","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":936.0,"maximum":2337.19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":936.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":954.72,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":945.36,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":964.08,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2337.19,"additional_payer_notes":"APC"}]}]},{"description":"X-linked intellectual dblt","code_information":[{"code":"81470","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":914.0,"maximum":2282.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":914.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":932.28,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":923.14,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":941.42,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2282.26,"additional_payer_notes":"APC"}]}]},{"description":"X-linked intellectual dblt","code_information":[{"code":"81471","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":914.0,"maximum":2282.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":914.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":932.28,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":923.14,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":941.42,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2282.26,"additional_payer_notes":"APC"}]}]},{"description":"Autoimmune rheumatoid arthr","code_information":[{"code":"81490","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":840.65,"maximum":2099.10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":840.65,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":857.46,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":849.06,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":865.87,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2099.1,"additional_payer_notes":"APC"}]}]},{"description":"Cor artery disease mrna","code_information":[{"code":"81493","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1050.0,"maximum":2621.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1050.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1071.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1060.5,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1081.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2621.85,"additional_payer_notes":"APC"}]}]},{"description":"Onco (ovar) two proteins","code_information":[{"code":"81500","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":260.5,"maximum":650.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":260.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":265.71,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":263.1,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":268.32,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":650.47,"additional_payer_notes":"APC"}]}]},{"description":"Onco (ovar) five proteins","code_information":[{"code":"81503","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":897.0,"maximum":2239.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":897.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":914.94,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":905.97,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":923.91,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":2239.81,"additional_payer_notes":"APC"}]}]},{"description":"Oncology tissue of origin","code_information":[{"code":"81504","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":520.0,"maximum":1298.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":520.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":530.4,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":525.2,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":535.6,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1298.44,"additional_payer_notes":"APC"}]}]},{"description":"Endo assay seven anal","code_information":[{"code":"81506","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":68.92,"maximum":172.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":68.92,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":70.3,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":69.61,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":70.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":172.09,"additional_payer_notes":"APC"}]}]},{"description":"Fetal aneuploidy trisom risk","code_information":[{"code":"81507","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":795.0,"maximum":1985.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":795.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":810.9,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":802.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":818.85,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1985.12,"additional_payer_notes":"APC"}]}]},{"description":"Ftl cgen abnor two proteins","code_information":[{"code":"81508","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":54.3,"maximum":135.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":54.3,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":55.39,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":54.84,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":55.93,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":135.59,"additional_payer_notes":"APC"}]}]},{"description":"Ftl cgen abnor 3 proteins","code_information":[{"code":"81509","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1487.37,"maximum":3713.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1487.37,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1517.12,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1502.24,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1531.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":3713.96,"additional_payer_notes":"APC"}]}]},{"description":"Ftl cgen abnor three anal","code_information":[{"code":"81510","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":55.54,"maximum":138.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":55.54,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":56.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":56.1,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":57.21,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":138.68,"additional_payer_notes":"APC"}]}]},{"description":"Ftl cgen abnor four anal","code_information":[{"code":"81511","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":153.5,"maximum":383.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":153.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":156.57,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":155.04,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":158.11,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":383.29,"additional_payer_notes":"APC"}]}]},{"description":"Ftl cgen abnor five anal","code_information":[{"code":"81512","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":69.52,"maximum":173.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":69.52,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":70.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":70.22,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":71.61,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":173.59,"additional_payer_notes":"APC"}]}]},{"description":"Nfct ds bv rna vag flu alg","code_information":[{"code":"81513","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":142.63,"maximum":356.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":142.63,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":145.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":144.06,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":146.91,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":356.15,"additional_payer_notes":"APC"}]}]},{"description":"Nfct ds bv&vaginitis dna alg","code_information":[{"code":"81514","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":262.99,"maximum":656.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":262.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":268.25,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":265.62,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":270.88,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":656.69,"additional_payer_notes":"APC"}]}]},{"description":"Nfct ds bv&vaginitis dna alg","code_information":[{"code":"81515","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":262.99,"maximum":656.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":262.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":268.25,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":265.62,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":270.88,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":656.69,"additional_payer_notes":"APC"}]}]},{"description":"Liver ds alys 3 bmrk srm alg","code_information":[{"code":"81517","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":176.19,"maximum":439.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":176.19,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":179.71,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":177.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":181.48,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":439.95,"additional_payer_notes":"APC"}]}]},{"description":"Onc brst mrna 11 genes","code_information":[{"code":"81518","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3873.0,"maximum":9670.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3873.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3950.46,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3911.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3989.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":9670.88,"additional_payer_notes":"APC"}]}]},{"description":"Oncology breast mrna","code_information":[{"code":"81519","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3873.0,"maximum":9670.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3873.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3950.46,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3911.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3989.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":9670.88,"additional_payer_notes":"APC"}]}]},{"description":"Onc breast mrna 58 genes","code_information":[{"code":"81520","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2510.21,"maximum":6267.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2510.21,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2560.41,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2535.31,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2585.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":6267.99,"additional_payer_notes":"APC"}]}]},{"description":"Onc breast mrna 70 genes","code_information":[{"code":"81521","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3873.0,"maximum":9670.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3873.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3950.46,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3911.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3989.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":9670.88,"additional_payer_notes":"APC"}]}]},{"description":"Onc breast mrna 12 genes","code_information":[{"code":"81522","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3873.0,"maximum":9670.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3873.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3950.46,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3911.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3989.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":9670.88,"additional_payer_notes":"APC"}]}]},{"description":"Onc brst mrna 70 cnt 31 gene","code_information":[{"code":"81523","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3873.0,"maximum":9670.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3873.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3950.46,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3911.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3989.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":9670.88,"additional_payer_notes":"APC"}]}]},{"description":"Oncology colon mrna","code_information":[{"code":"81525","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3116.0,"maximum":7780.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3116.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3178.32,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3147.16,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3209.48,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7780.65,"additional_payer_notes":"APC"}]}]},{"description":"Oncology colorectal scr","code_information":[{"code":"81528","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":508.87,"maximum":1270.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":508.87,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":519.05,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":513.96,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":524.14,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1270.65,"additional_payer_notes":"APC"}]}]},{"description":"Onc cutan mlnma mrna 31 gene","code_information":[{"code":"81529","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7193.0,"maximum":17960.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7193.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7336.86,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7264.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7408.79,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17960.92,"additional_payer_notes":"APC"}]}]},{"description":"Oncology gynecologic","code_information":[{"code":"81535","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":579.46,"maximum":1446.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":579.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":591.05,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":585.25,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":596.84,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1446.91,"additional_payer_notes":"APC"}]}]},{"description":"Oncology gynecologic","code_information":[{"code":"81536","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":177.56,"maximum":443.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":177.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":181.11,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":179.34,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":182.89,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":443.37,"additional_payer_notes":"APC"}]}]},{"description":"Oncology lung","code_information":[{"code":"81538","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2871.0,"maximum":7168.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2871.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2928.42,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2899.71,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2957.13,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7168.89,"additional_payer_notes":"APC"}]}]},{"description":"Oncology prostate prob score","code_information":[{"code":"81539","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":760.0,"maximum":1897.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":760.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":775.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":767.6,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":782.8,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1897.72,"additional_payer_notes":"APC"}]}]},{"description":"Oncology tum unknown origin","code_information":[{"code":"81540","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3750.0,"maximum":9363.75,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3750.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3825.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3787.5,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3862.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":9363.75,"additional_payer_notes":"APC"}]}]},{"description":"Onc prostate mrna 46 genes","code_information":[{"code":"81541","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3873.0,"maximum":9670.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3873.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3950.46,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3911.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3989.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":9670.88,"additional_payer_notes":"APC"}]}]},{"description":"Onc prostate mrna 22 cnt gen","code_information":[{"code":"81542","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3873.0,"maximum":9670.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3873.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3950.46,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3911.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3989.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":9670.88,"additional_payer_notes":"APC"}]}]},{"description":"Onc thyr mrna 10,196 gen alg","code_information":[{"code":"81546","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3600.0,"maximum":8989.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3600.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3672.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3636.0,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3708.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8989.2,"additional_payer_notes":"APC"}]}]},{"description":"Onc prostate 3 genes","code_information":[{"code":"81551","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2030.0,"maximum":5068.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2030.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2070.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2050.3,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2090.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":5068.91,"additional_payer_notes":"APC"}]}]},{"description":"Onc uveal mlnma mrna 15 gene","code_information":[{"code":"81552","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7776.0,"maximum":19416.67,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7776.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7931.52,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7853.76,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8009.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":19416.67,"additional_payer_notes":"APC"}]}]},{"description":"Pulm ds ipf mrna 190 gen alg","code_information":[{"code":"81554","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5409.6,"maximum":13507.77,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5409.6,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5517.79,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5463.7,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5571.89,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":13507.77,"additional_payer_notes":"APC"}]}]},{"description":"Trnspl rej kdn mrna qpcr 139","code_information":[{"code":"81558","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3240.0,"maximum":8090.28,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3240.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3304.8,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3272.4,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3337.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8090.28,"additional_payer_notes":"APC"}]}]},{"description":"Trnsplj pd lvr&bwl cd154+cll","code_information":[{"code":"81560","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":640.73,"maximum":1599.90,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":640.73,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":653.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":647.14,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":659.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1599.9,"additional_payer_notes":"APC"}]}]},{"description":"Cardiology hrt trnspl mrna","code_information":[{"code":"81595","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3240.0,"maximum":8090.28,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3240.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3304.8,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3272.4,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3337.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8090.28,"additional_payer_notes":"APC"}]}]},{"description":"Nfct ds chrnc hcv 6 assays","code_information":[{"code":"81596","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":72.19,"maximum":180.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":72.19,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":73.63,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":72.91,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":74.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":180.26,"additional_payer_notes":"APC"}]}]},{"description":"Test for acetone/ketones","code_information":[{"code":"82009","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.52,"maximum":11.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.52,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4.57,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.66,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":11.29,"additional_payer_notes":"APC"}]}]},{"description":"Acetone assay","code_information":[{"code":"82010","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":8.17,"maximum":20.40,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8.25,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.42,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":20.4,"additional_payer_notes":"APC"}]}]},{"description":"Acetylcholinesterase assay","code_information":[{"code":"82013","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.29,"maximum":30.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.29,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.41,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.66,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":30.69,"additional_payer_notes":"APC"}]}]},{"description":"Acylcarnitines qual","code_information":[{"code":"82016","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16.49,"maximum":41.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.49,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16.82,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16.65,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.98,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":41.18,"additional_payer_notes":"APC"}]}]},{"description":"Acylcarnitines quant","code_information":[{"code":"82017","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16.87,"maximum":42.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.87,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17.21,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17.04,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.38,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":42.12,"additional_payer_notes":"APC"}]}]},{"description":"Assay of acth","code_information":[{"code":"82024","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":38.62,"maximum":96.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":38.62,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39.39,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39.01,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":39.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":96.43,"additional_payer_notes":"APC"}]}]},{"description":"Assay of adp & amp","code_information":[{"code":"82030","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":25.8,"maximum":64.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25.8,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26.32,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26.06,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":64.42,"additional_payer_notes":"APC"}]}]},{"description":"Assay of serum albumin","code_information":[{"code":"82040","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.95,"maximum":12.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.95,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5.05,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5.0,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.1,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":12.36,"additional_payer_notes":"APC"}]}]},{"description":"Assay of urine albumin","code_information":[{"code":"82042","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7.78,"maximum":19.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.78,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7.94,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7.86,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.01,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":19.43,"additional_payer_notes":"APC"}]}]},{"description":"Microalbumin quantitative","code_information":[{"code":"82043","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5.78,"maximum":14.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.78,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5.9,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5.84,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14.43,"additional_payer_notes":"APC"}]}]},{"description":"Microalbumin semiquant","code_information":[{"code":"82044","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6.23,"maximum":15.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.23,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6.29,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.42,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":15.56,"additional_payer_notes":"APC"}]}]},{"description":"Albumin ischemia modified","code_information":[{"code":"82045","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":33.94,"maximum":84.75,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":33.94,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34.62,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34.28,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":34.96,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":84.75,"additional_payer_notes":"APC"}]}]},{"description":"Assay of breath ethanol","code_information":[{"code":"82075","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":30.0,"maximum":74.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30.3,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":74.91,"additional_payer_notes":"APC"}]}]},{"description":"Assay spec xcp ur&breath ia","code_information":[{"code":"82077","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.27,"maximum":43.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.27,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17.62,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.79,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":43.12,"additional_payer_notes":"APC"}]}]},{"description":"Assay of aldolase","code_information":[{"code":"82085","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9.71,"maximum":24.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.71,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9.9,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9.81,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":24.25,"additional_payer_notes":"APC"}]}]},{"description":"Assay of aldosterone","code_information":[{"code":"82088","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":40.75,"maximum":101.75,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":40.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":41.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":41.16,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":41.97,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":101.75,"additional_payer_notes":"APC"}]}]},{"description":"Alpha-1-antitrypsin total","code_information":[{"code":"82103","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.44,"maximum":33.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.44,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.71,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.57,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.84,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":33.56,"additional_payer_notes":"APC"}]}]},{"description":"Alpha-1-antitrypsin pheno","code_information":[{"code":"82104","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14.46,"maximum":36.11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.6,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.89,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":36.11,"additional_payer_notes":"APC"}]}]},{"description":"Alpha-fetoprotein serum","code_information":[{"code":"82105","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16.77,"maximum":41.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.77,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17.11,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16.94,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.27,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":41.87,"additional_payer_notes":"APC"}]}]},{"description":"Alpha-fetoprotein amniotic","code_information":[{"code":"82106","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.0,"maximum":42.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17.34,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17.17,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":42.45,"additional_payer_notes":"APC"}]}]},{"description":"Alpha-Fetoprotein L3","code_information":[{"code":"82107","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":64.41,"maximum":160.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":64.41,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":65.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":65.05,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":66.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":160.83,"additional_payer_notes":"APC"}]}]},{"description":"Assay of aluminum","code_information":[{"code":"82108","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":25.48,"maximum":63.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25.48,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25.99,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26.24,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":63.62,"additional_payer_notes":"APC"}]}]},{"description":"Amines vaginal fluid qual","code_information":[{"code":"82120","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5.99,"maximum":14.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6.11,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6.05,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.17,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14.96,"additional_payer_notes":"APC"}]}]},{"description":"Amino acid single qual","code_information":[{"code":"82127","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14.18,"maximum":35.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.46,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.32,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.61,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":35.41,"additional_payer_notes":"APC"}]}]},{"description":"Amino acids mult qual","code_information":[{"code":"82128","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.87,"maximum":34.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.87,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.15,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.01,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.29,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":34.63,"additional_payer_notes":"APC"}]}]},{"description":"Amino acids single quant","code_information":[{"code":"82131","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":22.98,"maximum":57.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22.98,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23.44,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23.21,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23.67,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":57.38,"additional_payer_notes":"APC"}]}]},{"description":"Assay aminolevulinic acid","code_information":[{"code":"82135","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16.45,"maximum":41.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.45,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16.78,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16.61,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.94,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":41.08,"additional_payer_notes":"APC"}]}]},{"description":"Amino acids quant 2-5","code_information":[{"code":"82136","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":19.61,"maximum":48.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19.81,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":48.97,"additional_payer_notes":"APC"}]}]},{"description":"Amino acids quan 6 or more","code_information":[{"code":"82139","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16.87,"maximum":42.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.87,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17.21,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17.04,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.38,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":42.12,"additional_payer_notes":"APC"}]}]},{"description":"Assay of ammonia","code_information":[{"code":"82140","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14.57,"maximum":36.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.57,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.86,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.72,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.01,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":36.38,"additional_payer_notes":"APC"}]}]},{"description":"Amniotic fluid scan","code_information":[{"code":"82143","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9.35,"maximum":23.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.35,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.63,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":23.35,"additional_payer_notes":"APC"}]}]},{"description":"Assay of amylase","code_information":[{"code":"82150","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6.48,"maximum":16.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.48,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6.54,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.67,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":16.18,"additional_payer_notes":"APC"}]}]},{"description":"Androstanediol glucuronide","code_information":[{"code":"82154","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":28.83,"maximum":71.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28.83,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29.41,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29.12,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":71.99,"additional_payer_notes":"APC"}]}]},{"description":"Assay of androstenedione","code_information":[{"code":"82157","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":29.28,"maximum":73.11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29.28,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29.87,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29.57,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30.16,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":73.11,"additional_payer_notes":"APC"}]}]},{"description":"Assay of androsterone","code_information":[{"code":"82160","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":25.55,"maximum":63.80,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25.55,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26.06,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25.81,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26.32,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":63.8,"additional_payer_notes":"APC"}]}]},{"description":"Assay of angiotensin II","code_information":[{"code":"82163","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":20.52,"maximum":51.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.52,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20.93,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21.14,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":51.24,"additional_payer_notes":"APC"}]}]},{"description":"Angiotensin I enzyme test","code_information":[{"code":"82164","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14.6,"maximum":36.46,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.6,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.89,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.75,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.04,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":36.46,"additional_payer_notes":"APC"}]}]},{"description":"Assay anti-mullerian horm","code_information":[{"code":"82166","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":38.62,"maximum":96.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":38.62,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39.39,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39.01,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":39.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":96.43,"additional_payer_notes":"APC"}]}]},{"description":"Assay of apolipoprotein","code_information":[{"code":"82172","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":21.09,"maximum":52.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21.09,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21.3,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21.72,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":52.66,"additional_payer_notes":"APC"}]}]},{"description":"Assay of arsenic","code_information":[{"code":"82175","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18.97,"maximum":47.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.97,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19.16,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.54,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":47.37,"additional_payer_notes":"APC"}]}]},{"description":"Assay of ascorbic acid","code_information":[{"code":"82180","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9.89,"maximum":24.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10.09,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9.99,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":24.7,"additional_payer_notes":"APC"}]}]},{"description":"Atomic absorption","code_information":[{"code":"82190","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":15.9,"maximum":39.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.9,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16.22,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16.06,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.38,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":39.7,"additional_payer_notes":"APC"}]}]},{"description":"Assay of beta-2 protein","code_information":[{"code":"82232","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16.18,"maximum":40.40,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16.34,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.67,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":40.4,"additional_payer_notes":"APC"}]}]},{"description":"Beta-amyloid 1-40 (abeta 40)","code_information":[{"code":"82233","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":128.92,"maximum":321.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":128.92,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":131.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":130.21,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":132.79,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":321.91,"additional_payer_notes":"APC"}]}]},{"description":"Beta-amyloid 1-42 (abeta 42)","code_information":[{"code":"82234","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":128.92,"maximum":321.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":128.92,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":131.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":130.21,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":132.79,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":321.91,"additional_payer_notes":"APC"}]}]},{"description":"Bile acids total","code_information":[{"code":"82239","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.12,"maximum":42.75,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.12,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17.46,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17.29,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.63,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":42.75,"additional_payer_notes":"APC"}]}]},{"description":"Bile acids cholylglycine","code_information":[{"code":"82240","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":26.58,"maximum":66.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26.58,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27.11,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26.85,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27.38,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":66.37,"additional_payer_notes":"APC"}]}]},{"description":"Bilirubin total","code_information":[{"code":"82247","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5.02,"maximum":12.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.02,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5.12,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5.07,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.17,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":12.53,"additional_payer_notes":"APC"}]}]},{"description":"Bilirubin direct","code_information":[{"code":"82248","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5.02,"maximum":12.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.02,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5.12,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5.07,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.17,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":12.53,"additional_payer_notes":"APC"}]}]},{"description":"Fecal bilirubin test","code_information":[{"code":"82252","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.56,"maximum":11.39,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4.61,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":11.39,"additional_payer_notes":"APC"}]}]},{"description":"Assay of biotinidase","code_information":[{"code":"82261","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16.87,"maximum":42.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.87,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17.21,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17.04,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.38,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":42.12,"additional_payer_notes":"APC"}]}]},{"description":"Occult blood feces","code_information":[{"code":"82270","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.38,"maximum":10.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.38,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4.47,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4.42,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":10.94,"additional_payer_notes":"APC"}]}]},{"description":"Occult blood other sources","code_information":[{"code":"82271","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5.32,"maximum":13.28,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.32,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5.43,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5.37,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.48,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":13.28,"additional_payer_notes":"APC"}]}]},{"description":"Occult bld feces 1-3 tests","code_information":[{"code":"82272","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.23,"maximum":10.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.23,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4.31,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4.27,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":10.56,"additional_payer_notes":"APC"}]}]},{"description":"Assay test for blood fecal","code_information":[{"code":"82274","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":15.92,"maximum":39.75,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.92,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16.24,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16.08,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":39.75,"additional_payer_notes":"APC"}]}]},{"description":"Assay of bradykinin","code_information":[{"code":"82286","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5.16,"maximum":12.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.16,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5.26,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5.21,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":12.88,"additional_payer_notes":"APC"}]}]},{"description":"Assay of cadmium","code_information":[{"code":"82300","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":23.64,"maximum":59.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23.64,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24.11,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23.88,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24.35,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":59.03,"additional_payer_notes":"APC"}]}]},{"description":"Vitamin d 25 hydroxy","code_information":[{"code":"82306","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":29.6,"maximum":73.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29.6,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30.49,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":73.91,"additional_payer_notes":"APC"}]}]},{"description":"Assay of calcitonin","code_information":[{"code":"82308","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":26.79,"maximum":66.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26.79,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27.06,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":66.89,"additional_payer_notes":"APC"}]}]},{"description":"Assay of calcium","code_information":[{"code":"82310","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5.16,"maximum":12.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.16,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5.26,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5.21,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":12.88,"additional_payer_notes":"APC"}]}]},{"description":"Assay of calcium","code_information":[{"code":"82330","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.68,"maximum":34.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.68,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.82,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.09,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":34.16,"additional_payer_notes":"APC"}]}]},{"description":"Calcium infusion test","code_information":[{"code":"82331","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.34,"maximum":33.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.34,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.47,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":33.31,"additional_payer_notes":"APC"}]}]},{"description":"Assay of calcium in urine","code_information":[{"code":"82340","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6.03,"maximum":15.06,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.03,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6.15,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6.09,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.21,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":15.06,"additional_payer_notes":"APC"}]}]},{"description":"Calculus analysis qual","code_information":[{"code":"82355","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.58,"maximum":28.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.58,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11.81,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11.7,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.93,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":28.92,"additional_payer_notes":"APC"}]}]},{"description":"Calculus assay quant","code_information":[{"code":"82360","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.87,"maximum":32.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.87,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.13,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.0,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.26,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":32.14,"additional_payer_notes":"APC"}]}]},{"description":"Calculus spectroscopy","code_information":[{"code":"82365","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.9,"maximum":32.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.9,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.16,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.03,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.29,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":32.21,"additional_payer_notes":"APC"}]}]},{"description":"X-ray assay calculus","code_information":[{"code":"82370","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.52,"maximum":31.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.52,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.77,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.65,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":31.26,"additional_payer_notes":"APC"}]}]},{"description":"Assay c-d transfer measure","code_information":[{"code":"82373","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18.06,"maximum":45.10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.06,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.42,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.24,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.6,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":45.1,"additional_payer_notes":"APC"}]}]},{"description":"Assay blood carbon dioxide","code_information":[{"code":"82374","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.88,"maximum":12.19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.88,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4.98,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.03,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":12.19,"additional_payer_notes":"APC"}]}]},{"description":"Assay carboxyhb quant","code_information":[{"code":"82375","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.32,"maximum":30.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.32,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.57,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":30.76,"additional_payer_notes":"APC"}]}]},{"description":"Assay carboxyhb qual","code_information":[{"code":"82376","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14.07,"maximum":35.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.07,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.21,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.49,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":35.13,"additional_payer_notes":"APC"}]}]},{"description":"Carcinoembryonic antigen","code_information":[{"code":"82378","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18.96,"maximum":47.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.96,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19.34,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19.15,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":47.34,"additional_payer_notes":"APC"}]}]},{"description":"Assay of carnitine","code_information":[{"code":"82379","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16.87,"maximum":42.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.87,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17.21,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17.04,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.38,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":42.12,"additional_payer_notes":"APC"}]}]},{"description":"Assay of carotene","code_information":[{"code":"82380","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9.22,"maximum":23.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.22,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9.4,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9.31,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":23.02,"additional_payer_notes":"APC"}]}]},{"description":"Assay urine catecholamines","code_information":[{"code":"82382","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":27.3,"maximum":68.17,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27.3,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27.85,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27.57,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28.12,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":68.17,"additional_payer_notes":"APC"}]}]},{"description":"Assay blood catecholamines","code_information":[{"code":"82383","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":29.08,"maximum":72.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29.08,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29.66,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29.37,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":72.61,"additional_payer_notes":"APC"}]}]},{"description":"Assay three catecholamines","code_information":[{"code":"82384","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":25.25,"maximum":63.05,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25.25,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25.76,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25.5,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26.01,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":63.05,"additional_payer_notes":"APC"}]}]},{"description":"Assay of cathepsin-d","code_information":[{"code":"82387","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18.06,"maximum":45.10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.06,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.42,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.24,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.6,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":45.1,"additional_payer_notes":"APC"}]}]},{"description":"Assay of ceruloplasmin","code_information":[{"code":"82390","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10.74,"maximum":26.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.74,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10.85,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":26.82,"additional_payer_notes":"APC"}]}]},{"description":"Chemiluminescent assay","code_information":[{"code":"82397","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14.12,"maximum":35.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.12,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.4,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.26,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.54,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":35.26,"additional_payer_notes":"APC"}]}]},{"description":"Assay of chloramphenicol","code_information":[{"code":"82415","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.67,"maximum":31.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.92,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.8,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.05,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":31.64,"additional_payer_notes":"APC"}]}]},{"description":"Assay of blood chloride","code_information":[{"code":"82435","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.6,"maximum":11.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.6,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4.69,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4.65,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":11.49,"additional_payer_notes":"APC"}]}]},{"description":"Assay of urine chloride","code_information":[{"code":"82436","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5.75,"maximum":14.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5.86,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5.81,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14.36,"additional_payer_notes":"APC"}]}]},{"description":"Assay other fluid chlorides","code_information":[{"code":"82438","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5.0,"maximum":12.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5.1,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5.05,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.15,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":12.48,"additional_payer_notes":"APC"}]}]},{"description":"Test for chlorohydrocarbons","code_information":[{"code":"82441","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6.01,"maximum":15.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.01,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6.13,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6.07,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":15.01,"additional_payer_notes":"APC"}]}]},{"description":"Assay bld/serum cholesterol","code_information":[{"code":"82465","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.35,"maximum":10.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.35,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4.44,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4.39,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.48,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":10.86,"additional_payer_notes":"APC"}]}]},{"description":"Assay serum cholinesterase","code_information":[{"code":"82480","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7.87,"maximum":19.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.87,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.11,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":19.65,"additional_payer_notes":"APC"}]}]},{"description":"Assay rbc cholinesterase","code_information":[{"code":"82482","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9.81,"maximum":24.50,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.81,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10.01,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9.91,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.1,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":24.5,"additional_payer_notes":"APC"}]}]},{"description":"Assay chondroitin sulfate","code_information":[{"code":"82485","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":20.65,"maximum":51.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.65,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21.06,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20.86,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21.27,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":51.56,"additional_payer_notes":"APC"}]}]},{"description":"Assay of chromium","code_information":[{"code":"82495","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":20.28,"maximum":50.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.28,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20.69,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20.48,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.89,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":50.64,"additional_payer_notes":"APC"}]}]},{"description":"Assay of citrate","code_information":[{"code":"82507","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":27.8,"maximum":69.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27.8,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28.08,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28.63,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":69.42,"additional_payer_notes":"APC"}]}]},{"description":"Collagen crosslinks","code_information":[{"code":"82523","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18.68,"maximum":46.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.68,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19.05,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.87,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.24,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":46.64,"additional_payer_notes":"APC"}]}]},{"description":"Assay of copper","code_information":[{"code":"82525","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.41,"maximum":30.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.41,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.66,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.53,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":30.99,"additional_payer_notes":"APC"}]}]},{"description":"Assay of corticosterone","code_information":[{"code":"82528","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":22.52,"maximum":56.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22.52,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22.97,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22.75,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":56.23,"additional_payer_notes":"APC"}]}]},{"description":"Cortisol free","code_information":[{"code":"82530","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16.71,"maximum":41.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.71,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17.04,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16.88,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.21,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":41.72,"additional_payer_notes":"APC"}]}]},{"description":"Total cortisol","code_information":[{"code":"82533","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16.3,"maximum":40.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.3,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16.63,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16.46,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.79,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":40.7,"additional_payer_notes":"APC"}]}]},{"description":"Assay of creatine","code_information":[{"code":"82540","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.64,"maximum":11.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.64,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4.73,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4.69,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":11.59,"additional_payer_notes":"APC"}]}]},{"description":"Col chromotography qual/quan","code_information":[{"code":"82542","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":24.09,"maximum":60.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24.09,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24.57,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":60.15,"additional_payer_notes":"APC"}]}]},{"description":"Assay of ck (cpk)","code_information":[{"code":"82550","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6.51,"maximum":16.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.51,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6.64,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6.58,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.71,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":16.26,"additional_payer_notes":"APC"}]}]},{"description":"Assay of cpk in blood","code_information":[{"code":"82552","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.39,"maximum":33.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.39,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.66,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.52,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.79,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":33.43,"additional_payer_notes":"APC"}]}]},{"description":"Creatine mb fraction","code_information":[{"code":"82553","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.55,"maximum":28.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.55,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11.78,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11.67,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":28.84,"additional_payer_notes":"APC"}]}]},{"description":"Creatine isoforms","code_information":[{"code":"82554","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.87,"maximum":29.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.87,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.11,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11.99,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.23,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":29.64,"additional_payer_notes":"APC"}]}]},{"description":"Assay of creatinine","code_information":[{"code":"82565","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5.12,"maximum":12.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.12,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5.22,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5.17,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.27,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":12.78,"additional_payer_notes":"APC"}]}]},{"description":"Assay of urine creatinine","code_information":[{"code":"82570","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5.18,"maximum":12.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5.28,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5.23,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":12.93,"additional_payer_notes":"APC"}]}]},{"description":"Creatinine clearance test","code_information":[{"code":"82575","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9.46,"maximum":23.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9.55,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":23.62,"additional_payer_notes":"APC"}]}]},{"description":"Assay of cryofibrinogen","code_information":[{"code":"82585","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14.14,"maximum":35.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.14,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.42,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.28,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.56,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":35.31,"additional_payer_notes":"APC"}]}]},{"description":"Assay of cryoglobulin","code_information":[{"code":"82595","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6.47,"maximum":16.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.47,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6.53,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.66,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":16.16,"additional_payer_notes":"APC"}]}]},{"description":"Assay of cyanide","code_information":[{"code":"82600","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":19.4,"maximum":48.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19.79,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19.59,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.98,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":48.44,"additional_payer_notes":"APC"}]}]},{"description":"Vitamin B-12","code_information":[{"code":"82607","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":15.08,"maximum":37.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.08,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15.23,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":37.65,"additional_payer_notes":"APC"}]}]},{"description":"B-12 binding capacity","code_information":[{"code":"82608","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14.32,"maximum":35.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.32,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.46,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.75,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":35.76,"additional_payer_notes":"APC"}]}]},{"description":"Cystatin c","code_information":[{"code":"82610","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18.52,"maximum":46.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.52,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.89,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.71,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.08,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":46.24,"additional_payer_notes":"APC"}]}]},{"description":"Test for urine cystines","code_information":[{"code":"82615","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9.55,"maximum":23.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.55,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9.74,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9.65,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.84,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":23.85,"additional_payer_notes":"APC"}]}]},{"description":"Dehydroepiandrosterone","code_information":[{"code":"82626","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":25.27,"maximum":63.10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25.27,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25.78,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25.52,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26.03,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":63.1,"additional_payer_notes":"APC"}]}]},{"description":"Dehydroepiandrosterone","code_information":[{"code":"82627","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":22.23,"maximum":55.51,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22.23,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22.67,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22.45,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":55.51,"additional_payer_notes":"APC"}]}]},{"description":"Desoxycorticosterone","code_information":[{"code":"82633","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":30.98,"maximum":77.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30.98,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31.29,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":31.91,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":77.36,"additional_payer_notes":"APC"}]}]},{"description":"Deoxycortisol","code_information":[{"code":"82634","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":29.28,"maximum":73.11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29.28,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29.87,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29.57,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30.16,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":73.11,"additional_payer_notes":"APC"}]}]},{"description":"Assay of dibucaine number","code_information":[{"code":"82638","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.25,"maximum":30.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.25,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.37,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.62,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":30.59,"additional_payer_notes":"APC"}]}]},{"description":"Dihydrotestosterone","code_information":[{"code":"82642","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":29.28,"maximum":73.11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29.28,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29.87,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29.57,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30.16,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":73.11,"additional_payer_notes":"APC"}]}]},{"description":"Vit d 1 25-dihydroxy","code_information":[{"code":"82652","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":38.5,"maximum":96.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":38.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39.27,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38.88,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":39.66,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":96.13,"additional_payer_notes":"APC"}]}]},{"description":"El-1 fecal quantitative","code_information":[{"code":"82653","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":22.97,"maximum":57.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22.97,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23.43,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23.2,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23.66,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":57.36,"additional_payer_notes":"APC"}]}]},{"description":"Pancreatic elastase fecal","code_information":[{"code":"82656","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.53,"maximum":28.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.53,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11.76,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11.65,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.88,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":28.79,"additional_payer_notes":"APC"}]}]},{"description":"Enzyme cell activity","code_information":[{"code":"82657","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":22.17,"maximum":55.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22.39,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22.84,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":55.36,"additional_payer_notes":"APC"}]}]},{"description":"Enzyme cell activity ra","code_information":[{"code":"82658","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":44.03,"maximum":109.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":44.03,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":44.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":44.47,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":45.35,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":109.94,"additional_payer_notes":"APC"}]}]},{"description":"Electrophoretic test","code_information":[{"code":"82664","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":61.5,"maximum":153.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":61.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":62.73,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":62.12,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":63.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":153.57,"additional_payer_notes":"APC"}]}]},{"description":"Assay of erythropoietin","code_information":[{"code":"82668","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18.79,"maximum":46.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.79,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.98,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.35,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":46.92,"additional_payer_notes":"APC"}]}]},{"description":"Assay of estradiol","code_information":[{"code":"82670","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":27.94,"maximum":69.77,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27.94,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28.22,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":69.77,"additional_payer_notes":"APC"}]}]},{"description":"Assay of estrogens","code_information":[{"code":"82671","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":32.3,"maximum":80.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":32.3,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32.62,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":33.27,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":80.65,"additional_payer_notes":"APC"}]}]},{"description":"Assay of estrogen","code_information":[{"code":"82672","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":21.7,"maximum":54.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21.7,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22.13,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21.92,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22.35,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":54.18,"additional_payer_notes":"APC"}]}]},{"description":"Assay of estriol","code_information":[{"code":"82677","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":24.18,"maximum":60.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24.66,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24.42,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24.91,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":60.38,"additional_payer_notes":"APC"}]}]},{"description":"Assay of estrone","code_information":[{"code":"82679","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":24.95,"maximum":62.30,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24.95,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25.2,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":62.3,"additional_payer_notes":"APC"}]}]},{"description":"Assay dir meas fr estradiol","code_information":[{"code":"82681","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":27.94,"maximum":69.77,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27.94,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28.22,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":69.77,"additional_payer_notes":"APC"}]}]},{"description":"Assay of ethylene glycol","code_information":[{"code":"82693","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14.9,"maximum":37.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.9,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15.05,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.35,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":37.21,"additional_payer_notes":"APC"}]}]},{"description":"Assay of etiocholanolone","code_information":[{"code":"82696","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":26.24,"maximum":65.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26.24,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26.76,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26.5,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27.03,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":65.52,"additional_payer_notes":"APC"}]}]},{"description":"Fats/lipids feces qual","code_information":[{"code":"82705","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5.1,"maximum":12.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.1,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5.15,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.25,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":12.73,"additional_payer_notes":"APC"}]}]},{"description":"Fats/lipids feces quant","code_information":[{"code":"82710","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16.8,"maximum":41.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.8,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17.14,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16.97,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":41.95,"additional_payer_notes":"APC"}]}]},{"description":"Assay of fecal fat","code_information":[{"code":"82715","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":22.97,"maximum":57.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22.97,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23.43,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23.2,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23.66,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":57.36,"additional_payer_notes":"APC"}]}]},{"description":"Assay of blood fatty acids","code_information":[{"code":"82725","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18.77,"maximum":46.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.77,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19.15,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.96,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.33,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":46.87,"additional_payer_notes":"APC"}]}]},{"description":"Long chain fatty acids","code_information":[{"code":"82726","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":19.75,"maximum":49.32,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20.14,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":49.32,"additional_payer_notes":"APC"}]}]},{"description":"Assay of ferritin","code_information":[{"code":"82728","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.63,"maximum":34.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.63,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.9,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.77,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.04,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":34.03,"additional_payer_notes":"APC"}]}]},{"description":"Assay of fetal fibronectin","code_information":[{"code":"82731","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":64.41,"maximum":160.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":64.41,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":65.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":65.05,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":66.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":160.83,"additional_payer_notes":"APC"}]}]},{"description":"Assay of fluoride","code_information":[{"code":"82735","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18.54,"maximum":46.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.54,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.1,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":46.29,"additional_payer_notes":"APC"}]}]},{"description":"Assay of folic acid serum","code_information":[{"code":"82746","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14.7,"maximum":36.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.7,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.99,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.85,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.14,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":36.71,"additional_payer_notes":"APC"}]}]},{"description":"Assay of folic acid rbc","code_information":[{"code":"82747","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.65,"maximum":44.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.65,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17.83,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.18,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":44.07,"additional_payer_notes":"APC"}]}]},{"description":"Assay of semen fructose","code_information":[{"code":"82757","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.34,"maximum":43.30,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.34,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17.69,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17.51,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.86,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":43.3,"additional_payer_notes":"APC"}]}]},{"description":"Assay of rbc galactokinase","code_information":[{"code":"82759","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":21.48,"maximum":53.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21.48,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21.69,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22.12,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":53.64,"additional_payer_notes":"APC"}]}]},{"description":"Assay of galactose","code_information":[{"code":"82760","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.2,"maximum":27.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.2,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11.42,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11.31,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.54,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":27.97,"additional_payer_notes":"APC"}]}]},{"description":"Assay galactose transferase","code_information":[{"code":"82775","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":21.07,"maximum":52.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21.07,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21.28,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":52.61,"additional_payer_notes":"APC"}]}]},{"description":"Galactose transferase test","code_information":[{"code":"82776","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.74,"maximum":29.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.74,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11.97,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11.86,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.09,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":29.31,"additional_payer_notes":"APC"}]}]},{"description":"Galectin-3","code_information":[{"code":"82777","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":44.25,"maximum":110.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":44.25,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":45.14,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":44.69,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":45.58,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":110.49,"additional_payer_notes":"APC"}]}]},{"description":"Assay iga/igd/igg/igm each","code_information":[{"code":"82784","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9.3,"maximum":23.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.3,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9.39,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.58,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":23.22,"additional_payer_notes":"APC"}]}]},{"description":"Assay of ige","code_information":[{"code":"82785","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16.46,"maximum":41.10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16.79,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16.62,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":41.1,"additional_payer_notes":"APC"}]}]},{"description":"Igg 1 2 3 or 4 each","code_information":[{"code":"82787","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":8.02,"maximum":20.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.02,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8.18,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8.1,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.26,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":20.03,"additional_payer_notes":"APC"}]}]},{"description":"Blood pH","code_information":[{"code":"82800","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.0,"maximum":27.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11.22,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11.11,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.33,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":27.47,"additional_payer_notes":"APC"}]}]},{"description":"Blood gases any combination","code_information":[{"code":"82803","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":26.07,"maximum":65.10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26.07,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26.59,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26.85,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":65.1,"additional_payer_notes":"APC"}]}]},{"description":"Blood gases w/o2 saturation","code_information":[{"code":"82805","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":78.77,"maximum":196.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":78.77,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":80.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":79.56,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":81.13,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":196.69,"additional_payer_notes":"APC"}]}]},{"description":"Blood gases o2 sat only","code_information":[{"code":"82810","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9.77,"maximum":24.40,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.77,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9.97,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9.87,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":24.4,"additional_payer_notes":"APC"}]}]},{"description":"Hemoglobin-oxygen affinity","code_information":[{"code":"82820","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.34,"maximum":33.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.34,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.47,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":33.31,"additional_payer_notes":"APC"}]}]},{"description":"Gastric analy w/ph ea spec","code_information":[{"code":"82930","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6.71,"maximum":16.75,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.71,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6.84,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6.78,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.91,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":16.75,"additional_payer_notes":"APC"}]}]},{"description":"Gastrin test","code_information":[{"code":"82938","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.69,"maximum":44.17,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.69,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.04,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17.87,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":44.17,"additional_payer_notes":"APC"}]}]},{"description":"Assay of gastrin","code_information":[{"code":"82941","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.63,"maximum":44.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.63,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17.98,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17.81,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.16,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":44.02,"additional_payer_notes":"APC"}]}]},{"description":"Assay of glucagon","code_information":[{"code":"82943","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14.29,"maximum":35.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.29,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.58,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.43,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.72,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":35.68,"additional_payer_notes":"APC"}]}]},{"description":"Glucose Other Fluid","code_information":[{"code":"82945","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3.93,"maximum":9.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4.01,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3.97,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.05,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":9.81,"additional_payer_notes":"APC"}]}]},{"description":"Glucagon tolerance test","code_information":[{"code":"82946","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.77,"maximum":44.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.77,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.13,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":44.37,"additional_payer_notes":"APC"}]}]},{"description":"Assay glucose blood quant","code_information":[{"code":"82947","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3.93,"maximum":9.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4.01,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3.97,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.05,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":9.81,"additional_payer_notes":"APC"}]}]},{"description":"Reagent strip/blood glucose","code_information":[{"code":"82948","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5.04,"maximum":12.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.04,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5.14,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5.09,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":12.58,"additional_payer_notes":"APC"}]}]},{"description":"Glucose test","code_information":[{"code":"82950","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.75,"maximum":11.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4.84,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4.8,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.89,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":11.86,"additional_payer_notes":"APC"}]}]},{"description":"Glucose tolerance test (GTT)","code_information":[{"code":"82951","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.87,"maximum":32.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.87,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.13,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.0,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.26,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":32.14,"additional_payer_notes":"APC"}]}]},{"description":"GTT-added samples","code_information":[{"code":"82952","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3.92,"maximum":9.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3.92,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3.96,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.04,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":9.79,"additional_payer_notes":"APC"}]}]},{"description":"Assay of g6pd enzyme","code_information":[{"code":"82955","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9.7,"maximum":24.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.7,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9.89,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9.8,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":24.22,"additional_payer_notes":"APC"}]}]},{"description":"Test for G6PD enzyme","code_information":[{"code":"82960","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6.05,"maximum":15.11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.05,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6.11,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.23,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":15.11,"additional_payer_notes":"APC"}]}]},{"description":"Glucose blood test","code_information":[{"code":"82962","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3.28,"maximum":8.19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3.28,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3.31,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3.38,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8.19,"additional_payer_notes":"APC"}]}]},{"description":"Assay of glucosidase","code_information":[{"code":"82963","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":21.48,"maximum":53.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21.48,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21.69,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22.12,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":53.64,"additional_payer_notes":"APC"}]}]},{"description":"Assay of gdh enzyme","code_information":[{"code":"82965","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.15,"maximum":32.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.15,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.41,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.28,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.54,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":32.84,"additional_payer_notes":"APC"}]}]},{"description":"Assay of GGT","code_information":[{"code":"82977","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7.2,"maximum":17.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.2,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7.34,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7.27,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.42,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17.98,"additional_payer_notes":"APC"}]}]},{"description":"Assay of glutathione","code_information":[{"code":"82978","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":15.45,"maximum":38.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.45,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15.76,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15.6,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.91,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":38.58,"additional_payer_notes":"APC"}]}]},{"description":"Assay rbc glutathione","code_information":[{"code":"82979","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9.44,"maximum":23.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.44,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9.63,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9.53,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.72,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":23.57,"additional_payer_notes":"APC"}]}]},{"description":"Assay of glycated protein","code_information":[{"code":"82985","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16.76,"maximum":41.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.76,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17.1,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.26,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":41.85,"additional_payer_notes":"APC"}]}]},{"description":"Assay of gonadotropin (fsh)","code_information":[{"code":"83001","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18.58,"maximum":46.39,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.58,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.77,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.14,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":46.39,"additional_payer_notes":"APC"}]}]},{"description":"Assay of gonadotropin (lh)","code_information":[{"code":"83002","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18.52,"maximum":46.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.52,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.89,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.71,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.08,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":46.24,"additional_payer_notes":"APC"}]}]},{"description":"Assay growth hormone (hgh)","code_information":[{"code":"83003","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16.67,"maximum":41.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16.84,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.17,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":41.62,"additional_payer_notes":"APC"}]}]},{"description":"Growth stimulation gene 2","code_information":[{"code":"83006","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":75.6,"maximum":188.77,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":75.6,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":77.11,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":76.36,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":77.87,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":188.77,"additional_payer_notes":"APC"}]}]},{"description":"H pylori (c-13) blood","code_information":[{"code":"83009","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":67.36,"maximum":168.20,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":67.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":68.71,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":68.03,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":69.38,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":168.2,"additional_payer_notes":"APC"}]}]},{"description":"Assay of haptoglobin quant","code_information":[{"code":"83010","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.58,"maximum":31.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.58,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.83,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.71,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.96,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":31.41,"additional_payer_notes":"APC"}]}]},{"description":"Assay of haptoglobins","code_information":[{"code":"83012","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":26.89,"maximum":67.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27.43,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27.16,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":67.14,"additional_payer_notes":"APC"}]}]},{"description":"H pylori (c-13) breath","code_information":[{"code":"83013","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":67.36,"maximum":168.20,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":67.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":68.71,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":68.03,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":69.38,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":168.2,"additional_payer_notes":"APC"}]}]},{"description":"H pylori drug admin","code_information":[{"code":"83014","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7.86,"maximum":19.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.86,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8.02,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7.94,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.1,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":19.63,"additional_payer_notes":"APC"}]}]},{"description":"Heavy metal qual any anal","code_information":[{"code":"83015","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":20.94,"maximum":52.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.94,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21.15,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":52.29,"additional_payer_notes":"APC"}]}]},{"description":"Heavy metal quant each nes","code_information":[{"code":"83018","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":21.96,"maximum":54.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21.96,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22.4,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22.18,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22.62,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":54.83,"additional_payer_notes":"APC"}]}]},{"description":"Hemoglobin electrophoresis","code_information":[{"code":"83020","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.87,"maximum":32.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.87,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.13,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.0,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.26,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":32.14,"additional_payer_notes":"APC"}]}]},{"description":"Hemoglobin chromotography","code_information":[{"code":"83021","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18.06,"maximum":45.10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.06,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.42,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.24,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.6,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":45.1,"additional_payer_notes":"APC"}]}]},{"description":"Hemoglobin copper sulfate","code_information":[{"code":"83026","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.01,"maximum":10.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.01,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4.09,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4.05,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.13,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":10.01,"additional_payer_notes":"APC"}]}]},{"description":"Fetal hemoglobin chemical","code_information":[{"code":"83030","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10.74,"maximum":26.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.74,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10.85,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":26.82,"additional_payer_notes":"APC"}]}]},{"description":"Fetal hemoglobin assay qual","code_information":[{"code":"83033","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":8.0,"maximum":19.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8.16,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8.08,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.24,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":19.98,"additional_payer_notes":"APC"}]}]},{"description":"Glycosylated hemoglobin test","code_information":[{"code":"83036","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9.71,"maximum":24.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.71,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9.9,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9.81,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":24.25,"additional_payer_notes":"APC"}]}]},{"description":"Glycosylated hb home device","code_information":[{"code":"83037","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9.71,"maximum":24.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.71,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9.9,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9.81,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":24.25,"additional_payer_notes":"APC"}]}]},{"description":"Blood methemoglobin test","code_information":[{"code":"83045","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6.49,"maximum":16.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.49,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6.62,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6.55,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":16.21,"additional_payer_notes":"APC"}]}]},{"description":"Blood methemoglobin assay","code_information":[{"code":"83050","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":8.2,"maximum":20.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.2,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8.28,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.45,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":20.48,"additional_payer_notes":"APC"}]}]},{"description":"Assay of plasma hemoglobin","code_information":[{"code":"83051","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7.31,"maximum":18.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7.46,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7.38,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":18.25,"additional_payer_notes":"APC"}]}]},{"description":"Blood sulfhemoglobin assay","code_information":[{"code":"83060","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":8.8,"maximum":21.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.8,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8.98,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8.89,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":21.97,"additional_payer_notes":"APC"}]}]},{"description":"Assay of hemoglobin heat","code_information":[{"code":"83065","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9.0,"maximum":22.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9.18,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9.09,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.27,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":22.47,"additional_payer_notes":"APC"}]}]},{"description":"Hemoglobin stability screen","code_information":[{"code":"83068","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9.47,"maximum":23.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.47,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9.66,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9.56,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.75,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":23.65,"additional_payer_notes":"APC"}]}]},{"description":"Assay of urine hemoglobin","code_information":[{"code":"83069","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3.95,"maximum":9.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3.95,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3.99,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":9.86,"additional_payer_notes":"APC"}]}]},{"description":"Assay of hemosiderin qual","code_information":[{"code":"83070","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.75,"maximum":11.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4.84,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4.8,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.89,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":11.86,"additional_payer_notes":"APC"}]}]},{"description":"Assay of b hexosaminidase","code_information":[{"code":"83080","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16.87,"maximum":42.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.87,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17.21,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17.04,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.38,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":42.12,"additional_payer_notes":"APC"}]}]},{"description":"Assay of histamine","code_information":[{"code":"83088","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":29.53,"maximum":73.74,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29.53,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30.12,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29.83,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30.42,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":73.74,"additional_payer_notes":"APC"}]}]},{"description":"Assay Of Homocystine","code_information":[{"code":"83090","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.92,"maximum":44.75,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.92,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.28,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.1,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.46,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":44.75,"additional_payer_notes":"APC"}]}]},{"description":"Assay of homovanillic acid","code_information":[{"code":"83150","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":22.41,"maximum":55.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22.41,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22.86,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22.63,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23.08,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":55.96,"additional_payer_notes":"APC"}]}]},{"description":"Assay of corticosteroids 17","code_information":[{"code":"83491","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.9,"maximum":44.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.9,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.26,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.08,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.44,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":44.7,"additional_payer_notes":"APC"}]}]},{"description":"Assay of 5-hiaa","code_information":[{"code":"83497","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.9,"maximum":32.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.9,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.16,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.03,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.29,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":32.21,"additional_payer_notes":"APC"}]}]},{"description":"Assay of progesterone 17-d","code_information":[{"code":"83498","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":27.17,"maximum":67.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27.71,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":67.84,"additional_payer_notes":"APC"}]}]},{"description":"Assay free hydroxyproline","code_information":[{"code":"83500","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":22.65,"maximum":56.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22.65,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23.1,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22.88,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23.33,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":56.56,"additional_payer_notes":"APC"}]}]},{"description":"Assay total hydroxyproline","code_information":[{"code":"83505","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":24.3,"maximum":60.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24.3,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24.79,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24.54,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25.03,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":60.68,"additional_payer_notes":"APC"}]}]},{"description":"Immunoassay nonantibody","code_information":[{"code":"83516","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.53,"maximum":28.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.53,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11.76,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11.65,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.88,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":28.79,"additional_payer_notes":"APC"}]}]},{"description":"Immunoassay dipstick","code_information":[{"code":"83518","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9.64,"maximum":24.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.64,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9.83,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9.74,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.93,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":24.07,"additional_payer_notes":"APC"}]}]},{"description":"Ria nonantibody","code_information":[{"code":"83519","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18.4,"maximum":45.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.77,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.58,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":45.94,"additional_payer_notes":"APC"}]}]},{"description":"Immunoassay quant nos nonab","code_information":[{"code":"83520","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.27,"maximum":43.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.27,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17.62,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.79,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":43.12,"additional_payer_notes":"APC"}]}]},{"description":"Ig light chains free each","code_information":[{"code":"83521","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.27,"maximum":43.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.27,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17.62,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.79,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":43.12,"additional_payer_notes":"APC"}]}]},{"description":"Assay of insulin","code_information":[{"code":"83525","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.43,"maximum":28.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.43,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11.66,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11.54,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":28.54,"additional_payer_notes":"APC"}]}]},{"description":"Assay of insulin","code_information":[{"code":"83527","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.95,"maximum":32.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.95,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.21,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.08,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":32.34,"additional_payer_notes":"APC"}]}]},{"description":"Assay of intrinsic factor","code_information":[{"code":"83528","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":19.82,"maximum":49.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.82,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20.22,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.41,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":49.49,"additional_payer_notes":"APC"}]}]},{"description":"Asay of interleukin-6 (il-6)","code_information":[{"code":"83529","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.27,"maximum":43.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.27,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17.62,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.79,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":43.12,"additional_payer_notes":"APC"}]}]},{"description":"Assay of iron","code_information":[{"code":"83540","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6.47,"maximum":16.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.47,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6.53,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.66,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":16.16,"additional_payer_notes":"APC"}]}]},{"description":"Iron binding test","code_information":[{"code":"83550","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":8.74,"maximum":21.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.74,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8.83,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":21.82,"additional_payer_notes":"APC"}]}]},{"description":"Assay of idh enzyme","code_information":[{"code":"83570","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":8.85,"maximum":22.10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.85,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8.94,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.12,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":22.1,"additional_payer_notes":"APC"}]}]},{"description":"Assay of ketogenic steroids","code_information":[{"code":"83582","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":15.47,"maximum":38.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.47,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15.78,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15.62,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.93,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":38.63,"additional_payer_notes":"APC"}]}]},{"description":"Assay 17- ketosteroids","code_information":[{"code":"83586","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.8,"maximum":31.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.8,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.06,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.18,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":31.96,"additional_payer_notes":"APC"}]}]},{"description":"Fractionation ketosteroids","code_information":[{"code":"83593","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":28.5,"maximum":71.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29.07,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28.78,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":71.16,"additional_payer_notes":"APC"}]}]},{"description":"Assay of lactic acid","code_information":[{"code":"83605","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.57,"maximum":28.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.57,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11.8,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11.69,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":28.89,"additional_payer_notes":"APC"}]}]},{"description":"Lactate (LD) (LDH) enzyme","code_information":[{"code":"83615","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6.04,"maximum":15.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.04,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6.16,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6.1,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":15.08,"additional_payer_notes":"APC"}]}]},{"description":"Assay of ldh enzymes","code_information":[{"code":"83625","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.79,"maximum":31.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.79,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.05,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.92,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.17,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":31.94,"additional_payer_notes":"APC"}]}]},{"description":"Lactoferrin fecal (qual)","code_information":[{"code":"83630","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":19.7,"maximum":49.19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.7,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20.09,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.29,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":49.19,"additional_payer_notes":"APC"}]}]},{"description":"Lactoferrin fecal (quant)","code_information":[{"code":"83631","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":19.63,"maximum":49.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.63,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20.02,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19.83,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":49.02,"additional_payer_notes":"APC"}]}]},{"description":"Placental lactogen","code_information":[{"code":"83632","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":20.22,"maximum":50.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.22,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20.62,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20.42,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.83,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":50.49,"additional_payer_notes":"APC"}]}]},{"description":"Test urine for lactose","code_information":[{"code":"83633","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.25,"maximum":28.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.25,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11.36,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":28.09,"additional_payer_notes":"APC"}]}]},{"description":"Assay of lead","code_information":[{"code":"83655","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.11,"maximum":30.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.11,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.23,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":30.24,"additional_payer_notes":"APC"}]}]},{"description":"L/s ratio fetal lung","code_information":[{"code":"83661","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":21.99,"maximum":54.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22.43,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22.21,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22.65,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":54.91,"additional_payer_notes":"APC"}]}]},{"description":"Foam stability fetal lung","code_information":[{"code":"83662","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18.91,"maximum":47.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.91,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19.29,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19.1,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.48,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":47.22,"additional_payer_notes":"APC"}]}]},{"description":"Fluoro polarize fetal lung","code_information":[{"code":"83663","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18.91,"maximum":47.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.91,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19.29,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19.1,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.48,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":47.22,"additional_payer_notes":"APC"}]}]},{"description":"Lamellar bdy fetal lung","code_information":[{"code":"83664","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":19.32,"maximum":48.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.32,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19.71,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19.51,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":48.24,"additional_payer_notes":"APC"}]}]},{"description":"Assay of lap enzyme","code_information":[{"code":"83670","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9.81,"maximum":24.50,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.81,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10.01,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9.91,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.1,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":24.5,"additional_payer_notes":"APC"}]}]},{"description":"Assay of lipase","code_information":[{"code":"83690","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6.89,"maximum":17.20,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6.96,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.1,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17.2,"additional_payer_notes":"APC"}]}]},{"description":"Assay of lipoprotein(a)","code_information":[{"code":"83695","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14.32,"maximum":35.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.32,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.46,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.75,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":35.76,"additional_payer_notes":"APC"}]}]},{"description":"Assay Lipoprotein Pla2","code_information":[{"code":"83698","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":46.31,"maximum":115.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":46.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":47.24,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":46.77,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":47.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":115.64,"additional_payer_notes":"APC"}]}]},{"description":"Lipopro bld electrophoretic","code_information":[{"code":"83700","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.26,"maximum":28.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.26,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11.37,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.6,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":28.12,"additional_payer_notes":"APC"}]}]},{"description":"Lipoprotein bld hr fraction","code_information":[{"code":"83701","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":33.86,"maximum":84.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":33.86,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34.2,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":34.88,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":84.55,"additional_payer_notes":"APC"}]}]},{"description":"Lipoprotein bld quan part","code_information":[{"code":"83704","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":34.19,"maximum":85.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":34.19,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34.87,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34.53,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":85.37,"additional_payer_notes":"APC"}]}]},{"description":"Assay of lipoprotein","code_information":[{"code":"83718","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":8.19,"maximum":20.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.19,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8.27,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.44,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":20.45,"additional_payer_notes":"APC"}]}]},{"description":"Assay of blood lipoprotein","code_information":[{"code":"83719","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.75,"maximum":31.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.88,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.13,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":31.84,"additional_payer_notes":"APC"}]}]},{"description":"Assay of blood lipoprotein","code_information":[{"code":"83721","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10.5,"maximum":26.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10.71,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10.6,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.82,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":26.22,"additional_payer_notes":"APC"}]}]},{"description":"Lipoprtn dir meas sd ldl chl","code_information":[{"code":"83722","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":34.19,"maximum":85.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":34.19,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34.87,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34.53,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":85.37,"additional_payer_notes":"APC"}]}]},{"description":"Assay of lrh hormone","code_information":[{"code":"83727","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.19,"maximum":42.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.19,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17.53,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17.36,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.71,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":42.92,"additional_payer_notes":"APC"}]}]},{"description":"Assay of magnesium","code_information":[{"code":"83735","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6.7,"maximum":16.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.7,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6.83,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6.77,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":16.73,"additional_payer_notes":"APC"}]}]},{"description":"Assay malate dehydrogenase","code_information":[{"code":"83775","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7.37,"maximum":18.40,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.37,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7.52,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":18.4,"additional_payer_notes":"APC"}]}]},{"description":"Assay of manganese","code_information":[{"code":"83785","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":26.65,"maximum":66.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26.65,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27.18,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26.92,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27.45,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":66.55,"additional_payer_notes":"APC"}]}]},{"description":"Mass spectrometry qual/quan","code_information":[{"code":"83789","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":24.11,"maximum":60.20,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24.11,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24.59,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24.35,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24.83,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":60.2,"additional_payer_notes":"APC"}]}]},{"description":"Assay of mercury","code_information":[{"code":"83825","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16.26,"maximum":40.60,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.26,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16.59,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16.42,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.75,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":40.6,"additional_payer_notes":"APC"}]}]},{"description":"Assay of metanephrines","code_information":[{"code":"83835","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16.94,"maximum":42.30,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.94,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17.28,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17.11,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.45,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":42.3,"additional_payer_notes":"APC"}]}]},{"description":"Assay of methemalbumin","code_information":[{"code":"83857","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10.74,"maximum":26.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.74,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10.85,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":26.82,"additional_payer_notes":"APC"}]}]},{"description":"Microfluid analy tears","code_information":[{"code":"83861","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":22.48,"maximum":56.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22.48,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22.93,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22.7,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23.15,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":56.13,"additional_payer_notes":"APC"}]}]},{"description":"Mucopolysaccharides","code_information":[{"code":"83864","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":28.5,"maximum":71.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29.07,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28.78,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":71.16,"additional_payer_notes":"APC"}]}]},{"description":"Assay synovial fluid mucin","code_information":[{"code":"83872","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5.86,"maximum":14.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.86,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5.98,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5.92,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.04,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14.63,"additional_payer_notes":"APC"}]}]},{"description":"Assay of csf protein","code_information":[{"code":"83873","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.2,"maximum":42.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.2,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17.37,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.72,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":42.95,"additional_payer_notes":"APC"}]}]},{"description":"Assay of myoglobin","code_information":[{"code":"83874","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.92,"maximum":32.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.92,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.18,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.05,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":32.26,"additional_payer_notes":"APC"}]}]},{"description":"Assay myeloperoxidase","code_information":[{"code":"83876","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":50.86,"maximum":127.00,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":50.86,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":51.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":51.37,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":52.39,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":127.0,"additional_payer_notes":"APC"}]}]},{"description":"Assay of natriuretic peptide","code_information":[{"code":"83880","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":39.26,"maximum":98.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":39.26,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":40.05,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39.65,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":40.44,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":98.03,"additional_payer_notes":"APC"}]}]},{"description":"Assay nephelometry not spec","code_information":[{"code":"83883","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.6,"maximum":33.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.6,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.87,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.74,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.01,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":33.96,"additional_payer_notes":"APC"}]}]},{"description":"Assay neurflmnt light chain","code_information":[{"code":"83884","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":116.23,"maximum":290.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":116.23,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":118.55,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":117.39,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":119.72,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":290.23,"additional_payer_notes":"APC"}]}]},{"description":"Assay of nickel","code_information":[{"code":"83885","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":24.51,"maximum":61.20,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24.51,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24.76,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25.25,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":61.2,"additional_payer_notes":"APC"}]}]},{"description":"Assay of nucleotidase","code_information":[{"code":"83915","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.15,"maximum":27.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.15,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11.26,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.48,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":27.84,"additional_payer_notes":"APC"}]}]},{"description":"Oligoclonal bands","code_information":[{"code":"83916","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":27.39,"maximum":68.39,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27.39,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27.94,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27.66,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28.21,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":68.39,"additional_payer_notes":"APC"}]}]},{"description":"Organic acids total quant","code_information":[{"code":"83918","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":23.6,"maximum":58.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23.6,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24.07,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23.84,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":58.93,"additional_payer_notes":"APC"}]}]},{"description":"Organic acids qual each","code_information":[{"code":"83919","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16.45,"maximum":41.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.45,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16.78,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16.61,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.94,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":41.08,"additional_payer_notes":"APC"}]}]},{"description":"Organic acid single quant","code_information":[{"code":"83921","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":21.21,"maximum":52.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21.21,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21.63,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21.42,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21.85,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":52.96,"additional_payer_notes":"APC"}]}]},{"description":"Assay of blood osmolality","code_information":[{"code":"83930","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6.61,"maximum":16.51,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6.74,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6.68,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":16.51,"additional_payer_notes":"APC"}]}]},{"description":"Assay of urine osmolality","code_information":[{"code":"83935","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6.82,"maximum":17.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.82,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6.96,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6.89,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.02,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17.03,"additional_payer_notes":"APC"}]}]},{"description":"Assay of osteocalcin","code_information":[{"code":"83937","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":29.85,"maximum":74.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29.85,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30.15,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30.75,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":74.54,"additional_payer_notes":"APC"}]}]},{"description":"Assay of oxalate","code_information":[{"code":"83945","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14.45,"maximum":36.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.45,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.74,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.59,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.88,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":36.08,"additional_payer_notes":"APC"}]}]},{"description":"Oncoprotein her-2/neu","code_information":[{"code":"83950","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":64.41,"maximum":160.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":64.41,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":65.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":65.05,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":66.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":160.83,"additional_payer_notes":"APC"}]}]},{"description":"Oncoprotein dcp","code_information":[{"code":"83951","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":64.41,"maximum":160.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":64.41,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":65.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":65.05,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":66.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":160.83,"additional_payer_notes":"APC"}]}]},{"description":"Assay of parathormone","code_information":[{"code":"83970","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":41.28,"maximum":103.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":41.28,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":42.11,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":41.69,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":42.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":103.08,"additional_payer_notes":"APC"}]}]},{"description":"Assay ph body fluid nos","code_information":[{"code":"83986","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3.58,"maximum":8.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3.58,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3.62,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8.94,"additional_payer_notes":"APC"}]}]},{"description":"Exhaled breath condensate","code_information":[{"code":"83987","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3.58,"maximum":8.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3.58,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3.62,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8.94,"additional_payer_notes":"APC"}]}]},{"description":"Assay for calprotectin fecal","code_information":[{"code":"83993","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":19.63,"maximum":49.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.63,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20.02,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19.83,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":49.02,"additional_payer_notes":"APC"}]}]},{"description":"Assay of blood pku","code_information":[{"code":"84030","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5.5,"maximum":13.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5.56,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.66,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":13.73,"additional_payer_notes":"APC"}]}]},{"description":"Assay of phenylketones","code_information":[{"code":"84035","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3.98,"maximum":9.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3.98,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4.06,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.1,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":9.94,"additional_payer_notes":"APC"}]}]},{"description":"Assay acid phosphatase","code_information":[{"code":"84060","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7.64,"maximum":19.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.64,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7.79,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7.72,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.87,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":19.08,"additional_payer_notes":"APC"}]}]},{"description":"Assay prostate phosphatase","code_information":[{"code":"84066","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9.66,"maximum":24.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9.85,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9.76,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":24.12,"additional_payer_notes":"APC"}]}]},{"description":"Assay alkaline phosphatase","code_information":[{"code":"84075","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5.18,"maximum":12.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5.28,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5.23,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":12.93,"additional_payer_notes":"APC"}]}]},{"description":"Assay alkaline phosphatase","code_information":[{"code":"84078","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":8.26,"maximum":20.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.26,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8.43,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8.34,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":20.63,"additional_payer_notes":"APC"}]}]},{"description":"Assay alkaline phosphatases","code_information":[{"code":"84080","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14.78,"maximum":36.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.78,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15.08,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":36.91,"additional_payer_notes":"APC"}]}]},{"description":"Assay phosphatidylglycerol","code_information":[{"code":"84081","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16.52,"maximum":41.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.52,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16.85,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16.69,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.02,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":41.25,"additional_payer_notes":"APC"}]}]},{"description":"Assay of rbc pg6d enzyme","code_information":[{"code":"84085","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9.44,"maximum":23.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.44,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9.63,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9.53,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.72,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":23.57,"additional_payer_notes":"APC"}]}]},{"description":"Assay phosphohexose enzymes","code_information":[{"code":"84087","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10.73,"maximum":26.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.73,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10.94,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10.84,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.05,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":26.79,"additional_payer_notes":"APC"}]}]},{"description":"Assay of phosphorus","code_information":[{"code":"84100","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.74,"maximum":11.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.74,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4.83,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4.79,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.88,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":11.84,"additional_payer_notes":"APC"}]}]},{"description":"Assay of urine phosphorus","code_information":[{"code":"84105","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5.78,"maximum":14.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.78,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5.9,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5.84,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14.43,"additional_payer_notes":"APC"}]}]},{"description":"Test for porphobilinogen","code_information":[{"code":"84106","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5.82,"maximum":14.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.82,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5.94,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5.88,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14.53,"additional_payer_notes":"APC"}]}]},{"description":"Assay of porphobilinogen","code_information":[{"code":"84110","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":8.44,"maximum":21.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.44,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8.52,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":21.07,"additional_payer_notes":"APC"}]}]},{"description":"Eval amniotic fluid protein","code_information":[{"code":"84112","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":98.11,"maximum":244.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":98.11,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":100.07,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":99.09,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":101.05,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":244.98,"additional_payer_notes":"APC"}]}]},{"description":"Test urine for porphyrins","code_information":[{"code":"84119","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.36,"maximum":33.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.63,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.49,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.76,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":33.36,"additional_payer_notes":"APC"}]}]},{"description":"Assay of urine porphyrins","code_information":[{"code":"84120","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14.71,"maximum":36.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.71,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.86,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.15,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":36.73,"additional_payer_notes":"APC"}]}]},{"description":"Assay of feces porphyrins","code_information":[{"code":"84126","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":39.11,"maximum":97.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":39.11,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39.89,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39.5,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":40.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":97.66,"additional_payer_notes":"APC"}]}]},{"description":"Assay of serum potassium","code_information":[{"code":"84132","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.76,"maximum":11.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.76,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4.86,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4.81,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":11.89,"additional_payer_notes":"APC"}]}]},{"description":"Assay of urine potassium","code_information":[{"code":"84133","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.73,"maximum":11.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.73,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4.82,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4.78,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.87,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":11.81,"additional_payer_notes":"APC"}]}]},{"description":"Assay of prealbumin","code_information":[{"code":"84134","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14.59,"maximum":36.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.59,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.74,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.03,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":36.43,"additional_payer_notes":"APC"}]}]},{"description":"Assay of pregnanediol","code_information":[{"code":"84135","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":21.27,"maximum":53.11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21.27,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21.48,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21.91,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":53.11,"additional_payer_notes":"APC"}]}]},{"description":"Assay of pregnanetriol","code_information":[{"code":"84138","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":21.05,"maximum":52.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21.05,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21.47,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21.26,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":52.56,"additional_payer_notes":"APC"}]}]},{"description":"Assay of pregnenolone","code_information":[{"code":"84140","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":20.67,"maximum":51.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21.08,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20.88,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21.29,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":51.61,"additional_payer_notes":"APC"}]}]},{"description":"Assay of 17-hydroxypregneno","code_information":[{"code":"84143","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":22.81,"maximum":56.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22.81,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23.27,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23.04,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23.49,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":56.96,"additional_payer_notes":"APC"}]}]},{"description":"Assay of progesterone","code_information":[{"code":"84144","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":20.86,"maximum":52.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.86,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21.28,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21.07,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21.49,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":52.09,"additional_payer_notes":"APC"}]}]},{"description":"Procalcitonin (PCT)","code_information":[{"code":"84145","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":27.22,"maximum":67.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27.22,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27.76,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27.49,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28.04,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":67.97,"additional_payer_notes":"APC"}]}]},{"description":"Assay of prolactin","code_information":[{"code":"84146","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":19.38,"maximum":48.39,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.38,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19.77,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19.57,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.96,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":48.39,"additional_payer_notes":"APC"}]}]},{"description":"Assay of prostaglandin","code_information":[{"code":"84150","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":41.77,"maximum":104.30,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":41.77,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":42.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":42.19,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":43.02,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":104.3,"additional_payer_notes":"APC"}]}]},{"description":"Assay of psa complexed","code_information":[{"code":"84152","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18.39,"maximum":45.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.39,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.76,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.57,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.94,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":45.92,"additional_payer_notes":"APC"}]}]},{"description":"Assay of psa total","code_information":[{"code":"84153","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18.39,"maximum":45.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.39,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.76,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.57,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.94,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":45.92,"additional_payer_notes":"APC"}]}]},{"description":"Assay of psa free","code_information":[{"code":"84154","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18.39,"maximum":45.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.39,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.76,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.57,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.94,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":45.92,"additional_payer_notes":"APC"}]}]},{"description":"Assay of protein serum","code_information":[{"code":"84155","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3.67,"maximum":9.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3.74,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3.71,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":9.16,"additional_payer_notes":"APC"}]}]},{"description":"Assay of protein urine","code_information":[{"code":"84156","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3.67,"maximum":9.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3.74,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3.71,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":9.16,"additional_payer_notes":"APC"}]}]},{"description":"Assay of protein other","code_information":[{"code":"84157","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.0,"maximum":9.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4.08,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4.04,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.12,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":9.99,"additional_payer_notes":"APC"}]}]},{"description":"Assay of protein any source","code_information":[{"code":"84160","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5.61,"maximum":14.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5.72,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5.67,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14.01,"additional_payer_notes":"APC"}]}]},{"description":"Pappa serum","code_information":[{"code":"84163","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":15.05,"maximum":37.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.05,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15.2,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":37.58,"additional_payer_notes":"APC"}]}]},{"description":"Protein e-phoresis serum","code_information":[{"code":"84165","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10.74,"maximum":26.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.74,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10.85,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":26.82,"additional_payer_notes":"APC"}]}]},{"description":"Protein e-phoresis/urine/csf","code_information":[{"code":"84166","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.83,"maximum":44.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.83,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.01,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":44.52,"additional_payer_notes":"APC"}]}]},{"description":"Western blot test","code_information":[{"code":"84181","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.03,"maximum":42.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.03,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17.2,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.54,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":42.52,"additional_payer_notes":"APC"}]}]},{"description":"Protein western blot test","code_information":[{"code":"84182","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":29.21,"maximum":72.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29.21,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29.79,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29.5,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30.09,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":72.94,"additional_payer_notes":"APC"}]}]},{"description":"Assay RBC protoporphyrin","code_information":[{"code":"84202","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14.35,"maximum":35.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.35,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.64,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.49,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":35.83,"additional_payer_notes":"APC"}]}]},{"description":"Test RBC protoporphyrin","code_information":[{"code":"84203","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9.74,"maximum":24.32,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.74,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9.93,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9.84,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.03,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":24.32,"additional_payer_notes":"APC"}]}]},{"description":"Assay of proinsulin","code_information":[{"code":"84206","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":26.69,"maximum":66.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26.69,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27.22,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26.96,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27.49,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":66.64,"additional_payer_notes":"APC"}]}]},{"description":"Assay of vitamin b-6","code_information":[{"code":"84207","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":28.1,"maximum":70.17,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28.1,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28.66,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28.38,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28.94,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":70.17,"additional_payer_notes":"APC"}]}]},{"description":"Assay of pyruvate","code_information":[{"code":"84210","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14.48,"maximum":36.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.48,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.77,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.62,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.91,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":36.16,"additional_payer_notes":"APC"}]}]},{"description":"Assay of pyruvate kinase","code_information":[{"code":"84220","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9.44,"maximum":23.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.44,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9.63,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9.53,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.72,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":23.57,"additional_payer_notes":"APC"}]}]},{"description":"Assay of quinine","code_information":[{"code":"84228","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.63,"maximum":29.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.63,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11.86,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11.75,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.98,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":29.04,"additional_payer_notes":"APC"}]}]},{"description":"Assay of estrogen","code_information":[{"code":"84233","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":87.88,"maximum":219.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":87.88,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":89.64,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":88.76,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":90.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":219.44,"additional_payer_notes":"APC"}]}]},{"description":"Assay of progesterone","code_information":[{"code":"84234","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":64.88,"maximum":162.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":64.88,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":66.18,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":65.53,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":66.83,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":162.01,"additional_payer_notes":"APC"}]}]},{"description":"Assay of endocrine hormone","code_information":[{"code":"84235","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":71.23,"maximum":177.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":71.23,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":72.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":71.94,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":73.37,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":177.86,"additional_payer_notes":"APC"}]}]},{"description":"Assay nonendocrine receptor","code_information":[{"code":"84238","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":36.57,"maximum":91.32,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.57,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37.3,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.94,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":37.67,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":91.32,"additional_payer_notes":"APC"}]}]},{"description":"Assay of renin","code_information":[{"code":"84244","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":21.99,"maximum":54.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22.43,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22.21,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22.65,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":54.91,"additional_payer_notes":"APC"}]}]},{"description":"Assay of vitamin b-2","code_information":[{"code":"84252","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":20.24,"maximum":50.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.24,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20.64,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.85,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":50.54,"additional_payer_notes":"APC"}]}]},{"description":"Assay of selenium","code_information":[{"code":"84255","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":25.53,"maximum":63.75,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25.53,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26.04,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25.79,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":63.75,"additional_payer_notes":"APC"}]}]},{"description":"Assay of serotonin","code_information":[{"code":"84260","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":30.98,"maximum":77.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30.98,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31.29,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":31.91,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":77.36,"additional_payer_notes":"APC"}]}]},{"description":"Assay of sex hormone globul","code_information":[{"code":"84270","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":21.73,"maximum":54.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21.73,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22.16,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22.38,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":54.26,"additional_payer_notes":"APC"}]}]},{"description":"Assay of sialic acid","code_information":[{"code":"84275","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.44,"maximum":33.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.44,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.71,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.57,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.84,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":33.56,"additional_payer_notes":"APC"}]}]},{"description":"Assay of silica","code_information":[{"code":"84285","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":25.21,"maximum":62.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25.21,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25.71,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25.46,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25.97,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":62.95,"additional_payer_notes":"APC"}]}]},{"description":"Assay of serum sodium","code_information":[{"code":"84295","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.81,"maximum":12.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.81,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4.86,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":12.01,"additional_payer_notes":"APC"}]}]},{"description":"Assay of urine sodium","code_information":[{"code":"84300","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5.06,"maximum":12.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.06,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5.16,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5.11,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.21,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":12.63,"additional_payer_notes":"APC"}]}]},{"description":"Assay of sweat sodium","code_information":[{"code":"84302","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.86,"maximum":12.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.86,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4.96,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4.91,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.01,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":12.14,"additional_payer_notes":"APC"}]}]},{"description":"Assay of somatomedin","code_information":[{"code":"84305","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":21.26,"maximum":53.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21.26,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21.69,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21.47,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":53.09,"additional_payer_notes":"APC"}]}]},{"description":"Assay of somatostatin","code_information":[{"code":"84307","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18.28,"maximum":45.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.28,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.46,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.83,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":45.65,"additional_payer_notes":"APC"}]}]},{"description":"Spectrophotometry","code_information":[{"code":"84311","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":8.1,"maximum":20.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.1,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8.26,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8.18,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":20.23,"additional_payer_notes":"APC"}]}]},{"description":"Body fluid specific gravity","code_information":[{"code":"84315","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3.28,"maximum":8.19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3.28,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3.31,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3.38,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8.19,"additional_payer_notes":"APC"}]}]},{"description":"Chromatogram assay sugars","code_information":[{"code":"84375","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":39.0,"maximum":97.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":39.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39.78,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39.39,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":40.17,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":97.38,"additional_payer_notes":"APC"}]}]},{"description":"Sugars single qual","code_information":[{"code":"84376","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5.5,"maximum":13.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5.56,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.66,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":13.73,"additional_payer_notes":"APC"}]}]},{"description":"Sugars multiple qual","code_information":[{"code":"84377","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5.5,"maximum":13.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5.56,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.66,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":13.73,"additional_payer_notes":"APC"}]}]},{"description":"Sugars single quant","code_information":[{"code":"84378","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.53,"maximum":28.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.53,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11.76,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11.65,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.88,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":28.79,"additional_payer_notes":"APC"}]}]},{"description":"Sugars multiple quant","code_information":[{"code":"84379","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.53,"maximum":28.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.53,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11.76,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11.65,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.88,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":28.79,"additional_payer_notes":"APC"}]}]},{"description":"Assay of urine sulfate","code_information":[{"code":"84392","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5.49,"maximum":13.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.49,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5.54,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.65,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":13.71,"additional_payer_notes":"APC"}]}]},{"description":"Tau phosphorylated ea","code_information":[{"code":"84393","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":128.92,"maximum":321.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":128.92,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":131.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":130.21,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":132.79,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":321.91,"additional_payer_notes":"APC"}]}]},{"description":"Total tau","code_information":[{"code":"84394","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":128.92,"maximum":321.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":128.92,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":131.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":130.21,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":132.79,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":321.91,"additional_payer_notes":"APC"}]}]},{"description":"Assay of free testosterone","code_information":[{"code":"84402","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":25.47,"maximum":63.60,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25.47,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25.98,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25.72,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26.23,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":63.6,"additional_payer_notes":"APC"}]}]},{"description":"Assay of total testosterone","code_information":[{"code":"84403","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":25.81,"maximum":64.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25.81,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26.07,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26.58,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":64.45,"additional_payer_notes":"APC"}]}]},{"description":"Testosterone bioavailable","code_information":[{"code":"84410","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":51.28,"maximum":128.05,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":51.28,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":52.31,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":51.79,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":52.82,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":128.05,"additional_payer_notes":"APC"}]}]},{"description":"Assay of vitamin b-1","code_information":[{"code":"84425","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":21.23,"maximum":53.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21.23,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21.87,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":53.01,"additional_payer_notes":"APC"}]}]},{"description":"Assay of thiocyanate","code_information":[{"code":"84430","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.63,"maximum":29.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.63,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11.86,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11.75,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.98,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":29.04,"additional_payer_notes":"APC"}]}]},{"description":"Thromboxane urine","code_information":[{"code":"84431","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.11,"maximum":87.67,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.11,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35.81,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35.46,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.16,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":87.67,"additional_payer_notes":"APC"}]}]},{"description":"Assay of thyroglobulin","code_information":[{"code":"84432","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16.06,"maximum":40.10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.06,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16.22,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.54,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":40.1,"additional_payer_notes":"APC"}]}]},{"description":"Asy thiopurin s-mthyltrnsfrs","code_information":[{"code":"84433","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":22.17,"maximum":55.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22.39,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22.84,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":55.36,"additional_payer_notes":"APC"}]}]},{"description":"Assay of total thyroxine","code_information":[{"code":"84436","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6.87,"maximum":17.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.87,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7.01,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6.94,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.08,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17.15,"additional_payer_notes":"APC"}]}]},{"description":"Assay of neonatal thyroxine","code_information":[{"code":"84437","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6.47,"maximum":16.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.47,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6.53,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.66,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":16.16,"additional_payer_notes":"APC"}]}]},{"description":"Assay of free thyroxine","code_information":[{"code":"84439","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9.02,"maximum":22.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.02,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9.11,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.29,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":22.52,"additional_payer_notes":"APC"}]}]},{"description":"Assay of thyroid activity","code_information":[{"code":"84442","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14.78,"maximum":36.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.78,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15.08,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":36.91,"additional_payer_notes":"APC"}]}]},{"description":"Assay thyroid stim hormone","code_information":[{"code":"84443","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16.8,"maximum":41.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.8,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17.14,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16.97,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":41.95,"additional_payer_notes":"APC"}]}]},{"description":"Assay of tsi globulin","code_information":[{"code":"84445","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":50.86,"maximum":127.00,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":50.86,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":51.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":51.37,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":52.39,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":127.0,"additional_payer_notes":"APC"}]}]},{"description":"Assay of vitamin e","code_information":[{"code":"84446","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14.18,"maximum":35.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.46,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.32,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.61,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":35.41,"additional_payer_notes":"APC"}]}]},{"description":"Assay of transcortin","code_information":[{"code":"84449","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18.0,"maximum":44.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.18,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.54,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":44.95,"additional_payer_notes":"APC"}]}]},{"description":"Transferase (AST) (SGOT)","code_information":[{"code":"84450","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5.18,"maximum":12.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5.28,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5.23,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":12.93,"additional_payer_notes":"APC"}]}]},{"description":"Alanine amino (ALT) (SGPT)","code_information":[{"code":"84460","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5.3,"maximum":13.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.3,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5.41,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5.35,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.46,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":13.23,"additional_payer_notes":"APC"}]}]},{"description":"Assay of transferrin","code_information":[{"code":"84466","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.76,"maximum":31.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.76,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.02,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.89,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.14,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":31.86,"additional_payer_notes":"APC"}]}]},{"description":"Assay of triglycerides","code_information":[{"code":"84478","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5.74,"maximum":14.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.74,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5.85,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5.8,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.91,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14.33,"additional_payer_notes":"APC"}]}]},{"description":"Assay of thyroid (t3 or t4)","code_information":[{"code":"84479","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6.47,"maximum":16.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.47,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6.53,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.66,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":16.16,"additional_payer_notes":"APC"}]}]},{"description":"Assay triiodothyronine (t3)","code_information":[{"code":"84480","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14.18,"maximum":35.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.46,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.32,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.61,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":35.41,"additional_payer_notes":"APC"}]}]},{"description":"Free assay (FT-3)","code_information":[{"code":"84481","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16.94,"maximum":42.30,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.94,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17.28,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17.11,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.45,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":42.3,"additional_payer_notes":"APC"}]}]},{"description":"T3 reverse","code_information":[{"code":"84482","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":15.76,"maximum":39.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.76,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16.08,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15.92,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.23,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":39.35,"additional_payer_notes":"APC"}]}]},{"description":"Assay of troponin quant","code_information":[{"code":"84484","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.47,"maximum":31.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.47,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.72,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.59,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.84,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":31.14,"additional_payer_notes":"APC"}]}]},{"description":"Assay duodenal fluid trypsin","code_information":[{"code":"84485","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7.2,"maximum":17.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.2,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7.34,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7.27,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.42,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17.98,"additional_payer_notes":"APC"}]}]},{"description":"Test feces for trypsin","code_information":[{"code":"84488","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7.3,"maximum":18.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.3,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7.37,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":18.23,"additional_payer_notes":"APC"}]}]},{"description":"Assay of feces for trypsin","code_information":[{"code":"84490","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9.93,"maximum":24.80,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10.13,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10.03,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.23,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":24.8,"additional_payer_notes":"APC"}]}]},{"description":"Assay of tyrosine","code_information":[{"code":"84510","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10.63,"maximum":26.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.63,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10.84,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10.74,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":26.54,"additional_payer_notes":"APC"}]}]},{"description":"Assay of troponin qual","code_information":[{"code":"84512","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10.09,"maximum":25.19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.09,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10.29,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10.19,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.39,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":25.19,"additional_payer_notes":"APC"}]}]},{"description":"Assay of urea nitrogen","code_information":[{"code":"84520","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3.95,"maximum":9.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3.95,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3.99,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":9.86,"additional_payer_notes":"APC"}]}]},{"description":"Urea nitrogen semi-quant","code_information":[{"code":"84525","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5.13,"maximum":12.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.13,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5.23,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5.18,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":12.81,"additional_payer_notes":"APC"}]}]},{"description":"Assay of urine/urea-n","code_information":[{"code":"84540","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5.56,"maximum":13.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5.67,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5.62,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":13.88,"additional_payer_notes":"APC"}]}]},{"description":"Urea-N clearance test","code_information":[{"code":"84545","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7.2,"maximum":17.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.2,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7.34,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7.27,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.42,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17.98,"additional_payer_notes":"APC"}]}]},{"description":"Assay of blood/uric acid","code_information":[{"code":"84550","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.52,"maximum":11.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.52,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4.57,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.66,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":11.29,"additional_payer_notes":"APC"}]}]},{"description":"Assay of urine/uric acid","code_information":[{"code":"84560","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5.08,"maximum":12.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.08,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5.18,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5.13,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.23,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":12.68,"additional_payer_notes":"APC"}]}]},{"description":"Assay of feces/urobilinogen","code_information":[{"code":"84577","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16.8,"maximum":41.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.8,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17.14,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16.97,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":41.95,"additional_payer_notes":"APC"}]}]},{"description":"Test urine urobilinogen","code_information":[{"code":"84578","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.47,"maximum":11.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.47,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4.51,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.6,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":11.16,"additional_payer_notes":"APC"}]}]},{"description":"Assay of urine urobilinogen","code_information":[{"code":"84580","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9.55,"maximum":23.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.55,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9.74,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9.65,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.84,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":23.85,"additional_payer_notes":"APC"}]}]},{"description":"Assay of urine urobilinogen","code_information":[{"code":"84583","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6.05,"maximum":15.11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.05,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6.11,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.23,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":15.11,"additional_payer_notes":"APC"}]}]},{"description":"Assay of urine vma","code_information":[{"code":"84585","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":15.5,"maximum":38.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15.81,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15.66,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.96,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":38.7,"additional_payer_notes":"APC"}]}]},{"description":"Assay of vip","code_information":[{"code":"84586","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.33,"maximum":88.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.33,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.04,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35.68,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.39,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":88.22,"additional_payer_notes":"APC"}]}]},{"description":"Assay of vasopressin","code_information":[{"code":"84588","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":33.94,"maximum":84.75,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":33.94,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34.62,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34.28,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":34.96,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":84.75,"additional_payer_notes":"APC"}]}]},{"description":"Assay of vitamin a","code_information":[{"code":"84590","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.61,"maximum":28.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11.84,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.96,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":28.99,"additional_payer_notes":"APC"}]}]},{"description":"Assay Of Nos Vitamin","code_information":[{"code":"84591","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.06,"maximum":42.60,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.06,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17.4,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17.23,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":42.6,"additional_payer_notes":"APC"}]}]},{"description":"Assay of vitamin k","code_information":[{"code":"84597","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.72,"maximum":34.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.72,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.99,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.86,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.13,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":34.26,"additional_payer_notes":"APC"}]}]},{"description":"Assay of volatiles","code_information":[{"code":"84600","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.11,"maximum":42.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.11,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17.28,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.62,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":42.72,"additional_payer_notes":"APC"}]}]},{"description":"Xylose tolerance test","code_information":[{"code":"84620","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.91,"maximum":32.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.91,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.04,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":32.24,"additional_payer_notes":"APC"}]}]},{"description":"Assay of zinc","code_information":[{"code":"84630","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.39,"maximum":28.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.39,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11.62,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11.5,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":28.44,"additional_payer_notes":"APC"}]}]},{"description":"Assay of c-peptide","code_information":[{"code":"84681","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":20.81,"maximum":51.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.81,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21.23,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21.43,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":51.96,"additional_payer_notes":"APC"}]}]},{"description":"Chorionic gonadotropin test","code_information":[{"code":"84702","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":15.05,"maximum":37.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.05,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15.2,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":37.58,"additional_payer_notes":"APC"}]}]},{"description":"Chorionic gonadotropin assay","code_information":[{"code":"84703","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7.52,"maximum":18.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.52,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7.67,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7.6,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.75,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":18.78,"additional_payer_notes":"APC"}]}]},{"description":"Hcg free betachain test","code_information":[{"code":"84704","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":15.29,"maximum":38.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.29,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.75,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":38.18,"additional_payer_notes":"APC"}]}]},{"description":"Ovulation tests","code_information":[{"code":"84830","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.7,"maximum":31.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.7,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.83,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.08,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":31.71,"additional_payer_notes":"APC"}]}]},{"description":"Bleeding time test","code_information":[{"code":"85002","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.82,"maximum":12.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.82,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4.92,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4.87,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.96,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":12.04,"additional_payer_notes":"APC"}]}]},{"description":"Automated diff wbc count","code_information":[{"code":"85004","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6.47,"maximum":16.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.47,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6.53,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.66,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":16.16,"additional_payer_notes":"APC"}]}]},{"description":"Bl smear w/diff wbc count","code_information":[{"code":"85007","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3.8,"maximum":9.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3.8,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3.84,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3.91,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":9.49,"additional_payer_notes":"APC"}]}]},{"description":"Bl smear w/o diff wbc count","code_information":[{"code":"85008","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3.43,"maximum":8.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3.43,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3.46,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":8.56,"additional_payer_notes":"APC"}]}]},{"description":"Manual diff wbc count b-coat","code_information":[{"code":"85009","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5.07,"maximum":12.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.07,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5.12,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":12.66,"additional_payer_notes":"APC"}]}]},{"description":"Spun microhematocrit","code_information":[{"code":"85013","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7.0,"maximum":17.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7.14,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7.07,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.21,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17.48,"additional_payer_notes":"APC"}]}]},{"description":"Hematocrit","code_information":[{"code":"85014","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2.37,"maximum":5.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2.37,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2.42,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2.39,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2.44,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":5.92,"additional_payer_notes":"APC"}]}]},{"description":"Hemoglobin","code_information":[{"code":"85018","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2.37,"maximum":5.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2.37,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2.42,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2.39,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2.44,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":5.92,"additional_payer_notes":"APC"}]}]},{"description":"Complete cbc w/auto diff wbc","code_information":[{"code":"85025","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7.77,"maximum":19.40,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.77,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7.93,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7.85,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":19.4,"additional_payer_notes":"APC"}]}]},{"description":"Complete cbc automated","code_information":[{"code":"85027","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6.47,"maximum":16.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.47,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6.53,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.66,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":16.16,"additional_payer_notes":"APC"}]}]},{"description":"Manual cell count each","code_information":[{"code":"85032","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.31,"maximum":10.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4.4,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4.35,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.44,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":10.76,"additional_payer_notes":"APC"}]}]},{"description":"Automated rbc count","code_information":[{"code":"85041","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3.02,"maximum":7.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3.02,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3.08,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3.05,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3.11,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":7.54,"additional_payer_notes":"APC"}]}]},{"description":"Manual reticulocyte count","code_information":[{"code":"85044","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.31,"maximum":10.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4.4,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4.35,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.44,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":10.76,"additional_payer_notes":"APC"}]}]},{"description":"Automated reticulocyte count","code_information":[{"code":"85045","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3.99,"maximum":9.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4.07,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4.03,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.11,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":9.96,"additional_payer_notes":"APC"}]}]},{"description":"Reticyte/hgb concentrate","code_information":[{"code":"85046","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5.57,"maximum":13.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.57,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5.68,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5.63,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":13.91,"additional_payer_notes":"APC"}]}]},{"description":"Automated leukocyte count","code_information":[{"code":"85048","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2.54,"maximum":6.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2.54,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2.59,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2.57,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2.62,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":6.34,"additional_payer_notes":"APC"}]}]},{"description":"Automated platelet count","code_information":[{"code":"85049","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.48,"maximum":11.19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.48,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4.57,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4.52,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.61,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":11.19,"additional_payer_notes":"APC"}]}]},{"description":"Reticulated platelet assay","code_information":[{"code":"85055","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.74,"maximum":89.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.74,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.1,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":89.24,"additional_payer_notes":"APC"}]}]},{"description":"Chromogenic substrate assay","code_information":[{"code":"85130","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.89,"maximum":29.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.13,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.01,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.25,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":29.69,"additional_payer_notes":"APC"}]}]},{"description":"Blood clot retraction","code_information":[{"code":"85170","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16.3,"maximum":40.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.3,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16.63,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16.46,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.79,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":40.7,"additional_payer_notes":"APC"}]}]},{"description":"Blood clot lysis time","code_information":[{"code":"85175","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":20.37,"maximum":50.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.37,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20.78,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20.57,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.98,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":50.86,"additional_payer_notes":"APC"}]}]},{"description":"Clot factor ii prothrom spec","code_information":[{"code":"85210","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.98,"maximum":32.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.98,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.24,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.11,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.37,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":32.41,"additional_payer_notes":"APC"}]}]},{"description":"Blooc clot factor v test","code_information":[{"code":"85220","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.65,"maximum":44.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.65,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17.83,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.18,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":44.07,"additional_payer_notes":"APC"}]}]},{"description":"Clot factor vii proconvertin","code_information":[{"code":"85230","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.9,"maximum":44.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.9,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.26,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.08,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.44,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":44.7,"additional_payer_notes":"APC"}]}]},{"description":"Clot factor viii ahg 1 stage","code_information":[{"code":"85240","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.9,"maximum":44.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.9,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.26,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.08,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.44,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":44.7,"additional_payer_notes":"APC"}]}]},{"description":"Clot factor viii reltd antgn","code_information":[{"code":"85244","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":20.42,"maximum":50.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.42,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20.83,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20.62,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21.03,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":50.99,"additional_payer_notes":"APC"}]}]},{"description":"Clot factor viii vw ristoctn","code_information":[{"code":"85245","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":22.94,"maximum":57.28,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22.94,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23.4,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23.17,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23.63,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":57.28,"additional_payer_notes":"APC"}]}]},{"description":"Clot factor viii vw antigen","code_information":[{"code":"85246","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":22.94,"maximum":57.28,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22.94,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23.4,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23.17,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23.63,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":57.28,"additional_payer_notes":"APC"}]}]},{"description":"Clot factor viii multimetric","code_information":[{"code":"85247","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":22.94,"maximum":57.28,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22.94,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23.4,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23.17,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23.63,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":57.28,"additional_payer_notes":"APC"}]}]},{"description":"Clot factor ix ptc/chrstmas","code_information":[{"code":"85250","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":19.04,"maximum":47.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.04,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19.42,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19.23,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.61,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":47.54,"additional_payer_notes":"APC"}]}]},{"description":"Clot factor x stuart-power","code_information":[{"code":"85260","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.9,"maximum":44.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.9,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.26,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.08,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.44,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":44.7,"additional_payer_notes":"APC"}]}]},{"description":"Clot factor xi pta","code_information":[{"code":"85270","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.9,"maximum":44.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.9,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.26,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.08,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.44,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":44.7,"additional_payer_notes":"APC"}]}]},{"description":"Clot factor xii hageman","code_information":[{"code":"85280","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":19.35,"maximum":48.32,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.35,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19.74,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19.54,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.93,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":48.32,"additional_payer_notes":"APC"}]}]},{"description":"Clot factor xiii fibrin stab","code_information":[{"code":"85290","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16.34,"maximum":40.80,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.34,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16.67,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16.5,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.83,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":40.8,"additional_payer_notes":"APC"}]}]},{"description":"Clot factor xiii fibrin scrn","code_information":[{"code":"85291","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9.11,"maximum":22.75,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.11,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9.29,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9.2,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.38,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":22.75,"additional_payer_notes":"APC"}]}]},{"description":"Clot factor fletcher fact","code_information":[{"code":"85292","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18.93,"maximum":47.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19.31,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19.12,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":47.27,"additional_payer_notes":"APC"}]}]},{"description":"Clot factor wght kininogen","code_information":[{"code":"85293","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18.93,"maximum":47.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19.31,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19.12,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":47.27,"additional_payer_notes":"APC"}]}]},{"description":"Antithrombin iii activity","code_information":[{"code":"85300","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.85,"maximum":29.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.85,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.09,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11.97,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.21,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":29.59,"additional_payer_notes":"APC"}]}]},{"description":"Antithrombin iii antigen","code_information":[{"code":"85301","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10.81,"maximum":26.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.81,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10.92,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.13,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":26.99,"additional_payer_notes":"APC"}]}]},{"description":"Clot inhibit prot c antigen","code_information":[{"code":"85302","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.01,"maximum":29.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.01,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.25,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.13,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.37,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":29.99,"additional_payer_notes":"APC"}]}]},{"description":"Clot inhibit prot c activity","code_information":[{"code":"85303","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.84,"maximum":34.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.84,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.12,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.98,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.26,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":34.56,"additional_payer_notes":"APC"}]}]},{"description":"Clot inhibit prot s total","code_information":[{"code":"85305","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.61,"maximum":28.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11.84,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.96,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":28.99,"additional_payer_notes":"APC"}]}]},{"description":"Clot inhibit prot s free","code_information":[{"code":"85306","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":15.32,"maximum":38.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.32,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15.63,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15.47,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":38.25,"additional_payer_notes":"APC"}]}]},{"description":"Assay Activated Protein C","code_information":[{"code":"85307","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":15.32,"maximum":38.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.32,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15.63,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15.47,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":38.25,"additional_payer_notes":"APC"}]}]},{"description":"Factor inhibitor test","code_information":[{"code":"85335","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.87,"maximum":32.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.87,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.13,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.0,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.26,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":32.14,"additional_payer_notes":"APC"}]}]},{"description":"Thrombomodulin","code_information":[{"code":"85337","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.27,"maximum":43.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.27,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17.62,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.79,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":43.12,"additional_payer_notes":"APC"}]}]},{"description":"Coagulation time lee & white","code_information":[{"code":"85345","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.69,"maximum":11.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.69,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4.78,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4.74,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.83,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":11.71,"additional_payer_notes":"APC"}]}]},{"description":"Coagulation time activated","code_information":[{"code":"85347","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.28,"maximum":10.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.28,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4.32,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.41,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":10.69,"additional_payer_notes":"APC"}]}]},{"description":"Coagulation time otr method","code_information":[{"code":"85348","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.49,"maximum":11.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.49,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4.58,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4.53,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.62,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":11.21,"additional_payer_notes":"APC"}]}]},{"description":"Euglobulin lysis","code_information":[{"code":"85360","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":8.41,"maximum":21.00,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.41,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8.58,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8.49,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.66,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":21.0,"additional_payer_notes":"APC"}]}]},{"description":"Fibrin degradation products","code_information":[{"code":"85362","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6.89,"maximum":17.20,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6.96,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.1,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17.2,"additional_payer_notes":"APC"}]}]},{"description":"Fibrinogen test","code_information":[{"code":"85366","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":80.46,"maximum":200.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":80.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":82.07,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":81.26,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":82.87,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":200.91,"additional_payer_notes":"APC"}]}]},{"description":"Fibrinogen test","code_information":[{"code":"85370","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.43,"maximum":31.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.43,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.68,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.55,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.8,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":31.04,"additional_payer_notes":"APC"}]}]},{"description":"Fibrin degrade semiquant","code_information":[{"code":"85378","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9.72,"maximum":24.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.72,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9.82,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.01,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":24.27,"additional_payer_notes":"APC"}]}]},{"description":"Fibrin degradation quant","code_information":[{"code":"85379","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10.18,"maximum":25.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10.28,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.49,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":25.42,"additional_payer_notes":"APC"}]}]},{"description":"Fibrin degradj d-dimer","code_information":[{"code":"85380","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10.18,"maximum":25.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10.28,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.49,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":25.42,"additional_payer_notes":"APC"}]}]},{"description":"Fibrinogen activity","code_information":[{"code":"85384","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9.72,"maximum":24.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.72,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9.82,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.01,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":24.27,"additional_payer_notes":"APC"}]}]},{"description":"Fibrinogen antigen","code_information":[{"code":"85385","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14.46,"maximum":36.11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.6,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.89,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":36.11,"additional_payer_notes":"APC"}]}]},{"description":"Fibrinolysins screen i&r","code_information":[{"code":"85390","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":15.48,"maximum":38.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.48,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15.79,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15.63,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.94,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":38.65,"additional_payer_notes":"APC"}]}]},{"description":"Clotting funct activity","code_information":[{"code":"85397","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":30.86,"maximum":77.06,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30.86,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31.17,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":31.79,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":77.06,"additional_payer_notes":"APC"}]}]},{"description":"Fibrinolytic plasmin","code_information":[{"code":"85400","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7.71,"maximum":19.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.71,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7.86,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7.79,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.94,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":19.25,"additional_payer_notes":"APC"}]}]},{"description":"Fibrinolytic antiplasmin","code_information":[{"code":"85410","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7.71,"maximum":19.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.71,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7.86,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7.79,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.94,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":19.25,"additional_payer_notes":"APC"}]}]},{"description":"Fibrinolytic plasminogen","code_information":[{"code":"85415","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.19,"maximum":42.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.19,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17.53,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17.36,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.71,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":42.92,"additional_payer_notes":"APC"}]}]},{"description":"Fibrinolytic plasminogen","code_information":[{"code":"85420","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6.53,"maximum":16.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.53,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6.66,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6.6,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":16.31,"additional_payer_notes":"APC"}]}]},{"description":"Fibrinolytic plasminogen","code_information":[{"code":"85421","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10.18,"maximum":25.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10.28,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.49,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":25.42,"additional_payer_notes":"APC"}]}]},{"description":"Heinz bodies direct","code_information":[{"code":"85441","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.2,"maximum":10.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.2,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4.28,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4.24,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.33,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":10.49,"additional_payer_notes":"APC"}]}]},{"description":"Heinz bodies induced","code_information":[{"code":"85445","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6.82,"maximum":17.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.82,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6.96,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6.89,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.02,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17.03,"additional_payer_notes":"APC"}]}]},{"description":"Hemoglobin fetal","code_information":[{"code":"85460","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7.73,"maximum":19.30,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.73,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7.81,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.96,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":19.3,"additional_payer_notes":"APC"}]}]},{"description":"Hemoglobin fetal","code_information":[{"code":"85461","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9.36,"maximum":23.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9.55,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9.45,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.64,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":23.37,"additional_payer_notes":"APC"}]}]},{"description":"Hemolysin acid","code_information":[{"code":"85475","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":8.87,"maximum":22.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.87,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9.05,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8.96,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.14,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":22.15,"additional_payer_notes":"APC"}]}]},{"description":"Heparin assay","code_information":[{"code":"85520","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.09,"maximum":32.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.09,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.22,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.48,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":32.69,"additional_payer_notes":"APC"}]}]},{"description":"Heparin neutralization","code_information":[{"code":"85525","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.84,"maximum":29.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.84,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.08,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11.96,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":29.56,"additional_payer_notes":"APC"}]}]},{"description":"Heparin-protamine tolerance","code_information":[{"code":"85530","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.09,"maximum":32.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.09,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.22,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.48,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":32.69,"additional_payer_notes":"APC"}]}]},{"description":"Iron Stain Peripheral Blood","code_information":[{"code":"85536","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6.88,"maximum":17.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.88,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7.02,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.09,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17.18,"additional_payer_notes":"APC"}]}]},{"description":"Wbc alkaline phosphatase","code_information":[{"code":"85540","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":8.6,"maximum":21.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.6,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8.77,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8.69,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.86,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":21.47,"additional_payer_notes":"APC"}]}]},{"description":"RBC mechanical fragility","code_information":[{"code":"85547","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":8.6,"maximum":21.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.6,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8.77,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8.69,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.86,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":21.47,"additional_payer_notes":"APC"}]}]},{"description":"Muramidase","code_information":[{"code":"85549","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18.75,"maximum":46.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19.12,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.94,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":46.82,"additional_payer_notes":"APC"}]}]},{"description":"RBC osmotic fragility","code_information":[{"code":"85555","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7.47,"maximum":18.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.47,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7.62,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7.54,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":18.65,"additional_payer_notes":"APC"}]}]},{"description":"RBC osmotic fragility","code_information":[{"code":"85557","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.36,"maximum":33.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.63,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.49,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.76,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":33.36,"additional_payer_notes":"APC"}]}]},{"description":"Blood platelet aggregation","code_information":[{"code":"85576","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":24.91,"maximum":62.20,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24.91,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25.41,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25.16,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25.66,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":62.2,"additional_payer_notes":"APC"}]}]},{"description":"Phospholipid pltlt neutraliz","code_information":[{"code":"85597","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.98,"maximum":44.90,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.98,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.34,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.16,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":44.9,"additional_payer_notes":"APC"}]}]},{"description":"Hexagnal phosph pltlt neutrl","code_information":[{"code":"85598","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.98,"maximum":44.90,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.98,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.34,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.16,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":44.9,"additional_payer_notes":"APC"}]}]},{"description":"Prothrombin time","code_information":[{"code":"85610","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.29,"maximum":10.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.29,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.42,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":10.71,"additional_payer_notes":"APC"}]}]},{"description":"Prothrombin test","code_information":[{"code":"85611","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3.94,"maximum":9.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3.94,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4.02,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3.98,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":9.84,"additional_payer_notes":"APC"}]}]},{"description":"Viper venom prothrombin time","code_information":[{"code":"85612","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.49,"maximum":43.67,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.49,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17.84,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17.66,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.01,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":43.67,"additional_payer_notes":"APC"}]}]},{"description":"Russell viper venom diluted","code_information":[{"code":"85613","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9.58,"maximum":23.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.58,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9.77,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9.68,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.87,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":23.92,"additional_payer_notes":"APC"}]}]},{"description":"Reptilase test","code_information":[{"code":"85635","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9.85,"maximum":24.60,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.85,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10.05,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.15,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":24.6,"additional_payer_notes":"APC"}]}]},{"description":"Rbc sed rate nonautomated","code_information":[{"code":"85651","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.27,"maximum":10.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.27,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4.31,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":10.66,"additional_payer_notes":"APC"}]}]},{"description":"Rbc sed rate automated","code_information":[{"code":"85652","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2.7,"maximum":6.74,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2.7,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":6.74,"additional_payer_notes":"APC"}]}]},{"description":"RBC sickle cell test","code_information":[{"code":"85660","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5.51,"maximum":13.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.51,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5.62,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5.57,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":13.76,"additional_payer_notes":"APC"}]}]},{"description":"Thrombin time plasma","code_information":[{"code":"85670","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5.77,"maximum":14.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.77,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5.89,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5.83,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.94,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14.41,"additional_payer_notes":"APC"}]}]},{"description":"Thrombin time titer","code_information":[{"code":"85675","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6.85,"maximum":17.10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.85,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6.99,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6.92,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17.1,"additional_payer_notes":"APC"}]}]},{"description":"Thromboplastin inhibition","code_information":[{"code":"85705","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9.63,"maximum":24.05,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.63,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9.82,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":24.05,"additional_payer_notes":"APC"}]}]},{"description":"Thromboplastin time partial","code_information":[{"code":"85730","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6.01,"maximum":15.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.01,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6.13,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6.07,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":15.01,"additional_payer_notes":"APC"}]}]},{"description":"Thromboplastin time partial","code_information":[{"code":"85732","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6.47,"maximum":16.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.47,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6.53,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.66,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":16.16,"additional_payer_notes":"APC"}]}]},{"description":"Blood viscosity examination","code_information":[{"code":"85810","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.67,"maximum":29.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11.9,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11.79,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.02,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":29.14,"additional_payer_notes":"APC"}]}]},{"description":"Agglutinins febrile antigen","code_information":[{"code":"86000","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6.98,"maximum":17.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.98,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7.12,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7.05,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17.43,"additional_payer_notes":"APC"}]}]},{"description":"Allergen Specific Igg","code_information":[{"code":"86001","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7.82,"maximum":19.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.82,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7.98,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.05,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":19.53,"additional_payer_notes":"APC"}]}]},{"description":"Allergen specific IgE","code_information":[{"code":"86003","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5.22,"maximum":13.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.22,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5.32,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5.27,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.38,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":13.03,"additional_payer_notes":"APC"}]}]},{"description":"Allergen specific IgE","code_information":[{"code":"86005","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7.97,"maximum":19.90,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.97,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8.13,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8.05,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.21,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":19.9,"additional_payer_notes":"APC"}]}]},{"description":"Allg spec ige recomb ea","code_information":[{"code":"86008","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.93,"maximum":44.77,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.29,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.11,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":44.77,"additional_payer_notes":"APC"}]}]},{"description":"Actin antibody each","code_information":[{"code":"86015","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.05,"maximum":30.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.05,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.29,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.17,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.41,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":30.09,"additional_payer_notes":"APC"}]}]},{"description":"WBC antibody identification","code_information":[{"code":"86021","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":15.05,"maximum":37.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.05,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15.2,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":37.58,"additional_payer_notes":"APC"}]}]},{"description":"Platelet antibodies","code_information":[{"code":"86022","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18.37,"maximum":45.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.37,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.74,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.55,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":45.87,"additional_payer_notes":"APC"}]}]},{"description":"Immunoglobulin assay","code_information":[{"code":"86023","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.46,"maximum":31.11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.71,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.58,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.83,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":31.11,"additional_payer_notes":"APC"}]}]},{"description":"Anca screen each antibody","code_information":[{"code":"86036","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.05,"maximum":30.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.05,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.29,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.17,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.41,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":30.09,"additional_payer_notes":"APC"}]}]},{"description":"Anca titer each antibody","code_information":[{"code":"86037","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.05,"maximum":30.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.05,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.29,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.17,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.41,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":30.09,"additional_payer_notes":"APC"}]}]},{"description":"Antinuclear antibodies","code_information":[{"code":"86038","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.09,"maximum":30.19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.09,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.21,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.45,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":30.19,"additional_payer_notes":"APC"}]}]},{"description":"Antinuclear antibodies (ANA)","code_information":[{"code":"86039","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.16,"maximum":27.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.16,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11.27,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.49,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":27.87,"additional_payer_notes":"APC"}]}]},{"description":"Acetylcholn rcptr bndng antb","code_information":[{"code":"86041","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18.4,"maximum":45.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.77,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.58,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":45.94,"additional_payer_notes":"APC"}]}]},{"description":"Acetylcholn rcptr blckg antb","code_information":[{"code":"86042","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18.4,"maximum":45.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.77,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.58,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":45.94,"additional_payer_notes":"APC"}]}]},{"description":"Acetylcholn rcptr modlg antb","code_information":[{"code":"86043","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.05,"maximum":30.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.05,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.29,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.17,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.41,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":30.09,"additional_payer_notes":"APC"}]}]},{"description":"Aquaporin-4 antb elisa","code_information":[{"code":"86051","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.53,"maximum":28.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.53,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11.76,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11.65,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.88,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":28.79,"additional_payer_notes":"APC"}]}]},{"description":"Aquaporin-4 antb cba each","code_information":[{"code":"86052","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.05,"maximum":30.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.05,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.29,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.17,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.41,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":30.09,"additional_payer_notes":"APC"}]}]},{"description":"Aqaprn-4 antb flo cytmtry ea","code_information":[{"code":"86053","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":37.73,"maximum":94.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":37.73,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38.11,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":38.86,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":94.21,"additional_payer_notes":"APC"}]}]},{"description":"Antistreptolysin o titer","code_information":[{"code":"86060","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7.3,"maximum":18.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.3,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7.37,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":18.23,"additional_payer_notes":"APC"}]}]},{"description":"Antistreptolysin o screen","code_information":[{"code":"86063","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5.77,"maximum":14.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.77,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5.89,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5.83,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.94,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14.41,"additional_payer_notes":"APC"}]}]},{"description":"C-reactive protein","code_information":[{"code":"86140","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5.18,"maximum":12.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5.28,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5.23,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":12.93,"additional_payer_notes":"APC"}]}]},{"description":"C-reactive protein hs","code_information":[{"code":"86141","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.95,"maximum":32.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.95,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.21,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.08,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":32.34,"additional_payer_notes":"APC"}]}]},{"description":"Beta-2 glycoprotein antibody","code_information":[{"code":"86146","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":25.45,"maximum":63.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25.45,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25.96,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25.7,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26.21,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":63.55,"additional_payer_notes":"APC"}]}]},{"description":"Cardiolipin antibody ea ig","code_information":[{"code":"86147","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":25.45,"maximum":63.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25.45,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25.96,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25.7,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26.21,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":63.55,"additional_payer_notes":"APC"}]}]},{"description":"Anti-phospholipid antibody","code_information":[{"code":"86148","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16.07,"maximum":40.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.07,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16.39,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16.23,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.55,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":40.13,"additional_payer_notes":"APC"}]}]},{"description":"Cell enumeration & id","code_information":[{"code":"86152","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":250.78,"maximum":626.20,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":250.78,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":255.8,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":253.29,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":258.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":626.2,"additional_payer_notes":"APC"}]}]},{"description":"Chemotaxis assay","code_information":[{"code":"86155","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":15.99,"maximum":39.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16.31,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16.15,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":39.93,"additional_payer_notes":"APC"}]}]},{"description":"Cold agglutinin screen","code_information":[{"code":"86156","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":8.07,"maximum":20.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.07,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8.23,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8.15,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":20.15,"additional_payer_notes":"APC"}]}]},{"description":"Cold agglutinin titer","code_information":[{"code":"86157","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":8.06,"maximum":20.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.06,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8.22,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8.14,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":20.13,"additional_payer_notes":"APC"}]}]},{"description":"Complement antigen","code_information":[{"code":"86160","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.0,"maximum":29.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.24,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.12,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":29.96,"additional_payer_notes":"APC"}]}]},{"description":"Complement/function activity","code_information":[{"code":"86161","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.0,"maximum":29.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.24,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.12,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":29.96,"additional_payer_notes":"APC"}]}]},{"description":"Complement total (ch50)","code_information":[{"code":"86162","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":20.32,"maximum":50.74,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.32,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20.73,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20.52,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.93,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":50.74,"additional_payer_notes":"APC"}]}]},{"description":"Complement fixation each","code_information":[{"code":"86171","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10.01,"maximum":24.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.01,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10.21,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10.11,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":24.99,"additional_payer_notes":"APC"}]}]},{"description":"Ccp antibody","code_information":[{"code":"86200","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.95,"maximum":32.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.95,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.21,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.08,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":32.34,"additional_payer_notes":"APC"}]}]},{"description":"Deoxyribonuclease antibody","code_information":[{"code":"86215","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.25,"maximum":33.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.25,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.52,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.38,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.65,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":33.09,"additional_payer_notes":"APC"}]}]},{"description":"Dna antibody native","code_information":[{"code":"86225","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.74,"maximum":34.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.74,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.01,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.88,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.15,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":34.31,"additional_payer_notes":"APC"}]}]},{"description":"Dna antibody single strand","code_information":[{"code":"86226","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.11,"maximum":30.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.11,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.23,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":30.24,"additional_payer_notes":"APC"}]}]},{"description":"Ema each ig class","code_information":[{"code":"86231","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.09,"maximum":30.19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.09,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.21,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.45,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":30.19,"additional_payer_notes":"APC"}]}]},{"description":"Nuclear antigen antibody","code_information":[{"code":"86235","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.93,"maximum":44.77,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.29,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.11,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":44.77,"additional_payer_notes":"APC"}]}]},{"description":"Fluorescent antibody screen","code_information":[{"code":"86255","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.05,"maximum":30.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.05,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.29,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.17,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.41,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":30.09,"additional_payer_notes":"APC"}]}]},{"description":"Fluorescent antibody titer","code_information":[{"code":"86256","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.05,"maximum":30.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.05,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.29,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.17,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.41,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":30.09,"additional_payer_notes":"APC"}]}]},{"description":"Dgp antibody each ig class","code_information":[{"code":"86258","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.05,"maximum":30.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.05,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.29,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.17,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.41,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":30.09,"additional_payer_notes":"APC"}]}]},{"description":"Growth hormone antibody","code_information":[{"code":"86277","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":15.74,"maximum":39.30,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.74,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16.05,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.21,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":39.3,"additional_payer_notes":"APC"}]}]},{"description":"Hemagglutination inhibition","code_information":[{"code":"86280","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":8.19,"maximum":20.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.19,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8.27,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.44,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":20.45,"additional_payer_notes":"APC"}]}]},{"description":"Immunoassay tumor qual","code_information":[{"code":"86294","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":25.57,"maximum":63.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25.57,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26.08,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25.83,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":63.85,"additional_payer_notes":"APC"}]}]},{"description":"Immunoassay tumor ca 15-3","code_information":[{"code":"86300","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":20.81,"maximum":51.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.81,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21.23,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21.43,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":51.96,"additional_payer_notes":"APC"}]}]},{"description":"Immunoassay tumor ca 19-9","code_information":[{"code":"86301","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":20.81,"maximum":51.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.81,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21.23,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21.43,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":51.96,"additional_payer_notes":"APC"}]}]},{"description":"Immunoassay tumor ca 125","code_information":[{"code":"86304","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":20.81,"maximum":51.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.81,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21.23,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21.43,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":51.96,"additional_payer_notes":"APC"}]}]},{"description":"Human epididymis protein 4","code_information":[{"code":"86305","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":20.81,"maximum":51.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.81,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21.23,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21.43,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":51.96,"additional_payer_notes":"APC"}]}]},{"description":"Heterophile antibody screen","code_information":[{"code":"86308","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5.18,"maximum":12.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5.28,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5.23,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":12.93,"additional_payer_notes":"APC"}]}]},{"description":"Heterophile antibody titer","code_information":[{"code":"86309","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6.47,"maximum":16.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.47,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6.53,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.66,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":16.16,"additional_payer_notes":"APC"}]}]},{"description":"Heterophile antibody absrbj","code_information":[{"code":"86310","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7.37,"maximum":18.40,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.37,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7.52,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":18.4,"additional_payer_notes":"APC"}]}]},{"description":"Immunoassay tumor other","code_information":[{"code":"86316","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":20.81,"maximum":51.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.81,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21.23,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21.43,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":51.96,"additional_payer_notes":"APC"}]}]},{"description":"Immunoassay infectious agent","code_information":[{"code":"86317","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14.99,"maximum":37.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15.29,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15.14,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.44,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":37.43,"additional_payer_notes":"APC"}]}]},{"description":"Immunoassay infectious agent","code_information":[{"code":"86318","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18.09,"maximum":45.17,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.09,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.27,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.63,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":45.17,"additional_payer_notes":"APC"}]}]},{"description":"Serum immunoelectrophoresis","code_information":[{"code":"86320","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":29.92,"maximum":74.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29.92,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30.52,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30.22,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30.82,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":74.71,"additional_payer_notes":"APC"}]}]},{"description":"Other immunoelectrophoresis","code_information":[{"code":"86325","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":23.13,"maximum":57.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23.13,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23.59,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23.36,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23.82,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":57.76,"additional_payer_notes":"APC"}]}]},{"description":"Ia nfct ab sarscov2 covid19","code_information":[{"code":"86328","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":45.28,"maximum":113.06,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":45.28,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":46.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":45.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":46.64,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":113.06,"additional_payer_notes":"APC"}]}]},{"description":"Immunodiffusion nes","code_information":[{"code":"86329","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14.05,"maximum":35.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.05,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.19,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":35.08,"additional_payer_notes":"APC"}]}]},{"description":"Immunodiffusion ouchterlony","code_information":[{"code":"86331","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.98,"maximum":29.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.98,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.22,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.1,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":29.91,"additional_payer_notes":"APC"}]}]},{"description":"Immune complex assay","code_information":[{"code":"86332","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":24.37,"maximum":60.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24.37,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24.86,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24.61,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25.1,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":60.85,"additional_payer_notes":"APC"}]}]},{"description":"Immunofix e-phoresis serum","code_information":[{"code":"86334","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":22.34,"maximum":55.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22.34,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22.79,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22.56,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23.01,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":55.78,"additional_payer_notes":"APC"}]}]},{"description":"Immunfix e-phorsis/urine/csf","code_information":[{"code":"86335","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":29.35,"maximum":73.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29.35,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29.94,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29.64,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30.23,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":73.29,"additional_payer_notes":"APC"}]}]},{"description":"Inhibin A","code_information":[{"code":"86336","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":15.59,"maximum":38.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.59,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15.9,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15.75,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":38.93,"additional_payer_notes":"APC"}]}]},{"description":"Insulin antibodies","code_information":[{"code":"86337","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":21.41,"maximum":53.46,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21.41,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21.84,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21.62,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22.05,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":53.46,"additional_payer_notes":"APC"}]}]},{"description":"Intrinsic factor antibody","code_information":[{"code":"86340","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":15.08,"maximum":37.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.08,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15.23,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":37.65,"additional_payer_notes":"APC"}]}]},{"description":"Islet cell antibody","code_information":[{"code":"86341","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":23.57,"maximum":58.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23.57,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24.04,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23.81,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":58.85,"additional_payer_notes":"APC"}]}]},{"description":"Leukocyte histamine release","code_information":[{"code":"86343","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.46,"maximum":31.11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.71,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.58,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.83,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":31.11,"additional_payer_notes":"APC"}]}]},{"description":"Leukocyte phagocytosis","code_information":[{"code":"86344","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10.39,"maximum":25.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.39,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10.49,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":25.94,"additional_payer_notes":"APC"}]}]},{"description":"Cell function assay w/stim","code_information":[{"code":"86352","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":135.86,"maximum":339.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":135.86,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":138.58,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":137.22,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":139.94,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":339.24,"additional_payer_notes":"APC"}]}]},{"description":"Lymphocyte transformation","code_information":[{"code":"86353","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":49.03,"maximum":122.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":49.03,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":50.01,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":49.52,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":50.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":122.43,"additional_payer_notes":"APC"}]}]},{"description":"B cells total count","code_information":[{"code":"86355","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":37.73,"maximum":94.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":37.73,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38.11,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":38.86,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":94.21,"additional_payer_notes":"APC"}]}]},{"description":"Mononuclear cell antigen","code_information":[{"code":"86356","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":26.78,"maximum":66.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26.78,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27.32,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27.05,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27.58,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":66.87,"additional_payer_notes":"APC"}]}]},{"description":"Nk cells total count","code_information":[{"code":"86357","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":37.73,"maximum":94.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":37.73,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38.11,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":38.86,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":94.21,"additional_payer_notes":"APC"}]}]},{"description":"T cells total count","code_information":[{"code":"86359","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":37.73,"maximum":94.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":37.73,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38.11,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":38.86,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":94.21,"additional_payer_notes":"APC"}]}]},{"description":"T cell absolute count/ratio","code_information":[{"code":"86360","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":46.98,"maximum":117.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":46.98,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":47.92,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":47.45,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":48.39,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":117.31,"additional_payer_notes":"APC"}]}]},{"description":"T cell absolute count","code_information":[{"code":"86361","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":26.78,"maximum":66.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26.78,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27.32,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27.05,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27.58,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":66.87,"additional_payer_notes":"APC"}]}]},{"description":"Mog-igg1 antb cba each","code_information":[{"code":"86362","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.05,"maximum":30.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.05,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.29,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.17,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.41,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":30.09,"additional_payer_notes":"APC"}]}]},{"description":"Mog-igg1 antb flo cytmtry ea","code_information":[{"code":"86363","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":37.73,"maximum":94.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":37.73,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38.11,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":38.86,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":94.21,"additional_payer_notes":"APC"}]}]},{"description":"Tiss trnsgltmnase ea ig clas","code_information":[{"code":"86364","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.53,"maximum":28.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.53,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11.76,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11.65,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.88,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":28.79,"additional_payer_notes":"APC"}]}]},{"description":"Muscle-specific kinase antb","code_information":[{"code":"86366","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18.4,"maximum":45.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.77,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.58,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":45.94,"additional_payer_notes":"APC"}]}]},{"description":"Stem cells total count","code_information":[{"code":"86367","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":77.78,"maximum":194.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":77.78,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":79.34,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":78.56,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":80.11,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":194.22,"additional_payer_notes":"APC"}]}]},{"description":"Microsomal antibody each","code_information":[{"code":"86376","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14.55,"maximum":36.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.55,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.84,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.7,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":36.33,"additional_payer_notes":"APC"}]}]},{"description":"Mitochondrial antibody each","code_information":[{"code":"86381","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":25.45,"maximum":63.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25.45,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25.96,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25.7,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26.21,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":63.55,"additional_payer_notes":"APC"}]}]},{"description":"Neutralization test viral","code_information":[{"code":"86382","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16.91,"maximum":42.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.91,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17.25,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17.08,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.42,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":42.22,"additional_payer_notes":"APC"}]}]},{"description":"Nitroblue tetrazolium dye","code_information":[{"code":"86384","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.61,"maximum":33.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.75,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.02,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":33.98,"additional_payer_notes":"APC"}]}]},{"description":"Nuclear matrix protein 22","code_information":[{"code":"86386","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":21.78,"maximum":54.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21.78,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22.22,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22.0,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22.43,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":54.38,"additional_payer_notes":"APC"}]}]},{"description":"Particle agglut antbdy scrn","code_information":[{"code":"86403","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.54,"maximum":28.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.54,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11.77,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11.66,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.89,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":28.82,"additional_payer_notes":"APC"}]}]},{"description":"Particle agglut antbdy titr","code_information":[{"code":"86406","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10.64,"maximum":26.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.64,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10.85,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10.75,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.96,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":26.57,"additional_payer_notes":"APC"}]}]},{"description":"Neutrlzg antb sarscov2 scr","code_information":[{"code":"86408","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":42.13,"maximum":105.20,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":42.13,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":42.97,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":42.55,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":43.39,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":105.2,"additional_payer_notes":"APC"}]}]},{"description":"Neutrlzg antb sarscov2 titer","code_information":[{"code":"86409","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":79.61,"maximum":198.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":79.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":81.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":80.41,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":82.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":198.79,"additional_payer_notes":"APC"}]}]},{"description":"Sars-cov-2 antb quantitative","code_information":[{"code":"86413","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":51.43,"maximum":128.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":51.43,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":52.46,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":51.94,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":52.97,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":128.42,"additional_payer_notes":"APC"}]}]},{"description":"Rheumatoid factor test qual","code_information":[{"code":"86430","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6.14,"maximum":15.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.14,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6.26,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6.2,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.32,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":15.33,"additional_payer_notes":"APC"}]}]},{"description":"Rheumatoid factor quant","code_information":[{"code":"86431","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5.67,"maximum":14.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5.78,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.84,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14.16,"additional_payer_notes":"APC"}]}]},{"description":"Tb test cell immun measure","code_information":[{"code":"86480","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":61.98,"maximum":154.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":61.98,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":63.22,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":62.6,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":63.84,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":154.76,"additional_payer_notes":"APC"}]}]},{"description":"Tb ag response t-cell susp","code_information":[{"code":"86481","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":100.0,"maximum":249.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":100.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":102.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":101.0,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":103.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":249.7,"additional_payer_notes":"APC"}]}]},{"description":"Strptcs pneum antb serot ia","code_information":[{"code":"86581","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":92.03,"maximum":229.80,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":92.03,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":93.87,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":92.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":94.79,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":229.8,"additional_payer_notes":"APC"}]}]},{"description":"Streptokinase antibody","code_information":[{"code":"86590","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.66,"maximum":31.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.79,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.04,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":31.61,"additional_payer_notes":"APC"}]}]},{"description":"Syphilis test non-trep qual","code_information":[{"code":"86592","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.27,"maximum":10.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.27,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4.31,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":10.66,"additional_payer_notes":"APC"}]}]},{"description":"Syphilis test non-trep quant","code_information":[{"code":"86593","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.4,"maximum":10.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":10.99,"additional_payer_notes":"APC"}]}]},{"description":"Voltage-gtd ca chnl antb ea","code_information":[{"code":"86596","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.05,"maximum":30.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.05,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.29,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.17,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.41,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":30.09,"additional_payer_notes":"APC"}]}]},{"description":"Antinomyces antibody","code_information":[{"code":"86602","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10.18,"maximum":25.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10.28,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.49,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":25.42,"additional_payer_notes":"APC"}]}]},{"description":"Adenovirus antibody","code_information":[{"code":"86603","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.87,"maximum":32.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.87,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.13,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.0,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.26,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":32.14,"additional_payer_notes":"APC"}]}]},{"description":"Aspergillus antibody","code_information":[{"code":"86606","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":15.05,"maximum":37.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.05,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15.2,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":37.58,"additional_payer_notes":"APC"}]}]},{"description":"Bacterium antibody","code_information":[{"code":"86609","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.88,"maximum":32.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.88,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.14,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.01,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.27,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":32.16,"additional_payer_notes":"APC"}]}]},{"description":"Bartonella Antibody","code_information":[{"code":"86611","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10.18,"maximum":25.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10.28,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.49,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":25.42,"additional_payer_notes":"APC"}]}]},{"description":"Blastomyces antibody","code_information":[{"code":"86612","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.9,"maximum":32.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.9,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.16,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.03,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.29,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":32.21,"additional_payer_notes":"APC"}]}]},{"description":"Bordetella antibody","code_information":[{"code":"86615","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.19,"maximum":32.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.19,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.32,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":32.94,"additional_payer_notes":"APC"}]}]},{"description":"Lyme disease antibody","code_information":[{"code":"86617","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":15.49,"maximum":38.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.49,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15.8,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15.64,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":38.68,"additional_payer_notes":"APC"}]}]},{"description":"Lyme disease antibody","code_information":[{"code":"86618","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.03,"maximum":42.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.03,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17.2,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.54,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":42.52,"additional_payer_notes":"APC"}]}]},{"description":"Borrelia antibody","code_information":[{"code":"86619","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.38,"maximum":33.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.38,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.51,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":33.41,"additional_payer_notes":"APC"}]}]},{"description":"Brucella antibody","code_information":[{"code":"86622","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":8.93,"maximum":22.30,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9.11,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":22.3,"additional_payer_notes":"APC"}]}]},{"description":"Campylobacter antibody","code_information":[{"code":"86625","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.12,"maximum":32.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.12,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.25,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":32.76,"additional_payer_notes":"APC"}]}]},{"description":"Candida antibody","code_information":[{"code":"86628","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.01,"maximum":29.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.01,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.25,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.13,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.37,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":29.99,"additional_payer_notes":"APC"}]}]},{"description":"Chlamydia antibody","code_information":[{"code":"86631","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.82,"maximum":29.51,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.82,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.06,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11.94,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.17,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":29.51,"additional_payer_notes":"APC"}]}]},{"description":"Chlamydia igm antibody","code_information":[{"code":"86632","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.68,"maximum":31.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.68,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.93,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.81,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":31.66,"additional_payer_notes":"APC"}]}]},{"description":"Coccidioides antibody","code_information":[{"code":"86635","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.47,"maximum":28.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.47,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11.58,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":28.64,"additional_payer_notes":"APC"}]}]},{"description":"Q fever antibody","code_information":[{"code":"86638","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.12,"maximum":30.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.12,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.24,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.48,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":30.26,"additional_payer_notes":"APC"}]}]},{"description":"Cryptococcus antibody","code_information":[{"code":"86641","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14.41,"maximum":35.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.41,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.55,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.84,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":35.98,"additional_payer_notes":"APC"}]}]},{"description":"CMV antibody","code_information":[{"code":"86644","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14.39,"maximum":35.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.39,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.68,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.53,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.82,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":35.93,"additional_payer_notes":"APC"}]}]},{"description":"Cmv antibody igm","code_information":[{"code":"86645","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16.85,"maximum":42.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.85,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":42.07,"additional_payer_notes":"APC"}]}]},{"description":"Diphtheria antibody","code_information":[{"code":"86648","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":15.21,"maximum":37.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.21,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15.36,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.67,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":37.98,"additional_payer_notes":"APC"}]}]},{"description":"Encephalitis californ antbdy","code_information":[{"code":"86651","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.19,"maximum":32.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.19,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.32,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":32.94,"additional_payer_notes":"APC"}]}]},{"description":"Encephaltis east eqne anbdy","code_information":[{"code":"86652","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.19,"maximum":32.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.19,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.32,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":32.94,"additional_payer_notes":"APC"}]}]},{"description":"Encephaltis st louis antbody","code_information":[{"code":"86653","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.19,"maximum":32.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.19,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.32,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":32.94,"additional_payer_notes":"APC"}]}]},{"description":"Encephaltis west eqne antbdy","code_information":[{"code":"86654","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.19,"maximum":32.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.19,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.32,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":32.94,"additional_payer_notes":"APC"}]}]},{"description":"Enterovirus antibody","code_information":[{"code":"86658","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.03,"maximum":32.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.03,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.29,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.16,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.42,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":32.54,"additional_payer_notes":"APC"}]}]},{"description":"Epstein-barr antibody","code_information":[{"code":"86663","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.12,"maximum":32.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.12,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.25,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":32.76,"additional_payer_notes":"APC"}]}]},{"description":"Epstein-barr nuclear antigen","code_information":[{"code":"86664","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":15.29,"maximum":38.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.29,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.75,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":38.18,"additional_payer_notes":"APC"}]}]},{"description":"Epstein-barr capsid vca","code_information":[{"code":"86665","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18.14,"maximum":45.30,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.14,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.32,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":45.3,"additional_payer_notes":"APC"}]}]},{"description":"Ehrlichia Antibody","code_information":[{"code":"86666","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10.18,"maximum":25.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10.28,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.49,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":25.42,"additional_payer_notes":"APC"}]}]},{"description":"Francisella tularensis","code_information":[{"code":"86668","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14.16,"maximum":35.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.16,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.44,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.3,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.58,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":35.36,"additional_payer_notes":"APC"}]}]},{"description":"Fungus nes antibody","code_information":[{"code":"86671","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.25,"maximum":30.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.25,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.37,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.62,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":30.59,"additional_payer_notes":"APC"}]}]},{"description":"Giardia lamblia antibody","code_information":[{"code":"86674","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14.72,"maximum":36.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.72,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15.01,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.87,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.16,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":36.76,"additional_payer_notes":"APC"}]}]},{"description":"Helicobacter pylori antibody","code_information":[{"code":"86677","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16.85,"maximum":42.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.85,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":42.07,"additional_payer_notes":"APC"}]}]},{"description":"Helminth antibody","code_information":[{"code":"86682","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.01,"maximum":32.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.01,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.27,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.14,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":32.49,"additional_payer_notes":"APC"}]}]},{"description":"Hemophilus influenza antibdy","code_information":[{"code":"86684","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":15.84,"maximum":39.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.84,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16.16,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16.0,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.32,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":39.55,"additional_payer_notes":"APC"}]}]},{"description":"Htlv-i antibody","code_information":[{"code":"86687","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9.09,"maximum":22.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.09,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9.27,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9.18,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":22.7,"additional_payer_notes":"APC"}]}]},{"description":"Htlv-ii antibody","code_information":[{"code":"86688","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14.0,"maximum":34.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.28,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.14,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.42,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":34.96,"additional_payer_notes":"APC"}]}]},{"description":"Htlv/hiv confirmj antibody","code_information":[{"code":"86689","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":19.35,"maximum":48.32,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.35,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19.74,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19.54,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.93,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":48.32,"additional_payer_notes":"APC"}]}]},{"description":"Hepatitis delta agent antbdy","code_information":[{"code":"86692","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.16,"maximum":42.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.16,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.67,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":42.85,"additional_payer_notes":"APC"}]}]},{"description":"Herpes simplex nes antbdy","code_information":[{"code":"86694","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14.39,"maximum":35.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.39,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.68,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.53,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.82,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":35.93,"additional_payer_notes":"APC"}]}]},{"description":"Herpes simplex type 1 test","code_information":[{"code":"86695","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.19,"maximum":32.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.19,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.32,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":32.94,"additional_payer_notes":"APC"}]}]},{"description":"Herpes simplex type 2 test","code_information":[{"code":"86696","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":19.35,"maximum":48.32,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.35,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19.74,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19.54,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.93,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":48.32,"additional_payer_notes":"APC"}]}]},{"description":"Histoplasma antibody","code_information":[{"code":"86698","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.79,"maximum":34.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.79,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.07,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":34.43,"additional_payer_notes":"APC"}]}]},{"description":"Hiv-1antibody","code_information":[{"code":"86701","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":8.89,"maximum":22.20,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9.07,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8.98,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.16,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":22.2,"additional_payer_notes":"APC"}]}]},{"description":"Hiv-2 antibody","code_information":[{"code":"86702","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.52,"maximum":33.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.52,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.79,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.66,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.93,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":33.76,"additional_payer_notes":"APC"}]}]},{"description":"Hiv-1/hiv-2 1 result antbdy","code_information":[{"code":"86703","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.71,"maximum":34.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.71,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.98,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.85,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.12,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":34.23,"additional_payer_notes":"APC"}]}]},{"description":"Hep b core antibody total","code_information":[{"code":"86704","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.05,"maximum":30.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.05,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.29,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.17,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.41,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":30.09,"additional_payer_notes":"APC"}]}]},{"description":"Hep b core antibody igm","code_information":[{"code":"86705","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.77,"maximum":29.39,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.77,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.01,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11.89,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.12,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":29.39,"additional_payer_notes":"APC"}]}]},{"description":"Hep b surface antibody","code_information":[{"code":"86706","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10.74,"maximum":26.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.74,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10.85,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":26.82,"additional_payer_notes":"APC"}]}]},{"description":"Hepatitis be antibody","code_information":[{"code":"86707","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.57,"maximum":28.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.57,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11.8,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11.69,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":28.89,"additional_payer_notes":"APC"}]}]},{"description":"Hepatitis a antibody","code_information":[{"code":"86708","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.39,"maximum":30.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.39,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.64,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.51,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.76,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":30.94,"additional_payer_notes":"APC"}]}]},{"description":"Hepatitis a igm antibody","code_information":[{"code":"86709","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.26,"maximum":28.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.26,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11.37,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.6,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":28.12,"additional_payer_notes":"APC"}]}]},{"description":"Influenza virus antibody","code_information":[{"code":"86710","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.55,"maximum":33.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.55,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.82,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.69,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.96,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":33.83,"additional_payer_notes":"APC"}]}]},{"description":"John cunningham antibody","code_information":[{"code":"86711","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16.89,"maximum":42.17,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17.23,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17.06,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":42.17,"additional_payer_notes":"APC"}]}]},{"description":"Legionella antibody","code_information":[{"code":"86713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":15.3,"maximum":38.20,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.3,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15.45,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.76,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":38.2,"additional_payer_notes":"APC"}]}]},{"description":"Leishmania antibody","code_information":[{"code":"86717","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.25,"maximum":30.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.25,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.37,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.62,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":30.59,"additional_payer_notes":"APC"}]}]},{"description":"Leptospira antibody","code_information":[{"code":"86720","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16.2,"maximum":40.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.2,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16.52,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16.36,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":40.45,"additional_payer_notes":"APC"}]}]},{"description":"Listeria monocytogenes","code_information":[{"code":"86723","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.19,"maximum":32.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.19,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.32,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":32.94,"additional_payer_notes":"APC"}]}]},{"description":"Lymph choriomeningitis ab","code_information":[{"code":"86727","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.87,"maximum":32.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.87,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.13,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.0,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.26,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":32.14,"additional_payer_notes":"APC"}]}]},{"description":"Mucormycosis antibody","code_information":[{"code":"86732","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":15.0,"maximum":37.46,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15.3,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15.15,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.45,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":37.46,"additional_payer_notes":"APC"}]}]},{"description":"Mumps antibody","code_information":[{"code":"86735","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.05,"maximum":32.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.05,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.31,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.18,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.44,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":32.59,"additional_payer_notes":"APC"}]}]},{"description":"Mycoplasma antibody","code_information":[{"code":"86738","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.24,"maximum":33.06,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.24,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.37,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.64,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":33.06,"additional_payer_notes":"APC"}]}]},{"description":"Neisseria meningitidis","code_information":[{"code":"86741","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.19,"maximum":32.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.19,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.32,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":32.94,"additional_payer_notes":"APC"}]}]},{"description":"Nocardia antibody","code_information":[{"code":"86744","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":15.99,"maximum":39.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16.31,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16.15,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":39.93,"additional_payer_notes":"APC"}]}]},{"description":"Parvovirus antibody","code_information":[{"code":"86747","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":15.03,"maximum":37.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.03,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15.18,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.48,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":37.53,"additional_payer_notes":"APC"}]}]},{"description":"Malaria antibody","code_information":[{"code":"86750","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.19,"maximum":32.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.19,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.32,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":32.94,"additional_payer_notes":"APC"}]}]},{"description":"Protozoa antibody nos","code_information":[{"code":"86753","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.39,"maximum":30.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.39,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.64,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.51,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.76,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":30.94,"additional_payer_notes":"APC"}]}]},{"description":"Respiratory virus antibody","code_information":[{"code":"86756","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":15.89,"maximum":39.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16.21,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16.05,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.37,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":39.68,"additional_payer_notes":"APC"}]}]},{"description":"Rickettsia Antibody","code_information":[{"code":"86757","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":19.35,"maximum":48.32,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.35,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19.74,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19.54,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.93,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":48.32,"additional_payer_notes":"APC"}]}]},{"description":"Rotavirus antibody","code_information":[{"code":"86759","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18.23,"maximum":45.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.23,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.59,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.41,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":45.52,"additional_payer_notes":"APC"}]}]},{"description":"Rubella antibody","code_information":[{"code":"86762","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14.39,"maximum":35.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.39,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.68,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.53,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.82,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":35.93,"additional_payer_notes":"APC"}]}]},{"description":"Rubeola antibody","code_information":[{"code":"86765","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.88,"maximum":32.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.88,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.14,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.01,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.27,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":32.16,"additional_payer_notes":"APC"}]}]},{"description":"Salmonella antibody","code_information":[{"code":"86768","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.19,"maximum":32.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.19,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.32,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":32.94,"additional_payer_notes":"APC"}]}]},{"description":"Sars-cov-2 covid-19 antibody","code_information":[{"code":"86769","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":42.13,"maximum":105.20,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":42.13,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":42.97,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":42.55,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":43.39,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":105.2,"additional_payer_notes":"APC"}]}]},{"description":"Shigella antibody","code_information":[{"code":"86771","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":24.48,"maximum":61.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24.48,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24.97,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24.72,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25.21,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":61.13,"additional_payer_notes":"APC"}]}]},{"description":"Tetanus antibody","code_information":[{"code":"86774","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14.8,"maximum":36.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.8,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15.1,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.24,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":36.96,"additional_payer_notes":"APC"}]}]},{"description":"Toxoplasma antibody","code_information":[{"code":"86777","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14.39,"maximum":35.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.39,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.68,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.53,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.82,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":35.93,"additional_payer_notes":"APC"}]}]},{"description":"Toxoplasma antibody igm","code_information":[{"code":"86778","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14.41,"maximum":35.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.41,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.55,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.84,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":35.98,"additional_payer_notes":"APC"}]}]},{"description":"Treponema pallidum","code_information":[{"code":"86780","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.24,"maximum":33.06,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.24,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.37,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.64,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":33.06,"additional_payer_notes":"APC"}]}]},{"description":"Trichinella antibody","code_information":[{"code":"86784","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.56,"maximum":31.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.81,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.69,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.94,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":31.36,"additional_payer_notes":"APC"}]}]},{"description":"Varicella-zoster antibody","code_information":[{"code":"86787","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.88,"maximum":32.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.88,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.14,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.01,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.27,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":32.16,"additional_payer_notes":"APC"}]}]},{"description":"West nile virus ab igm","code_information":[{"code":"86788","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16.85,"maximum":42.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.85,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":42.07,"additional_payer_notes":"APC"}]}]},{"description":"West Nile Virus Antibody","code_information":[{"code":"86789","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14.39,"maximum":35.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.39,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.68,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.53,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.82,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":35.93,"additional_payer_notes":"APC"}]}]},{"description":"Virus antibody nos","code_information":[{"code":"86790","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.88,"maximum":32.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.88,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.14,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.01,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.27,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":32.16,"additional_payer_notes":"APC"}]}]},{"description":"Yersinia antibody","code_information":[{"code":"86793","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.19,"maximum":32.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.19,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.32,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":32.94,"additional_payer_notes":"APC"}]}]},{"description":"Zika virus igm antibody","code_information":[{"code":"86794","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16.85,"maximum":42.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.85,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":42.07,"additional_payer_notes":"APC"}]}]},{"description":"Thyroglobulin antibody","code_information":[{"code":"86800","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":15.91,"maximum":39.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.91,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16.23,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16.07,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.39,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":39.73,"additional_payer_notes":"APC"}]}]},{"description":"Hepatitis c ab test","code_information":[{"code":"86803","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14.27,"maximum":35.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.27,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.41,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":35.63,"additional_payer_notes":"APC"}]}]},{"description":"Hep c ab test confirm","code_information":[{"code":"86804","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":15.49,"maximum":38.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.49,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15.8,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15.64,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":38.68,"additional_payer_notes":"APC"}]}]},{"description":"Lymphocytotoxicity assay","code_information":[{"code":"86805","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":189.51,"maximum":473.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":189.51,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":193.3,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":191.41,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":195.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":473.21,"additional_payer_notes":"APC"}]}]},{"description":"Lymphocytotoxicity assay","code_information":[{"code":"86806","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":47.59,"maximum":118.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":47.59,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":48.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":48.07,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":49.02,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":118.83,"additional_payer_notes":"APC"}]}]},{"description":"Cytotoxic antibody screening","code_information":[{"code":"86807","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":78.65,"maximum":196.39,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":78.65,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":80.22,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":79.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":81.01,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":196.39,"additional_payer_notes":"APC"}]}]},{"description":"Cytotoxic antibody screening","code_information":[{"code":"86808","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":29.68,"maximum":74.11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29.68,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30.27,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29.98,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":74.11,"additional_payer_notes":"APC"}]}]},{"description":"Hla typing a b or c","code_information":[{"code":"86812","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":25.81,"maximum":64.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25.81,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26.07,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26.58,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":64.45,"additional_payer_notes":"APC"}]}]},{"description":"Hla typing a b or c","code_information":[{"code":"86813","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":58.0,"maximum":144.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":58.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":59.16,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":58.58,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":59.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":144.83,"additional_payer_notes":"APC"}]}]},{"description":"Hla typing dr/dq","code_information":[{"code":"86816","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":30.17,"maximum":75.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30.77,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30.47,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":31.08,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":75.33,"additional_payer_notes":"APC"}]}]},{"description":"Hla typing dr/dq","code_information":[{"code":"86817","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":106.14,"maximum":265.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":106.14,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":108.26,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":107.2,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":109.32,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":265.03,"additional_payer_notes":"APC"}]}]},{"description":"Lymphocyte culture mixed","code_information":[{"code":"86821","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":36.56,"maximum":91.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37.29,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":37.66,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":91.29,"additional_payer_notes":"APC"}]}]},{"description":"Hla x-math non-cytotoxic","code_information":[{"code":"86825","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":109.49,"maximum":273.40,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":109.49,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":111.68,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":110.58,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":112.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":273.4,"additional_payer_notes":"APC"}]}]},{"description":"Hla x-match noncytotoxc addl","code_information":[{"code":"86826","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":36.53,"maximum":91.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.53,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37.26,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":37.63,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":91.22,"additional_payer_notes":"APC"}]}]},{"description":"Hla class i&ii antibody qual","code_information":[{"code":"86828","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":64.19,"maximum":160.28,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":64.19,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":65.47,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":64.83,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":66.12,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":160.28,"additional_payer_notes":"APC"}]}]},{"description":"Hla class i/ii antibody qual","code_information":[{"code":"86829","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":64.19,"maximum":160.28,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":64.19,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":65.47,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":64.83,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":66.12,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":160.28,"additional_payer_notes":"APC"}]}]},{"description":"Hla class i phenotype qual","code_information":[{"code":"86830","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":95.52,"maximum":238.51,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":95.52,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":97.43,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":96.48,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":98.39,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":238.51,"additional_payer_notes":"APC"}]}]},{"description":"Hla class ii phenotype qual","code_information":[{"code":"86831","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":81.88,"maximum":204.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":81.88,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":83.52,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":82.7,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":84.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":204.45,"additional_payer_notes":"APC"}]}]},{"description":"Hla class i high defin qual","code_information":[{"code":"86832","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":323.75,"maximum":808.40,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":323.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":330.22,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":326.99,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":333.46,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":808.4,"additional_payer_notes":"APC"}]}]},{"description":"Hla class ii high defin qual","code_information":[{"code":"86833","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":325.8,"maximum":813.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":325.8,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":332.32,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":329.06,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":335.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":813.52,"additional_payer_notes":"APC"}]}]},{"description":"Hla class i semiquant panel","code_information":[{"code":"86834","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":357.56,"maximum":892.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":357.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":364.71,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":361.14,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":368.29,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":892.83,"additional_payer_notes":"APC"}]}]},{"description":"Hla class ii semiquant panel","code_information":[{"code":"86835","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":322.96,"maximum":806.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":322.96,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":329.42,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":326.19,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":332.65,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":806.43,"additional_payer_notes":"APC"}]}]},{"description":"Hemolysins/agglutinins auto","code_information":[{"code":"86940","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":8.77,"maximum":21.90,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.77,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8.86,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.03,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":21.9,"additional_payer_notes":"APC"}]}]},{"description":"Hemolysins/agglutinins","code_information":[{"code":"86941","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.11,"maximum":30.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.11,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.23,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":30.24,"additional_payer_notes":"APC"}]}]},{"description":"Small animal inoculation","code_information":[{"code":"87003","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16.84,"maximum":42.05,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.84,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17.18,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17.01,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.35,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":42.05,"additional_payer_notes":"APC"}]}]},{"description":"Specimen infect agnt concntj","code_information":[{"code":"87015","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6.68,"maximum":16.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.68,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6.81,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6.75,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.88,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":16.68,"additional_payer_notes":"APC"}]}]},{"description":"Blood culture for bacteria","code_information":[{"code":"87040","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10.32,"maximum":25.77,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.32,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10.53,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10.42,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.63,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":25.77,"additional_payer_notes":"APC"}]}]},{"description":"Feces culture aerobic bact","code_information":[{"code":"87045","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9.44,"maximum":23.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.44,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9.63,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9.53,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.72,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":23.57,"additional_payer_notes":"APC"}]}]},{"description":"Stool cultr aerobic bact ea","code_information":[{"code":"87046","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9.44,"maximum":23.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.44,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9.63,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9.53,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.72,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":23.57,"additional_payer_notes":"APC"}]}]},{"description":"Culture othr specimn aerobic","code_information":[{"code":"87070","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":8.62,"maximum":21.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.62,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8.79,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8.71,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.88,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":21.52,"additional_payer_notes":"APC"}]}]},{"description":"Culture aerobic quant other","code_information":[{"code":"87071","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9.89,"maximum":24.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10.09,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9.99,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":24.7,"additional_payer_notes":"APC"}]}]},{"description":"Culture Bacteria Anaerobic","code_information":[{"code":"87073","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9.66,"maximum":24.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9.85,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9.76,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":24.12,"additional_payer_notes":"APC"}]}]},{"description":"Cultr bacteria except blood","code_information":[{"code":"87075","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9.47,"maximum":23.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.47,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9.66,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9.56,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.75,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":23.65,"additional_payer_notes":"APC"}]}]},{"description":"Culture anaerobe ident each","code_information":[{"code":"87076","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":8.08,"maximum":20.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.08,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8.24,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8.16,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.32,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":20.18,"additional_payer_notes":"APC"}]}]},{"description":"Culture Aerobic Identify","code_information":[{"code":"87077","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":8.08,"maximum":20.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.08,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8.24,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8.16,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.32,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":20.18,"additional_payer_notes":"APC"}]}]},{"description":"Culture screen only","code_information":[{"code":"87081","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6.63,"maximum":16.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.63,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6.76,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6.7,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.83,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":16.56,"additional_payer_notes":"APC"}]}]},{"description":"Culture of specimen by kit","code_information":[{"code":"87084","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":27.07,"maximum":67.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27.07,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27.34,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27.88,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":67.59,"additional_payer_notes":"APC"}]}]},{"description":"Urine culture/colony count","code_information":[{"code":"87086","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":8.07,"maximum":20.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.07,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8.23,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8.15,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":20.15,"additional_payer_notes":"APC"}]}]},{"description":"Urine bacteria culture","code_information":[{"code":"87088","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":8.09,"maximum":20.20,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.09,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8.25,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8.17,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.33,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":20.2,"additional_payer_notes":"APC"}]}]},{"description":"Skin fungi culture","code_information":[{"code":"87101","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7.71,"maximum":19.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.71,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7.86,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7.79,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.94,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":19.25,"additional_payer_notes":"APC"}]}]},{"description":"Fungus isolation culture","code_information":[{"code":"87102","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":8.41,"maximum":21.00,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.41,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8.58,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8.49,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.66,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":21.0,"additional_payer_notes":"APC"}]}]},{"description":"Blood fungus culture","code_information":[{"code":"87103","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":20.46,"maximum":51.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20.87,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20.66,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":51.09,"additional_payer_notes":"APC"}]}]},{"description":"Fungi identification yeast","code_information":[{"code":"87106","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10.32,"maximum":25.77,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.32,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10.53,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10.42,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.63,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":25.77,"additional_payer_notes":"APC"}]}]},{"description":"Fungi identification mold","code_information":[{"code":"87107","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10.32,"maximum":25.77,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.32,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10.53,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10.42,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.63,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":25.77,"additional_payer_notes":"APC"}]}]},{"description":"Mycoplasma","code_information":[{"code":"87109","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":15.39,"maximum":38.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.39,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15.54,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.85,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":38.43,"additional_payer_notes":"APC"}]}]},{"description":"Chlamydia culture","code_information":[{"code":"87110","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":19.6,"maximum":48.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.6,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19.99,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19.8,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":48.94,"additional_payer_notes":"APC"}]}]},{"description":"Mycobacteria culture","code_information":[{"code":"87116","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10.8,"maximum":26.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.8,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11.02,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10.91,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.12,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":26.97,"additional_payer_notes":"APC"}]}]},{"description":"Mycobacteric identification","code_information":[{"code":"87118","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14.61,"maximum":36.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.9,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.76,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.05,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":36.48,"additional_payer_notes":"APC"}]}]},{"description":"Culture type immunofluoresc","code_information":[{"code":"87140","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5.57,"maximum":13.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.57,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5.68,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5.63,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":13.91,"additional_payer_notes":"APC"}]}]},{"description":"Culture typing glc/hplc","code_information":[{"code":"87143","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.52,"maximum":31.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.52,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.77,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.65,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":31.26,"additional_payer_notes":"APC"}]}]},{"description":"Culture type immunologic","code_information":[{"code":"87147","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5.18,"maximum":12.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5.28,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5.23,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":12.93,"additional_payer_notes":"APC"}]}]},{"description":"Dna/rna direct probe","code_information":[{"code":"87149","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":20.05,"maximum":50.06,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.05,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20.25,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.65,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":50.06,"additional_payer_notes":"APC"}]}]},{"description":"Dna/rna amplified probe","code_information":[{"code":"87150","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.09,"maximum":87.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.09,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35.79,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.14,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":87.62,"additional_payer_notes":"APC"}]}]},{"description":"Culture Type Pulse Field Gel","code_information":[{"code":"87152","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7.74,"maximum":19.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.74,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7.89,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7.82,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.97,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":19.33,"additional_payer_notes":"APC"}]}]},{"description":"Dna/rna sequencing","code_information":[{"code":"87153","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":115.36,"maximum":288.05,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":115.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":117.67,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":116.51,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":118.82,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":288.05,"additional_payer_notes":"APC"}]}]},{"description":"Cul typ id bld pthgn 6+ trgt","code_information":[{"code":"87154","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":218.06,"maximum":544.50,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":218.06,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":222.42,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":220.24,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":224.6,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":544.5,"additional_payer_notes":"APC"}]}]},{"description":"Culture typing added method","code_information":[{"code":"87158","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7.74,"maximum":19.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.74,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7.89,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7.82,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.97,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":19.33,"additional_payer_notes":"APC"}]}]},{"description":"Dark field examination","code_information":[{"code":"87164","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10.74,"maximum":26.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.74,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10.85,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":26.82,"additional_payer_notes":"APC"}]}]},{"description":"Dark field examination","code_information":[{"code":"87166","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.3,"maximum":28.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.3,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11.53,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11.41,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.64,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":28.22,"additional_payer_notes":"APC"}]}]},{"description":"Macroscopic Exam Arthropod","code_information":[{"code":"87168","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.27,"maximum":10.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.27,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4.31,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":10.66,"additional_payer_notes":"APC"}]}]},{"description":"Macroscopic exam parasite","code_information":[{"code":"87169","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.31,"maximum":10.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4.4,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4.35,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.44,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":10.76,"additional_payer_notes":"APC"}]}]},{"description":"Pinworm Exam","code_information":[{"code":"87172","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.27,"maximum":10.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.27,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4.31,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":10.66,"additional_payer_notes":"APC"}]}]},{"description":"Tissue homogenization cultr","code_information":[{"code":"87176","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5.88,"maximum":14.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.88,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5.94,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14.68,"additional_payer_notes":"APC"}]}]},{"description":"Ova and parasites smears","code_information":[{"code":"87177","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":8.9,"maximum":22.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.9,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9.08,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8.99,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.17,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":22.22,"additional_payer_notes":"APC"}]}]},{"description":"Microbe susceptible diffuse","code_information":[{"code":"87181","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.75,"maximum":11.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4.84,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4.8,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.89,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":11.86,"additional_payer_notes":"APC"}]}]},{"description":"Sc std carbapenem resist gen","code_information":[{"code":"87183","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.09,"maximum":87.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.09,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35.79,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.14,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":87.62,"additional_payer_notes":"APC"}]}]},{"description":"Microbe susceptible disk","code_information":[{"code":"87184","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7.48,"maximum":18.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.48,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7.63,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7.55,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":18.68,"additional_payer_notes":"APC"}]}]},{"description":"Microbe susceptible enzyme","code_information":[{"code":"87185","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.75,"maximum":11.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4.84,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4.8,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.89,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":11.86,"additional_payer_notes":"APC"}]}]},{"description":"Microbe susceptible mic","code_information":[{"code":"87186","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":8.65,"maximum":21.60,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.65,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8.82,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8.74,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.91,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":21.6,"additional_payer_notes":"APC"}]}]},{"description":"Microbe susceptible mlc","code_information":[{"code":"87187","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":40.17,"maximum":100.30,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":40.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":40.97,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":40.57,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":41.38,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":100.3,"additional_payer_notes":"APC"}]}]},{"description":"Microbe suscept macrobroth","code_information":[{"code":"87188","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6.64,"maximum":16.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.64,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6.77,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6.71,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.84,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":16.58,"additional_payer_notes":"APC"}]}]},{"description":"Microbe suscept mycobacteri","code_information":[{"code":"87190","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7.31,"maximum":18.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7.46,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7.38,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":18.25,"additional_payer_notes":"APC"}]}]},{"description":"Bactericidal level serum","code_information":[{"code":"87197","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":15.02,"maximum":37.50,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.02,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15.32,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15.17,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":37.5,"additional_payer_notes":"APC"}]}]},{"description":"Smear gram stain","code_information":[{"code":"87205","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.27,"maximum":10.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.27,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4.31,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":10.66,"additional_payer_notes":"APC"}]}]},{"description":"Smear fluorescent/acid stai","code_information":[{"code":"87206","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5.39,"maximum":13.46,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.39,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.55,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":13.46,"additional_payer_notes":"APC"}]}]},{"description":"Smear special stain","code_information":[{"code":"87207","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5.99,"maximum":14.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6.11,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6.05,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.17,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14.96,"additional_payer_notes":"APC"}]}]},{"description":"Smear complex stain","code_information":[{"code":"87209","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.98,"maximum":44.90,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.98,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.34,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.16,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":44.9,"additional_payer_notes":"APC"}]}]},{"description":"Smear wet mount saline/ink","code_information":[{"code":"87210","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5.82,"maximum":14.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.82,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5.94,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5.88,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14.53,"additional_payer_notes":"APC"}]}]},{"description":"Tissue exam for fungi","code_information":[{"code":"87220","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.27,"maximum":10.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.27,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4.31,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":10.66,"additional_payer_notes":"APC"}]}]},{"description":"Assay toxin or antitoxin","code_information":[{"code":"87230","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":19.74,"maximum":49.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.74,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20.13,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19.94,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.33,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":49.29,"additional_payer_notes":"APC"}]}]},{"description":"Virus inoculate eggs/animal","code_information":[{"code":"87250","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":19.56,"maximum":48.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19.76,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.15,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":48.84,"additional_payer_notes":"APC"}]}]},{"description":"Virus inoculation tissue","code_information":[{"code":"87252","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":26.07,"maximum":65.10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26.07,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26.59,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26.85,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":65.1,"additional_payer_notes":"APC"}]}]},{"description":"Virus inoculate tissue addl","code_information":[{"code":"87253","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":20.2,"maximum":50.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.2,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20.4,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":50.44,"additional_payer_notes":"APC"}]}]},{"description":"Virus inoculation shell via","code_information":[{"code":"87254","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":19.56,"maximum":48.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19.76,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.15,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":48.84,"additional_payer_notes":"APC"}]}]},{"description":"Genet virus isolate hsv","code_information":[{"code":"87255","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":33.86,"maximum":84.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":33.86,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34.2,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":34.88,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":84.55,"additional_payer_notes":"APC"}]}]},{"description":"Adenovirus ag if","code_information":[{"code":"87260","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14.43,"maximum":36.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.43,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.72,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.57,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.86,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":36.03,"additional_payer_notes":"APC"}]}]},{"description":"Pertussis ag if","code_information":[{"code":"87265","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.98,"maximum":29.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.98,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.22,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.1,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":29.91,"additional_payer_notes":"APC"}]}]},{"description":"Enterovirus antibody dfa","code_information":[{"code":"87267","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.42,"maximum":33.51,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.42,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.69,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.55,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.82,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":33.51,"additional_payer_notes":"APC"}]}]},{"description":"Giardia ag if","code_information":[{"code":"87269","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.61,"maximum":33.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.75,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.02,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":33.98,"additional_payer_notes":"APC"}]}]},{"description":"Chlamydia trachomatis ag if","code_information":[{"code":"87270","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.98,"maximum":29.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.98,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.22,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.1,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":29.91,"additional_payer_notes":"APC"}]}]},{"description":"Cytomegalovirus dfa","code_information":[{"code":"87271","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.42,"maximum":33.51,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.42,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.69,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.55,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.82,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":33.51,"additional_payer_notes":"APC"}]}]},{"description":"Cryptosporidium ag if","code_information":[{"code":"87272","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.98,"maximum":29.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.98,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.22,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.1,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":29.91,"additional_payer_notes":"APC"}]}]},{"description":"Herpes simplex 2 ag if","code_information":[{"code":"87273","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.98,"maximum":29.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.98,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.22,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.1,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":29.91,"additional_payer_notes":"APC"}]}]},{"description":"Herpes simplex 1 ag if","code_information":[{"code":"87274","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.98,"maximum":29.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.98,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.22,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.1,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":29.91,"additional_payer_notes":"APC"}]}]},{"description":"Influenza b ag if","code_information":[{"code":"87275","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.25,"maximum":30.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.25,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.37,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.62,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":30.59,"additional_payer_notes":"APC"}]}]},{"description":"Influenza a ag if","code_information":[{"code":"87276","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16.07,"maximum":40.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.07,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16.39,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16.23,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.55,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":40.13,"additional_payer_notes":"APC"}]}]},{"description":"Legion pneumophilia ag if","code_information":[{"code":"87278","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":15.6,"maximum":38.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.6,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15.76,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":38.95,"additional_payer_notes":"APC"}]}]},{"description":"Parainfluenza ag if","code_information":[{"code":"87279","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16.43,"maximum":41.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.43,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16.76,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16.59,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":41.03,"additional_payer_notes":"APC"}]}]},{"description":"Respiratory syncytial ag if","code_information":[{"code":"87280","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.42,"maximum":33.51,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.42,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.69,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.55,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.82,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":33.51,"additional_payer_notes":"APC"}]}]},{"description":"Pneumocystis carinii ag if","code_information":[{"code":"87281","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.98,"maximum":29.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.98,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.22,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.1,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":29.91,"additional_payer_notes":"APC"}]}]},{"description":"Rubeola ag if","code_information":[{"code":"87283","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":60.8,"maximum":151.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":60.8,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":62.02,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":61.41,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":62.62,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":151.82,"additional_payer_notes":"APC"}]}]},{"description":"Treponema pallidum ag if","code_information":[{"code":"87285","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.18,"maximum":30.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.42,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.3,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.55,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":30.41,"additional_payer_notes":"APC"}]}]},{"description":"Varicella zoster ag if","code_information":[{"code":"87290","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.42,"maximum":33.51,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.42,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.69,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.55,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.82,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":33.51,"additional_payer_notes":"APC"}]}]},{"description":"Antibody detection nos if","code_information":[{"code":"87299","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16.1,"maximum":40.20,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.1,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16.42,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16.26,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.58,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":40.2,"additional_payer_notes":"APC"}]}]},{"description":"Ag detection polyval if","code_information":[{"code":"87300","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.98,"maximum":29.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.98,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.22,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.1,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":29.91,"additional_payer_notes":"APC"}]}]},{"description":"Adenovirus ag ia","code_information":[{"code":"87301","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.98,"maximum":29.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.98,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.22,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.1,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":29.91,"additional_payer_notes":"APC"}]}]},{"description":"Aspergillus ag ia","code_information":[{"code":"87305","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.98,"maximum":29.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.98,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.22,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.1,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":29.91,"additional_payer_notes":"APC"}]}]},{"description":"Chylmd trach ag ia","code_information":[{"code":"87320","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":15.0,"maximum":37.46,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15.3,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15.15,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.45,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":37.46,"additional_payer_notes":"APC"}]}]},{"description":"Clostridium ag ia","code_information":[{"code":"87324","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.98,"maximum":29.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.98,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.22,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.1,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":29.91,"additional_payer_notes":"APC"}]}]},{"description":"Cryptococcus neoform ag ia","code_information":[{"code":"87327","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.42,"maximum":33.51,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.42,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.69,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.55,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.82,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":33.51,"additional_payer_notes":"APC"}]}]},{"description":"Cryptosporidium ag ia","code_information":[{"code":"87328","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.82,"maximum":34.51,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.82,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.1,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.96,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.23,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":34.51,"additional_payer_notes":"APC"}]}]},{"description":"Giardia ag ia","code_information":[{"code":"87329","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.98,"maximum":29.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.98,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.22,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.1,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":29.91,"additional_payer_notes":"APC"}]}]},{"description":"Cytomegalovirus ag ia","code_information":[{"code":"87332","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.98,"maximum":29.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.98,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.22,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.1,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":29.91,"additional_payer_notes":"APC"}]}]},{"description":"E coli 0157 ag ia","code_information":[{"code":"87335","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.66,"maximum":31.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.79,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.04,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":31.61,"additional_payer_notes":"APC"}]}]},{"description":"Entamoeb hist dispr ag ia","code_information":[{"code":"87336","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16.0,"maximum":39.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16.32,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16.16,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.48,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":39.95,"additional_payer_notes":"APC"}]}]},{"description":"Entamoeb hist group ag ia","code_information":[{"code":"87337","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.98,"maximum":29.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.98,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.22,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.1,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":29.91,"additional_payer_notes":"APC"}]}]},{"description":"Hpylori stool ia","code_information":[{"code":"87338","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14.38,"maximum":35.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.38,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.67,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.52,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":35.91,"additional_payer_notes":"APC"}]}]},{"description":"H pylori ag ia","code_information":[{"code":"87339","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16.0,"maximum":39.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16.32,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16.16,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.48,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":39.95,"additional_payer_notes":"APC"}]}]},{"description":"Hepatitis b surface ag ia","code_information":[{"code":"87340","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10.33,"maximum":25.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.33,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10.43,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.64,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":25.79,"additional_payer_notes":"APC"}]}]},{"description":"Hepatitis b surface ag ia","code_information":[{"code":"87341","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10.33,"maximum":25.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.33,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10.43,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.64,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":25.79,"additional_payer_notes":"APC"}]}]},{"description":"Hepatitis be ag ia","code_information":[{"code":"87350","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.53,"maximum":28.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.53,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11.76,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11.65,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.88,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":28.79,"additional_payer_notes":"APC"}]}]},{"description":"Hepatitis delta ag ia","code_information":[{"code":"87380","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18.36,"maximum":45.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.73,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.54,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.91,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":45.84,"additional_payer_notes":"APC"}]}]},{"description":"Histoplasma capsul ag ia","code_information":[{"code":"87385","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.25,"maximum":33.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.25,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.52,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.38,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.65,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":33.09,"additional_payer_notes":"APC"}]}]},{"description":"Hiv-1 ag w/hiv-1 & hiv-2 ab","code_information":[{"code":"87389","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":24.08,"maximum":60.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24.08,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24.32,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24.8,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":60.13,"additional_payer_notes":"APC"}]}]},{"description":"Hiv-1 ag ia","code_information":[{"code":"87390","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":24.06,"maximum":60.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24.06,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24.3,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":60.08,"additional_payer_notes":"APC"}]}]},{"description":"Hiv-2 ag ia","code_information":[{"code":"87391","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":21.9,"maximum":54.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21.9,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22.34,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22.12,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22.56,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":54.68,"additional_payer_notes":"APC"}]}]},{"description":"Influenza a/b ag ia","code_information":[{"code":"87400","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14.13,"maximum":35.28,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.13,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.41,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.27,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.55,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":35.28,"additional_payer_notes":"APC"}]}]},{"description":"Resp syncytial ag ia","code_information":[{"code":"87420","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.91,"maximum":34.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.91,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.05,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.33,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":34.73,"additional_payer_notes":"APC"}]}]},{"description":"Rotavirus ag ia","code_information":[{"code":"87425","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.98,"maximum":29.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.98,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.22,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.1,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":29.91,"additional_payer_notes":"APC"}]}]},{"description":"Coronavirus ag ia","code_information":[{"code":"87426","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.33,"maximum":88.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.33,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.04,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35.68,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.39,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":88.22,"additional_payer_notes":"APC"}]}]},{"description":"Shiga-like toxin ag ia","code_information":[{"code":"87427","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.98,"maximum":29.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.98,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.22,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.1,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":29.91,"additional_payer_notes":"APC"}]}]},{"description":"Sarscov & inf vir a&b ag ia","code_information":[{"code":"87428","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":70.29,"maximum":175.51,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":70.29,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":71.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":70.99,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":72.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":175.51,"additional_payer_notes":"APC"}]}]},{"description":"Strep a ag ia","code_information":[{"code":"87430","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16.81,"maximum":41.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.81,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17.15,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16.98,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":41.97,"additional_payer_notes":"APC"}]}]},{"description":"Ag detect nos ia mult","code_information":[{"code":"87449","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.98,"maximum":29.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.98,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.22,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.1,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":29.91,"additional_payer_notes":"APC"}]}]},{"description":"Ag detect polyval ia mult","code_information":[{"code":"87451","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10.51,"maximum":26.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.51,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10.72,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10.62,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.83,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":26.24,"additional_payer_notes":"APC"}]}]},{"description":"Hepatitis b surface ag quan","code_information":[{"code":"87467","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":25.32,"maximum":63.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25.32,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25.83,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25.57,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26.08,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":63.22,"additional_payer_notes":"APC"}]}]},{"description":"Anaplsma phgcytophlm amp prb","code_information":[{"code":"87468","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.09,"maximum":87.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.09,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35.79,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.14,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":87.62,"additional_payer_notes":"APC"}]}]},{"description":"Babesia microti amp prb","code_information":[{"code":"87469","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.09,"maximum":87.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.09,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35.79,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.14,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":87.62,"additional_payer_notes":"APC"}]}]},{"description":"Bartonella dna amp probe","code_information":[{"code":"87471","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.09,"maximum":87.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.09,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35.79,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.14,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":87.62,"additional_payer_notes":"APC"}]}]},{"description":"Bartonella dna quant","code_information":[{"code":"87472","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":42.84,"maximum":106.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":42.84,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":43.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":43.27,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":44.13,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":106.97,"additional_payer_notes":"APC"}]}]},{"description":"Lyme dis dna dir probe","code_information":[{"code":"87475","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":20.05,"maximum":50.06,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.05,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20.25,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.65,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":50.06,"additional_payer_notes":"APC"}]}]},{"description":"Lyme dis dna amp probe","code_information":[{"code":"87476","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.09,"maximum":87.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.09,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35.79,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.14,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":87.62,"additional_payer_notes":"APC"}]}]},{"description":"Borrelia miyamotoi amp prb","code_information":[{"code":"87478","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.09,"maximum":87.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.09,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35.79,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.14,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":87.62,"additional_payer_notes":"APC"}]}]},{"description":"Candida dna dir probe","code_information":[{"code":"87480","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":20.05,"maximum":50.06,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.05,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20.25,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.65,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":50.06,"additional_payer_notes":"APC"}]}]},{"description":"Candida dna amp probe","code_information":[{"code":"87481","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.09,"maximum":87.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.09,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35.79,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.14,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":87.62,"additional_payer_notes":"APC"}]}]},{"description":"Candida dna quant","code_information":[{"code":"87482","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":55.74,"maximum":139.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":55.74,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":56.85,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":56.3,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":57.41,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":139.18,"additional_payer_notes":"APC"}]}]},{"description":"Cns dna amp probe type 12-25","code_information":[{"code":"87483","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":416.78,"maximum":1040.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":416.78,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":425.12,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":420.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":429.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1040.7,"additional_payer_notes":"APC"}]}]},{"description":"Ehrlicha chaffeensis amp prb","code_information":[{"code":"87484","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.09,"maximum":87.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.09,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35.79,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.14,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":87.62,"additional_payer_notes":"APC"}]}]},{"description":"Chylmd pneum dna dir probe","code_information":[{"code":"87485","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":20.05,"maximum":50.06,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.05,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20.25,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.65,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":50.06,"additional_payer_notes":"APC"}]}]},{"description":"Chylmd pneum dna amp probe","code_information":[{"code":"87486","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.09,"maximum":87.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.09,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35.79,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.14,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":87.62,"additional_payer_notes":"APC"}]}]},{"description":"Chylmd pneum dna quant","code_information":[{"code":"87487","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":42.84,"maximum":106.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":42.84,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":43.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":43.27,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":44.13,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":106.97,"additional_payer_notes":"APC"}]}]},{"description":"Chylmd trach dna dir probe","code_information":[{"code":"87490","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":22.75,"maximum":56.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22.98,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23.43,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":56.81,"additional_payer_notes":"APC"}]}]},{"description":"Chylmd trach dna amp probe","code_information":[{"code":"87491","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.09,"maximum":87.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.09,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35.79,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.14,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":87.62,"additional_payer_notes":"APC"}]}]},{"description":"Chylmd trach dna quant","code_information":[{"code":"87492","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":53.47,"maximum":133.51,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":53.47,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":54.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":54.0,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":55.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":133.51,"additional_payer_notes":"APC"}]}]},{"description":"C diff amplified probe","code_information":[{"code":"87493","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":37.27,"maximum":93.06,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":37.27,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38.02,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37.64,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":38.39,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":93.06,"additional_payer_notes":"APC"}]}]},{"description":"Chlmy trch&neisra gonor mult","code_information":[{"code":"87494","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":70.18,"maximum":175.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":70.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":71.58,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":70.88,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":72.29,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":175.24,"additional_payer_notes":"APC"}]}]},{"description":"Cytomeg dna dir probe","code_information":[{"code":"87495","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":30.03,"maximum":74.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30.03,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30.63,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30.93,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":74.98,"additional_payer_notes":"APC"}]}]},{"description":"Cytomeg dna amp probe","code_information":[{"code":"87496","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.09,"maximum":87.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.09,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35.79,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.14,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":87.62,"additional_payer_notes":"APC"}]}]},{"description":"Cytomeg dna quant","code_information":[{"code":"87497","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":42.84,"maximum":106.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":42.84,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":43.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":43.27,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":44.13,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":106.97,"additional_payer_notes":"APC"}]}]},{"description":"Enterovirus probe&revrs trns","code_information":[{"code":"87498","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.09,"maximum":87.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.09,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35.79,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.14,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":87.62,"additional_payer_notes":"APC"}]}]},{"description":"Vanomycin dna amp probe","code_information":[{"code":"87500","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.09,"maximum":87.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.09,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35.79,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.14,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":87.62,"additional_payer_notes":"APC"}]}]},{"description":"Influenza dna amp prob 1+","code_information":[{"code":"87501","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":51.31,"maximum":128.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":51.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":52.34,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":51.82,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":52.85,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":128.12,"additional_payer_notes":"APC"}]}]},{"description":"Influenza dna amp probe","code_information":[{"code":"87502","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":95.8,"maximum":239.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":95.8,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":97.72,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":96.76,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":98.67,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":239.21,"additional_payer_notes":"APC"}]}]},{"description":"Influenza dna amp prob addl","code_information":[{"code":"87503","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":29.22,"maximum":72.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29.22,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29.8,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29.51,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30.1,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":72.96,"additional_payer_notes":"APC"}]}]},{"description":"Nfct agent detection gi","code_information":[{"code":"87505","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":128.29,"maximum":320.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":128.29,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":130.86,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":129.57,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":132.14,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":320.34,"additional_payer_notes":"APC"}]}]},{"description":"Iadna-dna/rna probe tq 6-11","code_information":[{"code":"87506","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":262.99,"maximum":656.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":262.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":268.25,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":265.62,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":270.88,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":656.69,"additional_payer_notes":"APC"}]}]},{"description":"Iadna-dna/rna probe tq 12-25","code_information":[{"code":"87507","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":416.78,"maximum":1040.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":416.78,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":425.12,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":420.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":429.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1040.7,"additional_payer_notes":"APC"}]}]},{"description":"Gardner vag dna dir probe","code_information":[{"code":"87510","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":20.05,"maximum":50.06,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.05,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20.25,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.65,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":50.06,"additional_payer_notes":"APC"}]}]},{"description":"Gardner vag dna amp probe","code_information":[{"code":"87511","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.09,"maximum":87.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.09,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35.79,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.14,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":87.62,"additional_payer_notes":"APC"}]}]},{"description":"Gardner vag dna quant","code_information":[{"code":"87512","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":41.76,"maximum":104.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":41.76,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":42.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":42.18,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":43.01,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":104.27,"additional_payer_notes":"APC"}]}]},{"description":"H pylri clrthmcn rst amp prb","code_information":[{"code":"87513","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.09,"maximum":87.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.09,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35.79,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.14,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":87.62,"additional_payer_notes":"APC"}]}]},{"description":"Hepatitis b dna amp probe","code_information":[{"code":"87516","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.09,"maximum":87.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.09,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35.79,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.14,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":87.62,"additional_payer_notes":"APC"}]}]},{"description":"Hepatitis b dna quant","code_information":[{"code":"87517","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":42.84,"maximum":106.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":42.84,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":43.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":43.27,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":44.13,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":106.97,"additional_payer_notes":"APC"}]}]},{"description":"Hepatitis c rna dir probe","code_information":[{"code":"87520","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":31.22,"maximum":77.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":31.22,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31.84,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31.53,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":32.16,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":77.96,"additional_payer_notes":"APC"}]}]},{"description":"Hepatitis c probe&rvrs trnsc","code_information":[{"code":"87521","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.09,"maximum":87.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.09,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35.79,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.14,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":87.62,"additional_payer_notes":"APC"}]}]},{"description":"Hepatitis c revrs trnscrpj","code_information":[{"code":"87522","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":42.84,"maximum":106.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":42.84,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":43.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":43.27,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":44.13,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":106.97,"additional_payer_notes":"APC"}]}]},{"description":"Hepatitis d quantification","code_information":[{"code":"87523","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":42.84,"maximum":106.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":42.84,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":43.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":43.27,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":44.13,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":106.97,"additional_payer_notes":"APC"}]}]},{"description":"Hepatitis g dna dir probe","code_information":[{"code":"87525","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":29.8,"maximum":74.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29.8,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30.4,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30.1,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":74.41,"additional_payer_notes":"APC"}]}]},{"description":"Hepatitis g dna amp probe","code_information":[{"code":"87526","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":39.26,"maximum":98.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":39.26,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":40.05,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39.65,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":40.44,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":98.03,"additional_payer_notes":"APC"}]}]},{"description":"Hepatitis g dna quant","code_information":[{"code":"87527","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":41.76,"maximum":104.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":41.76,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":42.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":42.18,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":43.01,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":104.27,"additional_payer_notes":"APC"}]}]},{"description":"Hsv dna dir probe","code_information":[{"code":"87528","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":20.05,"maximum":50.06,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.05,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20.25,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.65,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":50.06,"additional_payer_notes":"APC"}]}]},{"description":"Hsv dna amp probe","code_information":[{"code":"87529","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.09,"maximum":87.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.09,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35.79,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.14,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":87.62,"additional_payer_notes":"APC"}]}]},{"description":"Hsv dna quant","code_information":[{"code":"87530","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":42.84,"maximum":106.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":42.84,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":43.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":43.27,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":44.13,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":106.97,"additional_payer_notes":"APC"}]}]},{"description":"Hhv-6 dna dir probe","code_information":[{"code":"87531","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":58.0,"maximum":144.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":58.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":59.16,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":58.58,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":59.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":144.83,"additional_payer_notes":"APC"}]}]},{"description":"Hhv-6 dna amp probe","code_information":[{"code":"87532","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.09,"maximum":87.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.09,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35.79,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.14,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":87.62,"additional_payer_notes":"APC"}]}]},{"description":"Hhv-6 dna quant","code_information":[{"code":"87533","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":41.76,"maximum":104.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":41.76,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":42.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":42.18,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":43.01,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":104.27,"additional_payer_notes":"APC"}]}]},{"description":"Hiv-1 dna dir probe","code_information":[{"code":"87534","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":21.92,"maximum":54.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21.92,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22.14,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22.58,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":54.73,"additional_payer_notes":"APC"}]}]},{"description":"Hiv-1 probe&reverse trnscrpj","code_information":[{"code":"87535","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.09,"maximum":87.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.09,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35.79,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.14,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":87.62,"additional_payer_notes":"APC"}]}]},{"description":"Hiv-1 quant&revrse trnscrpj","code_information":[{"code":"87536","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":85.1,"maximum":212.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":85.1,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":86.8,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":85.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":87.65,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":212.49,"additional_payer_notes":"APC"}]}]},{"description":"Hiv-2 dna dir probe","code_information":[{"code":"87537","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":21.92,"maximum":54.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21.92,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22.14,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22.58,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":54.73,"additional_payer_notes":"APC"}]}]},{"description":"Hiv-2 probe&revrse trnscripj","code_information":[{"code":"87538","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.09,"maximum":87.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.09,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35.79,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.14,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":87.62,"additional_payer_notes":"APC"}]}]},{"description":"Hiv-2 quant&revrse trnscripj","code_information":[{"code":"87539","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":58.62,"maximum":146.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":58.62,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":59.79,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":59.21,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":60.38,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":146.37,"additional_payer_notes":"APC"}]}]},{"description":"Legion pneumo dna dir prob","code_information":[{"code":"87540","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":20.05,"maximum":50.06,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.05,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20.25,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.65,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":50.06,"additional_payer_notes":"APC"}]}]},{"description":"Legion pneumo dna amp prob","code_information":[{"code":"87541","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.09,"maximum":87.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.09,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35.79,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.14,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":87.62,"additional_payer_notes":"APC"}]}]},{"description":"Legion pneumo dna quant","code_information":[{"code":"87542","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":41.76,"maximum":104.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":41.76,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":42.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":42.18,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":43.01,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":104.27,"additional_payer_notes":"APC"}]}]},{"description":"Mycobacteria dna dir probe","code_information":[{"code":"87550","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":20.05,"maximum":50.06,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.05,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20.25,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.65,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":50.06,"additional_payer_notes":"APC"}]}]},{"description":"Mycobacteria dna amp probe","code_information":[{"code":"87551","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":48.24,"maximum":120.46,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":48.24,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":49.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":48.72,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":49.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":120.46,"additional_payer_notes":"APC"}]}]},{"description":"Mycobacteria dna quant","code_information":[{"code":"87552","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":42.84,"maximum":106.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":42.84,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":43.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":43.27,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":44.13,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":106.97,"additional_payer_notes":"APC"}]}]},{"description":"M.tuberculo dna dir probe","code_information":[{"code":"87555","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":26.88,"maximum":67.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26.88,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27.42,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27.15,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":67.12,"additional_payer_notes":"APC"}]}]},{"description":"M.tuberculo dna amp probe","code_information":[{"code":"87556","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":41.68,"maximum":104.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":41.68,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":42.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":42.1,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":42.93,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":104.07,"additional_payer_notes":"APC"}]}]},{"description":"M.tuberculo dna quant","code_information":[{"code":"87557","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":42.84,"maximum":106.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":42.84,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":43.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":43.27,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":44.13,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":106.97,"additional_payer_notes":"APC"}]}]},{"description":"M.avium-intra dna dir prob","code_information":[{"code":"87560","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":27.29,"maximum":68.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27.29,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27.84,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27.56,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28.11,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":68.14,"additional_payer_notes":"APC"}]}]},{"description":"M.avium-intra dna amp prob","code_information":[{"code":"87561","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.09,"maximum":87.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.09,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35.79,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.14,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":87.62,"additional_payer_notes":"APC"}]}]},{"description":"M.avium-intra dna quant","code_information":[{"code":"87562","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":42.84,"maximum":106.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":42.84,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":43.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":43.27,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":44.13,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":106.97,"additional_payer_notes":"APC"}]}]},{"description":"M. genitalium amp probe","code_information":[{"code":"87563","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.09,"maximum":87.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.09,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35.79,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.14,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":87.62,"additional_payer_notes":"APC"}]}]},{"description":"Mtb rifampin rst amp prb tq","code_information":[{"code":"87564","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":76.77,"maximum":191.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":76.77,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":78.31,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":77.54,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":79.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":191.69,"additional_payer_notes":"APC"}]}]},{"description":"M.pneumon dna dir probe","code_information":[{"code":"87580","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":20.05,"maximum":50.06,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.05,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20.25,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.65,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":50.06,"additional_payer_notes":"APC"}]}]},{"description":"M.pneumon dna amp probe","code_information":[{"code":"87581","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.09,"maximum":87.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.09,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35.79,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.14,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":87.62,"additional_payer_notes":"APC"}]}]},{"description":"M.pneumon dna quant","code_information":[{"code":"87582","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":302.62,"maximum":755.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":302.62,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":308.67,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":305.65,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":311.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":755.64,"additional_payer_notes":"APC"}]}]},{"description":"N.gonorrhoeae dna dir prob","code_information":[{"code":"87590","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":26.88,"maximum":67.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26.88,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27.42,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27.15,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":67.12,"additional_payer_notes":"APC"}]}]},{"description":"N.gonorrhoeae dna amp prob","code_information":[{"code":"87591","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.09,"maximum":87.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.09,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35.79,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.14,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":87.62,"additional_payer_notes":"APC"}]}]},{"description":"N.gonorrhoeae dna quant","code_information":[{"code":"87592","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":42.84,"maximum":106.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":42.84,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":43.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":43.27,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":44.13,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":106.97,"additional_payer_notes":"APC"}]}]},{"description":"Orthopoxvirus amp prb each","code_information":[{"code":"87593","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":51.31,"maximum":128.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":51.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":52.34,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":51.82,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":52.85,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":128.12,"additional_payer_notes":"APC"}]}]},{"description":"Pneumcysts jirovecii amp prb","code_information":[{"code":"87594","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.09,"maximum":87.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.09,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35.79,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.14,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":87.62,"additional_payer_notes":"APC"}]}]},{"description":"Hpv low-risk types","code_information":[{"code":"87623","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.09,"maximum":87.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.09,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35.79,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.14,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":87.62,"additional_payer_notes":"APC"}]}]},{"description":"Hpv high-risk types","code_information":[{"code":"87624","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.09,"maximum":87.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.09,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35.79,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.14,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":87.62,"additional_payer_notes":"APC"}]}]},{"description":"Hpv types 16 & 18 only","code_information":[{"code":"87625","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":40.55,"maximum":101.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":40.55,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":41.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":40.96,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":41.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":101.25,"additional_payer_notes":"APC"}]}]},{"description":"Hpv sep hi-rsk typ&pool rslt","code_information":[{"code":"87626","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":70.2,"maximum":175.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":70.2,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":71.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":70.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":72.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":175.29,"additional_payer_notes":"APC"}]}]},{"description":"Jt spc pthgn&rx rsist gen26+","code_information":[{"code":"87627","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":679.77,"maximum":1697.39,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":679.77,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":693.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":686.57,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":700.16,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1697.39,"additional_payer_notes":"APC"}]}]},{"description":"Resp virus 3-5 targets","code_information":[{"code":"87631","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":142.63,"maximum":356.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":142.63,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":145.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":144.06,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":146.91,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":356.15,"additional_payer_notes":"APC"}]}]},{"description":"Resp virus 6-11 targets","code_information":[{"code":"87632","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":218.06,"maximum":544.50,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":218.06,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":222.42,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":220.24,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":224.6,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":544.5,"additional_payer_notes":"APC"}]}]},{"description":"Resp virus 12-25 targets","code_information":[{"code":"87633","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":416.78,"maximum":1040.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":416.78,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":425.12,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":420.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":429.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1040.7,"additional_payer_notes":"APC"}]}]},{"description":"Rsv dna/rna amp probe","code_information":[{"code":"87634","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":70.2,"maximum":175.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":70.2,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":71.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":70.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":72.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":175.29,"additional_payer_notes":"APC"}]}]},{"description":"Sars-cov-2 covid-19 amp prb","code_information":[{"code":"87635","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":51.31,"maximum":128.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":51.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":52.34,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":51.82,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":52.85,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":128.12,"additional_payer_notes":"APC"}]}]},{"description":"Sarscov2 & inf a&b amp prb","code_information":[{"code":"87636","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":142.63,"maximum":356.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":142.63,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":145.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":144.06,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":146.91,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":356.15,"additional_payer_notes":"APC"}]}]},{"description":"Sarscov2&inf a&b&rsv amp prb","code_information":[{"code":"87637","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":142.63,"maximum":356.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":142.63,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":145.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":144.06,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":146.91,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":356.15,"additional_payer_notes":"APC"}]}]},{"description":"Staph a dna amp probe","code_information":[{"code":"87640","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.09,"maximum":87.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.09,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35.79,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.14,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":87.62,"additional_payer_notes":"APC"}]}]},{"description":"Mr-staph dna amp probe","code_information":[{"code":"87641","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.09,"maximum":87.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.09,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35.79,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.14,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":87.62,"additional_payer_notes":"APC"}]}]},{"description":"Strep a dna dir probe","code_information":[{"code":"87650","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":20.05,"maximum":50.06,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.05,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20.25,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.65,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":50.06,"additional_payer_notes":"APC"}]}]},{"description":"Strep a dna amp probe","code_information":[{"code":"87651","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.09,"maximum":87.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.09,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35.79,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.14,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":87.62,"additional_payer_notes":"APC"}]}]},{"description":"Strep a dna quant","code_information":[{"code":"87652","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":41.76,"maximum":104.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":41.76,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":42.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":42.18,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":43.01,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":104.27,"additional_payer_notes":"APC"}]}]},{"description":"Strep b dna amp probe","code_information":[{"code":"87653","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.09,"maximum":87.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.09,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35.79,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.14,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":87.62,"additional_payer_notes":"APC"}]}]},{"description":"Trichomonas vagin dir probe","code_information":[{"code":"87660","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":20.05,"maximum":50.06,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.05,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20.25,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.65,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":50.06,"additional_payer_notes":"APC"}]}]},{"description":"Trichomonas vaginalis amplif","code_information":[{"code":"87661","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.09,"maximum":87.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.09,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35.79,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.14,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":87.62,"additional_payer_notes":"APC"}]}]},{"description":"Zika virus dna/rna amp probe","code_information":[{"code":"87662","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":51.31,"maximum":128.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":51.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":52.34,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":51.82,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":52.85,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":128.12,"additional_payer_notes":"APC"}]}]},{"description":"Detect agent nos dna dir","code_information":[{"code":"87797","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":30.03,"maximum":74.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30.03,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30.63,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30.93,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":74.98,"additional_payer_notes":"APC"}]}]},{"description":"Detect agent nos dna amp","code_information":[{"code":"87798","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.09,"maximum":87.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.09,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35.79,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.14,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":87.62,"additional_payer_notes":"APC"}]}]},{"description":"Detect agent nos dna quant","code_information":[{"code":"87799","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":42.84,"maximum":106.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":42.84,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":43.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":43.27,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":44.13,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":106.97,"additional_payer_notes":"APC"}]}]},{"description":"Detect agnt mult dna direc","code_information":[{"code":"87800","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":43.67,"maximum":109.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":43.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":44.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":44.11,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":44.98,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":109.04,"additional_payer_notes":"APC"}]}]},{"description":"Detect agnt mult dna ampli","code_information":[{"code":"87801","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":70.2,"maximum":175.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":70.2,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":71.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":70.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":72.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":175.29,"additional_payer_notes":"APC"}]}]},{"description":"Strep b assay w/optic","code_information":[{"code":"87802","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.73,"maximum":31.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.73,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.98,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.86,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.11,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":31.79,"additional_payer_notes":"APC"}]}]},{"description":"Clostridium toxin a w/optic","code_information":[{"code":"87803","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16.0,"maximum":39.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16.32,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16.16,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.48,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":39.95,"additional_payer_notes":"APC"}]}]},{"description":"Influenza assay w/optic","code_information":[{"code":"87804","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16.55,"maximum":41.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.55,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16.72,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.05,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":41.33,"additional_payer_notes":"APC"}]}]},{"description":"Hiv antigen w/hiv antibodies","code_information":[{"code":"87806","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":32.77,"maximum":81.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":32.77,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33.43,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33.1,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":33.75,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":81.83,"additional_payer_notes":"APC"}]}]},{"description":"Rsv assay w/optic","code_information":[{"code":"87807","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.1,"maximum":32.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.1,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.23,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.49,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":32.71,"additional_payer_notes":"APC"}]}]},{"description":"Trichomonas assay w/optic","code_information":[{"code":"87808","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":15.29,"maximum":38.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.29,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.75,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":38.18,"additional_payer_notes":"APC"}]}]},{"description":"Adenovirus assay w/optic","code_information":[{"code":"87809","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":21.76,"maximum":54.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21.76,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21.98,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22.41,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":54.33,"additional_payer_notes":"APC"}]}]},{"description":"Chylmd trach assay w/optic","code_information":[{"code":"87810","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.29,"maximum":88.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.29,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35.64,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.35,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":88.12,"additional_payer_notes":"APC"}]}]},{"description":"Sars-cov-2 covid19 w/optic","code_information":[{"code":"87811","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":41.38,"maximum":103.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":41.38,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":42.21,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":41.79,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":42.62,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":103.33,"additional_payer_notes":"APC"}]}]},{"description":"Sarscov2&inf typ a&b w/optic","code_information":[{"code":"87812","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":74.48,"maximum":185.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":74.48,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":75.97,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":75.22,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":76.71,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":185.98,"additional_payer_notes":"APC"}]}]},{"description":"N. gonorrhoeae assay w/optic","code_information":[{"code":"87850","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":24.56,"maximum":61.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25.05,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24.81,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":61.33,"additional_payer_notes":"APC"}]}]},{"description":"Strep a assay w/optic","code_information":[{"code":"87880","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16.53,"maximum":41.28,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.53,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16.86,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16.7,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.03,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":41.28,"additional_payer_notes":"APC"}]}]},{"description":"Agent nos assay w/optic","code_information":[{"code":"87899","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16.07,"maximum":40.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.07,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16.39,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16.23,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.55,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":40.13,"additional_payer_notes":"APC"}]}]},{"description":"Phenotype infect agent drug","code_information":[{"code":"87900","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":130.35,"maximum":325.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":130.35,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":132.96,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":131.65,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":134.26,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":325.48,"additional_payer_notes":"APC"}]}]},{"description":"Genotype dna hiv reverse t","code_information":[{"code":"87901","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":257.45,"maximum":642.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":257.45,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":262.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":260.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":265.17,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":642.85,"additional_payer_notes":"APC"}]}]},{"description":"Genotype dna/rna hep c","code_information":[{"code":"87902","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":257.45,"maximum":642.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":257.45,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":262.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":260.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":265.17,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":642.85,"additional_payer_notes":"APC"}]}]},{"description":"Phenotype dna hiv w/culture","code_information":[{"code":"87903","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":488.66,"maximum":1220.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":488.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":498.43,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":493.55,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":503.32,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1220.18,"additional_payer_notes":"APC"}]}]},{"description":"Phenotype dna hiv w/clt add","code_information":[{"code":"87904","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":26.07,"maximum":65.10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26.07,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26.59,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26.85,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":65.1,"additional_payer_notes":"APC"}]}]},{"description":"Sialidase enzyme assay","code_information":[{"code":"87905","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.22,"maximum":30.51,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.22,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.46,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.34,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":30.51,"additional_payer_notes":"APC"}]}]},{"description":"Genotype dna/rna hiv","code_information":[{"code":"87906","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":128.73,"maximum":321.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":128.73,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":131.3,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":130.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":132.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":321.44,"additional_payer_notes":"APC"}]}]},{"description":"Genotype cytomegalovirus","code_information":[{"code":"87910","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":257.45,"maximum":642.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":257.45,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":262.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":260.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":265.17,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":642.85,"additional_payer_notes":"APC"}]}]},{"description":"Genotype dna hepatitis b","code_information":[{"code":"87912","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":257.45,"maximum":642.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":257.45,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":262.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":260.02,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":265.17,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":642.85,"additional_payer_notes":"APC"}]}]},{"description":"Sex chromatin identification","code_information":[{"code":"88130","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.98,"maximum":44.90,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.98,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.34,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.16,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":44.9,"additional_payer_notes":"APC"}]}]},{"description":"Sex chromatin identification","code_information":[{"code":"88140","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7.99,"maximum":19.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8.15,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8.07,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.23,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":19.95,"additional_payer_notes":"APC"}]}]},{"description":"Cytopath c/v thin layer","code_information":[{"code":"88142","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":20.26,"maximum":50.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.26,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20.67,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20.46,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.87,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":50.59,"additional_payer_notes":"APC"}]}]},{"description":"Cytopath c/v thin layer redo","code_information":[{"code":"88143","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":23.04,"maximum":57.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23.04,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23.27,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":57.53,"additional_payer_notes":"APC"}]}]},{"description":"Cytopath c/v automated","code_information":[{"code":"88147","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":50.56,"maximum":126.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":50.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":51.57,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":51.07,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":52.08,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":126.25,"additional_payer_notes":"APC"}]}]},{"description":"Cytopath c/v auto rescreen","code_information":[{"code":"88148","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18.54,"maximum":46.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.54,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.1,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":46.29,"additional_payer_notes":"APC"}]}]},{"description":"Cytopath c/v manual","code_information":[{"code":"88150","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18.54,"maximum":46.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.54,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.1,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":46.29,"additional_payer_notes":"APC"}]}]},{"description":"Cytopath c/v auto redo","code_information":[{"code":"88152","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":27.64,"maximum":69.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27.64,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27.92,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":69.02,"additional_payer_notes":"APC"}]}]},{"description":"Cytopath c/v redo","code_information":[{"code":"88153","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":24.03,"maximum":60.00,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24.03,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24.27,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24.75,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":60.0,"additional_payer_notes":"APC"}]}]},{"description":"Cytopath c/v index add-on","code_information":[{"code":"88155","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14.65,"maximum":36.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.65,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.94,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.8,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.09,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":36.58,"additional_payer_notes":"APC"}]}]},{"description":"Cytopath tbs c/v manual","code_information":[{"code":"88164","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18.54,"maximum":46.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.54,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.1,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":46.29,"additional_payer_notes":"APC"}]}]},{"description":"Cytopath tbs c/v redo","code_information":[{"code":"88165","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":42.22,"maximum":105.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":42.22,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":43.06,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":42.64,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":43.49,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":105.42,"additional_payer_notes":"APC"}]}]},{"description":"Cytopath tbs c/v auto redo","code_information":[{"code":"88166","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18.54,"maximum":46.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.54,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.1,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":46.29,"additional_payer_notes":"APC"}]}]},{"description":"Cytopath tbs c/v select","code_information":[{"code":"88167","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18.54,"maximum":46.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.54,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.1,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":46.29,"additional_payer_notes":"APC"}]}]},{"description":"Cytopath c/v auto in fluid","code_information":[{"code":"88174","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":25.37,"maximum":63.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25.37,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25.62,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26.13,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":63.35,"additional_payer_notes":"APC"}]}]},{"description":"Cytopath c/v auto fluid redo","code_information":[{"code":"88175","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":26.61,"maximum":66.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27.14,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26.88,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27.41,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":66.45,"additional_payer_notes":"APC"}]}]},{"description":"Tissue culture lymphocyte","code_information":[{"code":"88230","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":116.49,"maximum":290.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":116.49,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":118.82,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":117.65,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":119.98,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":290.88,"additional_payer_notes":"APC"}]}]},{"description":"Tissue culture skin/biopsy","code_information":[{"code":"88233","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":140.73,"maximum":351.40,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":140.73,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":143.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":142.14,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":144.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":351.4,"additional_payer_notes":"APC"}]}]},{"description":"Tissue culture placenta","code_information":[{"code":"88235","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":150.3,"maximum":375.30,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":150.3,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":153.31,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":151.8,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":154.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":375.3,"additional_payer_notes":"APC"}]}]},{"description":"Tissue culture bone marrow","code_information":[{"code":"88237","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":143.75,"maximum":358.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":143.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":146.62,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":145.19,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":148.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":358.94,"additional_payer_notes":"APC"}]}]},{"description":"Tissue culture tumor","code_information":[{"code":"88239","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":147.52,"maximum":368.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":147.52,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":150.47,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":149.0,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":151.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":368.36,"additional_payer_notes":"APC"}]}]},{"description":"Cell cryopreserve/storage","code_information":[{"code":"88240","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.07,"maximum":32.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.07,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.2,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.46,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":32.64,"additional_payer_notes":"APC"}]}]},{"description":"Frozen cell preparation","code_information":[{"code":"88241","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.09,"maximum":30.19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.09,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.21,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.45,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":30.19,"additional_payer_notes":"APC"}]}]},{"description":"Chromosome analysis 20-25","code_information":[{"code":"88245","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":173.17,"maximum":432.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":173.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":176.63,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":174.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":178.37,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":432.41,"additional_payer_notes":"APC"}]}]},{"description":"Chromosome analysis 50-100","code_information":[{"code":"88248","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":173.17,"maximum":432.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":173.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":176.63,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":174.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":178.37,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":432.41,"additional_payer_notes":"APC"}]}]},{"description":"Chromosome analysis 100","code_information":[{"code":"88249","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":173.17,"maximum":432.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":173.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":176.63,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":174.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":178.37,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":432.41,"additional_payer_notes":"APC"}]}]},{"description":"Chromosome analysis 5","code_information":[{"code":"88261","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":264.34,"maximum":660.06,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":264.34,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":269.63,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":266.98,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":272.27,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":660.06,"additional_payer_notes":"APC"}]}]},{"description":"Chromosome analysis 15-20","code_information":[{"code":"88262","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":125.49,"maximum":313.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":125.49,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":126.74,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":129.25,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":313.35,"additional_payer_notes":"APC"}]}]},{"description":"Chromosome analysis 45","code_information":[{"code":"88263","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":150.29,"maximum":375.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":150.29,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":153.3,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":151.79,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":154.8,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":375.27,"additional_payer_notes":"APC"}]}]},{"description":"Chromosome analysis 20-25","code_information":[{"code":"88264","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":144.61,"maximum":361.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":144.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":147.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":146.06,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":148.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":361.09,"additional_payer_notes":"APC"}]}]},{"description":"Chromosome analys placenta","code_information":[{"code":"88267","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":188.57,"maximum":470.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":188.57,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":192.34,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":190.46,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":194.23,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":470.86,"additional_payer_notes":"APC"}]}]},{"description":"Chromosome analys amniotic","code_information":[{"code":"88269","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":173.66,"maximum":433.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":173.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":177.13,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":175.4,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":178.87,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":433.63,"additional_payer_notes":"APC"}]}]},{"description":"Cytogenetics dna probe","code_information":[{"code":"88271","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":21.42,"maximum":53.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21.42,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21.85,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21.63,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":53.49,"additional_payer_notes":"APC"}]}]},{"description":"Cytogenetics 3-5","code_information":[{"code":"88272","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":40.7,"maximum":101.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":40.7,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":41.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":41.11,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":41.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":101.63,"additional_payer_notes":"APC"}]}]},{"description":"Cytogenetics 10-30","code_information":[{"code":"88273","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":34.81,"maximum":86.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":34.81,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35.16,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.85,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":86.92,"additional_payer_notes":"APC"}]}]},{"description":"Cytogenetics 25-99","code_information":[{"code":"88274","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":42.38,"maximum":105.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":42.38,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":43.23,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":42.8,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":43.65,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":105.82,"additional_payer_notes":"APC"}]}]},{"description":"Cytogenetics 100-300","code_information":[{"code":"88275","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":51.19,"maximum":127.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":51.19,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":52.21,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":51.7,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":52.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":127.82,"additional_payer_notes":"APC"}]}]},{"description":"Chromosome karyotype study","code_information":[{"code":"88280","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":33.47,"maximum":83.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":33.47,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34.14,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33.8,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":34.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":83.57,"additional_payer_notes":"APC"}]}]},{"description":"Chromosome banding study","code_information":[{"code":"88283","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":68.6,"maximum":171.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":68.6,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":69.97,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":69.29,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":70.66,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":171.29,"additional_payer_notes":"APC"}]}]},{"description":"Chromosome count additional","code_information":[{"code":"88285","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":26.91,"maximum":67.19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26.91,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27.18,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27.72,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":67.19,"additional_payer_notes":"APC"}]}]},{"description":"Chromosome study additional","code_information":[{"code":"88289","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":34.43,"maximum":85.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":34.43,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35.12,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34.77,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.46,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":85.97,"additional_payer_notes":"APC"}]}]},{"description":"Bilirubin total transcut","code_information":[{"code":"88720","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5.02,"maximum":12.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.02,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5.12,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5.07,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.17,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":12.53,"additional_payer_notes":"APC"}]}]},{"description":"Hgb quant transcutaneous","code_information":[{"code":"88738","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5.02,"maximum":12.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.02,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5.12,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5.07,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.17,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":12.53,"additional_payer_notes":"APC"}]}]},{"description":"Transcutaneous carboxyhb","code_information":[{"code":"88740","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9.37,"maximum":23.40,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.37,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9.46,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.65,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":23.4,"additional_payer_notes":"APC"}]}]},{"description":"Transcutaneous methb","code_information":[{"code":"88741","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9.37,"maximum":23.40,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.37,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9.46,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.65,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":23.4,"additional_payer_notes":"APC"}]}]},{"description":"Body fluid cell count","code_information":[{"code":"89050","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.72,"maximum":11.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.72,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4.81,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4.77,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.86,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":11.79,"additional_payer_notes":"APC"}]}]},{"description":"Body fluid cell count","code_information":[{"code":"89051","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5.6,"maximum":13.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.6,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5.71,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5.66,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":13.98,"additional_payer_notes":"APC"}]}]},{"description":"Leukocyte assessment fecal","code_information":[{"code":"89055","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.27,"maximum":10.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.27,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4.31,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":10.66,"additional_payer_notes":"APC"}]}]},{"description":"Exam synovial fluid crystals","code_information":[{"code":"89060","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7.33,"maximum":18.30,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.33,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7.4,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.55,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":18.3,"additional_payer_notes":"APC"}]}]},{"description":"Specimen fat stain","code_information":[{"code":"89125","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5.88,"maximum":14.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.88,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5.94,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14.68,"additional_payer_notes":"APC"}]}]},{"description":"Exam feces for meat fibers","code_information":[{"code":"89160","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.85,"maximum":12.11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.85,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4.9,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":12.11,"additional_payer_notes":"APC"}]}]},{"description":"Nasal smear for eosinophils","code_information":[{"code":"89190","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5.79,"maximum":14.46,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.79,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5.85,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.96,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14.46,"additional_payer_notes":"APC"}]}]},{"description":"Semen analysis w/huhner","code_information":[{"code":"89300","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9.84,"maximum":24.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.84,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10.04,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9.94,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.14,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":24.57,"additional_payer_notes":"APC"}]}]},{"description":"Semen analysis w/count","code_information":[{"code":"89310","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":8.61,"maximum":21.50,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8.78,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8.7,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.87,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":21.5,"additional_payer_notes":"APC"}]}]},{"description":"Semen anal vol/count/mot","code_information":[{"code":"89320","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.31,"maximum":30.74,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.43,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":30.74,"additional_payer_notes":"APC"}]}]},{"description":"Semen anal sperm detection","code_information":[{"code":"89321","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.05,"maximum":30.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.05,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.29,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.17,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.41,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":30.09,"additional_payer_notes":"APC"}]}]},{"description":"Semen anal strict criteria","code_information":[{"code":"89322","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":15.5,"maximum":38.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15.81,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15.66,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.96,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":38.7,"additional_payer_notes":"APC"}]}]},{"description":"Sperm antibody test","code_information":[{"code":"89325","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10.67,"maximum":26.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10.78,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":26.64,"additional_payer_notes":"APC"}]}]},{"description":"Sperm evaluation test","code_information":[{"code":"89329","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":19.59,"maximum":48.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.59,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19.98,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19.79,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.18,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":48.92,"additional_payer_notes":"APC"}]}]},{"description":"Evaluation cervical mucus","code_information":[{"code":"89330","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10.38,"maximum":25.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.38,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10.59,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10.48,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":25.92,"additional_payer_notes":"APC"}]}]},{"description":"Retrograde ejaculation anal","code_information":[{"code":"89331","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":19.59,"maximum":48.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.59,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19.98,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19.79,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.18,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":48.92,"additional_payer_notes":"APC"}]}]},{"description":"Semen analysis","code_information":[{"code":"G0027","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6.5,"maximum":16.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6.63,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6.56,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":16.23,"additional_payer_notes":"APC"}]}]},{"description":"PSA Screening","code_information":[{"code":"G0103","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":19.31,"maximum":48.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19.5,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.89,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":48.22,"additional_payer_notes":"APC"}]}]},{"description":"Screen cerv/vag thin layer","code_information":[{"code":"G0123","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":20.26,"maximum":50.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.26,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20.67,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20.46,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.87,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":50.59,"additional_payer_notes":"APC"}]}]},{"description":"Scr c/v cyto,thinlayer,rescr","code_information":[{"code":"G0143","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":27.05,"maximum":67.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27.05,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27.59,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27.32,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27.86,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":67.54,"additional_payer_notes":"APC"}]}]},{"description":"Scr c/v cyto,thinlayer,rescr","code_information":[{"code":"G0144","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":43.97,"maximum":109.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":43.97,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":44.85,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":44.41,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":45.29,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":109.79,"additional_payer_notes":"APC"}]}]},{"description":"Scr c/v cyto,thinlayer,rescr","code_information":[{"code":"G0145","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":26.49,"maximum":66.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26.49,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27.02,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26.75,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":66.15,"additional_payer_notes":"APC"}]}]},{"description":"Scr c/v cyto, automated sys","code_information":[{"code":"G0147","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18.54,"maximum":46.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.54,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.1,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":46.29,"additional_payer_notes":"APC"}]}]},{"description":"Scr c/v cyto, autosys, rescr","code_information":[{"code":"G0148","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":31.94,"maximum":79.75,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":31.94,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32.58,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32.26,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":32.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":79.75,"additional_payer_notes":"APC"}]}]},{"description":"CBC/diffwbc w/o platelet","code_information":[{"code":"G0306","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7.77,"maximum":19.40,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.77,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7.93,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7.85,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":19.4,"additional_payer_notes":"APC"}]}]},{"description":"CBC without platelet","code_information":[{"code":"G0307","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6.47,"maximum":16.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.47,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6.53,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.66,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":16.16,"additional_payer_notes":"APC"}]}]},{"description":"Fecal blood scrn immunoassay","code_information":[{"code":"G0328","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18.05,"maximum":45.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.05,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.41,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.23,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":45.07,"additional_payer_notes":"APC"}]}]},{"description":"EIA HIV-1/HIV-2 screen","code_information":[{"code":"G0432","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":19.57,"maximum":48.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.57,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19.96,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19.77,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.16,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":48.87,"additional_payer_notes":"APC"}]}]},{"description":"ELISA HIV-1/HIV-2 screen","code_information":[{"code":"G0433","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18.29,"maximum":45.67,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.29,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.66,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.47,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.84,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":45.67,"additional_payer_notes":"APC"}]}]},{"description":"Oral hiv-1/hiv-2 screen","code_information":[{"code":"G0435","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.98,"maximum":29.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.98,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.22,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.1,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":29.91,"additional_payer_notes":"APC"}]}]},{"description":"Hep c screen high risk/other","code_information":[{"code":"G0472","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":46.35,"maximum":115.74,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":46.35,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":47.28,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":46.81,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":47.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":115.74,"additional_payer_notes":"APC"}]}]},{"description":"Hiv combination assay","code_information":[{"code":"G0475","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":24.08,"maximum":60.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24.08,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24.32,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24.8,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":60.13,"additional_payer_notes":"APC"}]}]},{"description":"Hpv combo assay ca screen","code_information":[{"code":"G0476","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.09,"maximum":87.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.09,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35.79,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.14,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":87.62,"additional_payer_notes":"APC"}]}]},{"description":"Drug test def 1-7 classes","code_information":[{"code":"G0480","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":114.43,"maximum":285.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":114.43,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":116.72,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":115.57,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":117.86,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":285.73,"additional_payer_notes":"APC"}]}]},{"description":"Drug test def 8-14 classes","code_information":[{"code":"G0481","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":156.59,"maximum":391.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":156.59,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":159.72,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":158.16,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":161.29,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":391.01,"additional_payer_notes":"APC"}]}]},{"description":"Drug test def 15-21 classes","code_information":[{"code":"G0482","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":198.74,"maximum":496.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":198.74,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":202.71,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":200.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":204.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":496.25,"additional_payer_notes":"APC"}]}]},{"description":"Drug test def 22+ classes","code_information":[{"code":"G0483","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":246.92,"maximum":616.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":246.92,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":251.86,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":249.39,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":254.33,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":616.56,"additional_payer_notes":"APC"}]}]},{"description":"Hepb screen high risk indiv","code_information":[{"code":"G0499","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":28.27,"maximum":70.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28.27,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28.84,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28.55,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29.12,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":70.59,"additional_payer_notes":"APC"}]}]},{"description":"Screening Hep C detect","code_information":[{"code":"G0567","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.09,"maximum":87.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.09,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35.79,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35.44,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.14,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":87.62,"additional_payer_notes":"APC"}]}]},{"description":"Drug test def simple all cl","code_information":[{"code":"G0659","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":62.14,"maximum":155.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":62.14,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":63.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":62.76,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":64.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":155.16,"additional_payer_notes":"APC"}]}]},{"description":"Cephalin floculation test","code_information":[{"code":"P2028","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.95,"maximum":12.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.95,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5.05,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5.0,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.1,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":12.36,"additional_payer_notes":"APC"}]}]},{"description":"Congo red blood test","code_information":[{"code":"P2029","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.95,"maximum":12.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.95,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5.05,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5.0,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.1,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":12.36,"additional_payer_notes":"APC"}]}]},{"description":"Blood thymol turbidity","code_information":[{"code":"P2033","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.95,"maximum":12.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.95,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5.05,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5.0,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.1,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":12.36,"additional_payer_notes":"APC"}]}]},{"description":"Blood mucoprotein","code_information":[{"code":"P2038","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.95,"maximum":12.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.95,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5.05,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5.0,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.1,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":12.36,"additional_payer_notes":"APC"}]}]},{"description":"Screen pap by tech w md supv","code_information":[{"code":"P3000","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18.54,"maximum":46.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.54,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.1,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":46.29,"additional_payer_notes":"APC"}]}]},{"description":"Catheterize for urine spec","code_information":[{"code":"P9612","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9.34,"maximum":23.32,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.34,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9.53,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9.43,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.62,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":23.32,"additional_payer_notes":"APC"}]}]},{"description":"Wet mounts/ w preparations","code_information":[{"code":"Q0111","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18.54,"maximum":46.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.54,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.73,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.1,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":46.29,"additional_payer_notes":"APC"}]}]},{"description":"Potassium hydroxide preps","code_information":[{"code":"Q0112","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5.83,"maximum":14.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.83,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5.89,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14.56,"additional_payer_notes":"APC"}]}]},{"description":"Pinworm examinations","code_information":[{"code":"Q0113","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.27,"maximum":10.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.27,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4.31,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":10.66,"additional_payer_notes":"APC"}]}]},{"description":"Fern test","code_information":[{"code":"Q0114","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9.74,"maximum":24.32,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.74,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9.93,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9.84,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.03,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":24.32,"additional_payer_notes":"APC"}]}]},{"description":"Post-coital mucous exam","code_information":[{"code":"Q0115","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":25.0,"maximum":62.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25.25,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25.75,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":62.42,"additional_payer_notes":"APC"}]}]},{"description":"2019 nCoV diagnostic P","code_information":[{"code":"U0001","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.92,"maximum":89.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.92,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.64,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.28,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":37.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":89.69,"additional_payer_notes":"APC"}]}]},{"description":"COVID-19 lab test non-CDC","code_information":[{"code":"U0002","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":51.31,"maximum":128.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":51.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":52.34,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":51.82,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":52.85,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":128.12,"additional_payer_notes":"APC"}]}]},{"description":"Cntct lens hydrophil photoch","code_information":[{"code":"V2524","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":154.45,"maximum":385.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":154.45,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":157.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":155.99,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":159.08,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":385.66,"additional_payer_notes":"APC"}]}]},{"description":"Electrical bone stimulation","code_information":[{"code":"20974","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":47.14,"maximum":117.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":47.14,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":48.08,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":47.61,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":48.55,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":117.71,"additional_payer_notes":"APC"}]}]},{"description":"Bfb training 1st 15 min","code_information":[{"code":"90912","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":36.43,"maximum":90.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.43,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37.16,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.79,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":37.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":90.97,"additional_payer_notes":"APC"}]}]},{"description":"Bfb training ea addl 15 min","code_information":[{"code":"90913","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":20.46,"maximum":51.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20.87,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20.66,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":51.09,"additional_payer_notes":"APC"}]}]},{"description":"Speech/hearing therapy","code_information":[{"code":"92507","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":73.86,"maximum":184.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":73.86,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":75.34,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":74.6,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":76.08,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":184.43,"additional_payer_notes":"APC"}]}]},{"description":"Speech/hearing therapy","code_information":[{"code":"92508","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":23.08,"maximum":57.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23.08,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23.31,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":57.63,"additional_payer_notes":"APC"}]}]},{"description":"Evaluation of speech fluency","code_information":[{"code":"92521","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":129.26,"maximum":322.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":129.26,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":131.85,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":130.55,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":133.14,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":322.76,"additional_payer_notes":"APC"}]}]},{"description":"Evaluate speech production","code_information":[{"code":"92522","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":108.3,"maximum":270.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":108.3,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":110.47,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":109.38,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":111.55,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":270.43,"additional_payer_notes":"APC"}]}]},{"description":"Speech sound lang comprehen","code_information":[{"code":"92523","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":219.78,"maximum":548.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":219.78,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":224.18,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":221.98,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":226.37,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":548.79,"additional_payer_notes":"APC"}]}]},{"description":"Behavral qualit analys voice","code_information":[{"code":"92524","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":106.22,"maximum":265.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":106.22,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":108.34,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":107.28,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":109.41,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":265.23,"additional_payer_notes":"APC"}]}]},{"description":"Oral function therapy","code_information":[{"code":"92526","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":81.43,"maximum":203.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":81.43,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":83.06,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":82.24,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":83.87,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":203.33,"additional_payer_notes":"APC"}]}]},{"description":"Oral speech device eval","code_information":[{"code":"92597","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":68.93,"maximum":172.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":68.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":70.31,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":69.62,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":71.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":172.12,"additional_payer_notes":"APC"}]}]},{"description":"Ex for speech device rx 1hr","code_information":[{"code":"92607","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":118.1,"maximum":294.90,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":118.1,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":120.46,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":119.28,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":121.64,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":294.9,"additional_payer_notes":"APC"}]}]},{"description":"Ex for speech device rx addl","code_information":[{"code":"92608","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":46.13,"maximum":115.19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":46.13,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":47.05,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":46.59,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":47.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":115.19,"additional_payer_notes":"APC"}]}]},{"description":"Use of speech device service","code_information":[{"code":"92609","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":98.93,"maximum":247.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":98.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":100.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":99.92,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":101.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":247.03,"additional_payer_notes":"APC"}]}]},{"description":"Evaluate swallowing function","code_information":[{"code":"92610","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":56.72,"maximum":141.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":56.72,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":57.85,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":57.29,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":58.42,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":141.63,"additional_payer_notes":"APC"}]}]},{"description":"Motion fluoroscopy/swallow","code_information":[{"code":"92611","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":87.83,"maximum":219.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":87.83,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":89.59,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":88.71,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":90.46,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":219.31,"additional_payer_notes":"APC"}]}]},{"description":"Endoscopy swallow (fees) vid","code_information":[{"code":"92612","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":52.77,"maximum":131.77,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":52.77,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":53.83,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":53.3,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":54.35,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":131.77,"additional_payer_notes":"APC"}]}]},{"description":"Laryngoscopic sensory vid","code_information":[{"code":"92614","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":52.67,"maximum":131.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":52.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":53.72,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":53.2,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":54.25,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":131.52,"additional_payer_notes":"APC"}]}]},{"description":"Fees w/laryngeal sense test","code_information":[{"code":"92616","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":77.89,"maximum":194.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":77.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":79.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":78.67,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":80.23,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":194.49,"additional_payer_notes":"APC"}]}]},{"description":"Range of motion measurements","code_information":[{"code":"95851","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6.49,"maximum":16.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.49,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6.62,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6.55,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":16.21,"additional_payer_notes":"APC"}]}]},{"description":"Range of motion measurements","code_information":[{"code":"95852","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.82,"maximum":12.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.82,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4.92,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4.87,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.96,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":12.04,"additional_payer_notes":"APC"}]}]},{"description":"Assessment of aphasia","code_information":[{"code":"96105","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":94.11,"maximum":234.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":94.11,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":95.99,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":95.05,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":96.93,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":234.99,"additional_payer_notes":"APC"}]}]},{"description":"Cognitive test by hc pro","code_information":[{"code":"96125","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":99.39,"maximum":248.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":99.39,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":101.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":100.38,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":102.37,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":248.18,"additional_payer_notes":"APC"}]}]},{"description":"Mlt fam grp bhv train 1st 60","code_information":[{"code":"96202","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.07,"maximum":42.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.07,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17.41,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17.24,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.58,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":42.62,"additional_payer_notes":"APC"}]}]},{"description":"Mlt fam grp bhv train ea add","code_information":[{"code":"96203","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.84,"maximum":12.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.84,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4.94,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4.89,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":12.09,"additional_payer_notes":"APC"}]}]},{"description":"Mechanical traction therapy","code_information":[{"code":"97012","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.84,"maximum":34.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.84,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.12,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.98,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.26,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":34.56,"additional_payer_notes":"APC"}]}]},{"description":"Vasopneumatic device therapy","code_information":[{"code":"97016","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.52,"maximum":28.77,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.52,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11.64,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.87,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":28.77,"additional_payer_notes":"APC"}]}]},{"description":"Paraffin bath therapy","code_information":[{"code":"97018","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5.65,"maximum":14.11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.65,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5.76,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5.71,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.82,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":14.11,"additional_payer_notes":"APC"}]}]},{"description":"Whirlpool therapy","code_information":[{"code":"97022","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14.93,"maximum":37.28,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15.23,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15.08,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.38,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":37.28,"additional_payer_notes":"APC"}]}]},{"description":"Diathermy eg microwave","code_information":[{"code":"97024","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6.89,"maximum":17.20,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6.96,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.1,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":17.2,"additional_payer_notes":"APC"}]}]},{"description":"Infrared therapy","code_information":[{"code":"97026","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6.27,"maximum":15.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.27,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6.4,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6.33,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.46,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":15.66,"additional_payer_notes":"APC"}]}]},{"description":"Ultraviolet therapy","code_information":[{"code":"97028","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7.87,"maximum":19.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.87,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.11,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":19.65,"additional_payer_notes":"APC"}]}]},{"description":"Electrical stimulation","code_information":[{"code":"97032","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14.17,"maximum":35.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.31,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.6,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":35.38,"additional_payer_notes":"APC"}]}]},{"description":"Electric current therapy","code_information":[{"code":"97033","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18.25,"maximum":45.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.25,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.62,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.43,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.8,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":45.57,"additional_payer_notes":"APC"}]}]},{"description":"Contrast bath therapy","code_information":[{"code":"97034","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.46,"maximum":33.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.73,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.59,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.86,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":33.61,"additional_payer_notes":"APC"}]}]},{"description":"Ultrasound therapy","code_information":[{"code":"97035","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.77,"maximum":34.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.77,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.05,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.91,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.18,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":34.38,"additional_payer_notes":"APC"}]}]},{"description":"Hydrotherapy","code_information":[{"code":"97036","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":32.94,"maximum":82.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":32.94,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33.27,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":33.93,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":82.25,"additional_payer_notes":"APC"}]}]},{"description":"Therapeutic exercises","code_information":[{"code":"97110","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":28.02,"maximum":69.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28.02,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28.58,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28.3,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28.86,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":69.97,"additional_payer_notes":"APC"}]}]},{"description":"Neuromuscular reeducation","code_information":[{"code":"97112","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":31.56,"maximum":78.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":31.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31.88,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":32.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":78.81,"additional_payer_notes":"APC"}]}]},{"description":"Aquatic therapy/exercises","code_information":[{"code":"97113","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.57,"maximum":88.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.57,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.28,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35.93,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.64,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":88.82,"additional_payer_notes":"APC"}]}]},{"description":"Gait training therapy","code_information":[{"code":"97116","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":28.02,"maximum":69.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28.02,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28.58,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28.3,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28.86,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":69.97,"additional_payer_notes":"APC"}]}]},{"description":"Massage therapy","code_information":[{"code":"97124","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":28.42,"maximum":70.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28.42,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28.99,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28.7,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29.27,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":70.96,"additional_payer_notes":"APC"}]}]},{"description":"Ther ivntj 1st 15 min","code_information":[{"code":"97129","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":19.41,"maximum":48.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.41,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19.8,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19.6,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":48.47,"additional_payer_notes":"APC"}]}]},{"description":"Ther ivntj ea addl 15 min","code_information":[{"code":"97130","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18.21,"maximum":45.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.21,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.57,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.39,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.76,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":45.47,"additional_payer_notes":"APC"}]}]},{"description":"Manual therapy 1/> regions","code_information":[{"code":"97140","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":26.73,"maximum":66.74,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26.73,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27.26,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27.0,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":66.74,"additional_payer_notes":"APC"}]}]},{"description":"Group therapeutic procedures","code_information":[{"code":"97150","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.38,"maximum":43.40,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.38,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17.73,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17.55,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":43.4,"additional_payer_notes":"APC"}]}]},{"description":"Pt eval low complex 20 min","code_information":[{"code":"97161","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":94.66,"maximum":236.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":94.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":96.55,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":95.61,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":97.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":236.37,"additional_payer_notes":"APC"}]}]},{"description":"Pt eval mod complex 30 min","code_information":[{"code":"97162","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":94.66,"maximum":236.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":94.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":96.55,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":95.61,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":97.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":236.37,"additional_payer_notes":"APC"}]}]},{"description":"Pt eval high complex 45 min","code_information":[{"code":"97163","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":94.66,"maximum":236.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":94.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":96.55,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":95.61,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":97.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":236.37,"additional_payer_notes":"APC"}]}]},{"description":"Pt re-eval est plan care","code_information":[{"code":"97164","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":65.0,"maximum":162.30,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":65.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":66.3,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":65.65,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":66.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":162.3,"additional_payer_notes":"APC"}]}]},{"description":"Ot eval low complex 30 min","code_information":[{"code":"97165","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":97.15,"maximum":242.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":97.15,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":99.09,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":98.12,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":100.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":242.58,"additional_payer_notes":"APC"}]}]},{"description":"Ot eval mod complex 45 min","code_information":[{"code":"97166","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":97.15,"maximum":242.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":97.15,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":99.09,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":98.12,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":100.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":242.58,"additional_payer_notes":"APC"}]}]},{"description":"Ot eval high complex 60 min","code_information":[{"code":"97167","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":97.15,"maximum":242.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":97.15,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":99.09,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":98.12,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":100.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":242.58,"additional_payer_notes":"APC"}]}]},{"description":"Ot re-eval est plan care","code_information":[{"code":"97168","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":65.93,"maximum":164.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":65.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":67.25,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":66.59,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":67.91,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":164.63,"additional_payer_notes":"APC"}]}]},{"description":"Therapeutic activities","code_information":[{"code":"97530","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":33.61,"maximum":83.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":33.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34.28,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33.95,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":34.62,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":83.92,"additional_payer_notes":"APC"}]}]},{"description":"Sensory Integration","code_information":[{"code":"97533","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":57.69,"maximum":144.05,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":57.69,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":58.84,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":58.27,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":59.42,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":144.05,"additional_payer_notes":"APC"}]}]},{"description":"Self care mngment training","code_information":[{"code":"97535","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":31.14,"maximum":77.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":31.14,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31.76,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31.45,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":32.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":77.76,"additional_payer_notes":"APC"}]}]},{"description":"Community/work reintegration","code_information":[{"code":"97537","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":30.89,"maximum":77.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31.2,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":31.82,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":77.13,"additional_payer_notes":"APC"}]}]},{"description":"Wheelchair mngment training","code_information":[{"code":"97542","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":29.96,"maximum":74.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29.96,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30.26,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30.86,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":74.81,"additional_payer_notes":"APC"}]}]},{"description":"Physical performance test","code_information":[{"code":"97750","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":32.38,"maximum":80.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":32.38,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32.7,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":33.35,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":80.85,"additional_payer_notes":"APC"}]}]},{"description":"Assistive technology assess","code_information":[{"code":"97755","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":36.5,"maximum":91.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37.23,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.86,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":37.6,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":91.14,"additional_payer_notes":"APC"}]}]},{"description":"Orthotic mgmt and training","code_information":[{"code":"97760","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":44.03,"maximum":109.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":44.03,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":44.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":44.47,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":45.35,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":109.94,"additional_payer_notes":"APC"}]}]},{"description":"Prosthetic training","code_information":[{"code":"97761","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":38.73,"maximum":96.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":38.73,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39.12,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":39.89,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":96.71,"additional_payer_notes":"APC"}]}]},{"description":"Orthc/prostc mgmt sbsq enc","code_information":[{"code":"97763","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":47.72,"maximum":119.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":47.72,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":48.67,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":48.2,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":49.15,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":119.16,"additional_payer_notes":"APC"}]}]},{"description":"Medical nutrition indiv in","code_information":[{"code":"97802","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":25.71,"maximum":64.20,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25.71,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26.22,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25.97,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26.48,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":64.2,"additional_payer_notes":"APC"}]}]},{"description":"Med nutrition indiv subseq","code_information":[{"code":"97803","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":21.48,"maximum":53.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21.48,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21.69,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22.12,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":53.64,"additional_payer_notes":"APC"}]}]},{"description":"Medical nutrition group","code_information":[{"code":"97804","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.99,"maximum":29.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.23,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.11,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.35,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":29.94,"additional_payer_notes":"APC"}]}]},{"description":"Vr cbt therapy","code_information":[{"code":"E1905","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":674.77,"maximum":1684.90,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":674.77,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":688.27,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":681.52,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":695.01,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":1684.9,"additional_payer_notes":"APC"}]}]},{"description":"Diab manage trn  per indiv","code_information":[{"code":"G0108","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":53.66,"maximum":133.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":53.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":54.73,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":54.2,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":55.27,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":133.99,"additional_payer_notes":"APC"}]}]},{"description":"Diab manage trn ind/group","code_information":[{"code":"G0109","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":15.42,"maximum":38.50,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.42,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15.73,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15.57,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.88,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":38.5,"additional_payer_notes":"APC"}]}]},{"description":"MNT subs tx for change dx","code_information":[{"code":"G0270","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":21.48,"maximum":53.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21.48,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21.69,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22.12,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":53.64,"additional_payer_notes":"APC"}]}]},{"description":"Group MNT 2 or more 30 mins","code_information":[{"code":"G0271","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.99,"maximum":29.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.23,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.11,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.35,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":29.94,"additional_payer_notes":"APC"}]}]},{"description":"Elec stim unattend for press","code_information":[{"code":"G0281","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.21,"maximum":27.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.21,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11.43,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11.32,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.55,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":27.99,"additional_payer_notes":"APC"}]}]},{"description":"Elec stim other than wound","code_information":[{"code":"G0283","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.15,"maximum":30.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.15,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.39,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.27,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":30.34,"additional_payer_notes":"APC"}]}]},{"description":"Electromagntic tx for ulcers","code_information":[{"code":"G0329","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10.01,"maximum":24.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.01,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10.21,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10.11,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":24.99,"additional_payer_notes":"APC"}]}]},{"description":"Breast tomosynthesis bi","code_information":[{"code":"77063","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","modifier_code":["TC"],"minimum":21.81,"maximum":54.46,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21.81,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22.25,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22.03,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22.46,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":54.46,"additional_payer_notes":"APC"}]}]},{"description":"Dx mammo incl cad uni","code_information":[{"code":"77065","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","modifier_code":["TC"],"minimum":80.3,"maximum":200.51,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":80.3,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":81.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":81.1,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":82.71,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":200.51,"additional_payer_notes":"APC"}]}]},{"description":"Dx mammo incl cad bi","code_information":[{"code":"77066","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","modifier_code":["TC"],"minimum":102.95,"maximum":257.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":102.95,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":105.01,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":103.98,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":106.04,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":257.07,"additional_payer_notes":"APC"}]}]},{"description":"Scr mammo bi incl cad","code_information":[{"code":"77067","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","modifier_code":["TC"],"minimum":84.98,"maximum":212.20,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":84.98,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":86.68,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":85.83,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":87.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":212.2,"additional_payer_notes":"APC"}]}]},{"description":"Breath tst attain/anal c-14","code_information":[{"code":"78267","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.06,"maximum":27.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.06,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11.28,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11.17,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.39,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":27.62,"additional_payer_notes":"APC"}]}]},{"description":"Breath test analysis c-14","code_information":[{"code":"78268","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":94.41,"maximum":235.74,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":94.41,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":96.3,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":95.35,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":97.24,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":235.74,"additional_payer_notes":"APC"}]}]},{"description":"Tomosynthesis, mammo","code_information":[{"code":"G0279","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","modifier_code":["TC"],"minimum":11.84,"maximum":29.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.84,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.08,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11.96,"additional_payer_notes":"APC"},{"payer_name":"Longevity Health Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar Health Plan","plan_name":"Individual Plan Hmo","methodology":"fee schedule","standard_charge_dollar":29.56,"additional_payer_notes":"APC"}]}]}]}